M. Tech. / Objective: This study was conducted in order to compare the effectiveness of Chiropractic spinal manipulative therapy (SMT) combined with guided imagery versus only guided imagery in the treatment of chronic neck pain and stiffness. Chiropractic SMT is aimed at treating neck pain as well as increasing the range of motion (ROM) of the neck. Guided imagery is aimed at reducing stress levels within the patient with a secondary effect of reducing tension in the neck muscles. This study therefore also has a secondary purpose to assess the effects of stress on chronic neck pain. It was hypothesised that Chiropractic SMT combined with guided imagery would be more effective in the reduction of chronic neck pain than guided imagery or alone. This is based on the fact that Chiropractic SMT has been exhaustively proven to be effective in treating chronic neck pain as well as increasing cervical range of motion. Guided imagery has also been proven to be effective in reducing stress even though there has not been enough research on its effect on chronic neck pain and cervical range of motion. Methods: Patients were recruited by means of placing advertisements in and around the University of Johannesburg. Patients that presented to the Chiropractic day clinic with chronic neck pain between the ages of 18 and 30 were included in this study. The participants were then randomly placed in one of two groups. Group A received four sessions of Chiropractic SMT combined with two sessions of guided imagery while Group B received two sessions of guided imagery relaxation techniques and four sessions of detuned ultrasound (U/S). The researcher performed all the sessions of Chiropractic SMT and detuned U/S while Dr A. Fourie (a registered Counselling Psychologist) performed the Guided Imagery sessions. In the initial visit patients in both groups had to undergo a history taking, physical examination and cervical spine regional examination. They were required to sign subject information and consent form and complete a Neck Disability Index (NDI) Questionnaire, Numerical Pain Rating Scale and the Stress Questionnaire. The researcher measured their cervical range of motion on the first and last treatments. The objective and subjective data was collected on the first visit and again on the final visit.

Background: Patients with chronic neck pain have a number of factors that could constitute a predisposition for respiratory dysfunction. However, the existing evidence is limited and not well established, and many questions such as the association of neck pain deficits with respiratory function remain unanswered. Thus, the aim of this study was to investigate whether patients with chronic neck have accompanying respiratory dysfunction and which are the neck pain deficits which principally predispose to these respiratory disturbances.Methods: In this case-control observational study, 45 patients with chronic idiopathic neck pain (>6 months, at least once per week) and 45 healthy age-, gender-, height- and weight-matched controls were voluntarily recruited. A third group of 10 patients with chronic non-spinal musculoskeletal pain was also used, but only for future reference. Participants' neck muscle strength and endurance were measured by an isometric neck dynamometer and craniocervical flexion test respectively. Range of movement was assessed by using an ultrasound-based motion analysis system. Forward head posture was assessed by obtaining lateral photographs and calculating the craniovertebral angle. Disability and neck pain intensity were assessed through the Neck Disability Index and Visual Analogue Scale. Psychological assessment was performed by using the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia. Spirometry was used for assessing pulmonary volumes, flows and maximal voluntary ventilation. Respiratory muscle strength was assessed by using a mouth pressure meter. Finally, PaCO2 was assessed by using transcutaneous blood gas monitoring.Results: Patients with chronic neck pain were found to have weaker respiratory muscles than healthy controls (p<0.05). Their pulmonary volumes and maximal voluntary ventilation were also found to be reduced (p<0.05). Their mean respiratory flows were found to be unaffected (p>0.05), whereas their peak flows were reduced (p<0.05). Their partial pressure of carbon dioxide was also found to be affected (p<0.05), revealing existence of hypocapnia (PaCO2<35mmHg). The neck pain deficits that were found to be mostly correlated with these respiratory parameters were the neck muscle strength, neck muscle endurance, kinesiophobia, catastrophizing and pain intensity (r>0.3, p<0.05). Finally, the regression models revealed that neck pain deficits and especially neck muscle strength can provide a quite generalizable accurate estimation of this respiratory dysfunction (R2=0.28-0.52).Conclusions: Patients with chronic neck pain present dysfunction of their respiratory system which can be mainly manifested as respiratory weakness and/or hypocapnia. Pain intensity, neck muscle weakness, fatigue and kinesiophobia seem to be the most important deficits predisposing to this respiratory dysfunction. The understanding of this dysfunction could have a great impact on various clinical aspects notably patient assessment, rehabilitation and drug prescription. However, further research is suggested mainly directed towards optimizing treatment protocols and developing classification systems improving clinical reasoning.

The aim of this study was to establish reference data for the cervical spine’s dynamic force characteristics in a healthy adult urban South African population aged 19 to 69 years. The reference data was classified according to gender discriminate age categories. In total ten gender discriminate age categories, five male and five female, were created; 19 to 29, 30 to 39, 40 to 49, 50 to 59 and 60 to 69-year-olds. The force characteristics measured, analysed and used to generate reference data in stanine format were: absolute peak torque (P-), relative peak torque (P-/BW), peak power (Pow-), relative peak power (Pow-/BW), peak work (W-), relative peak work (W-/BW), torque acceleration energy (TAE-), maximal voluntary cervical muscle contraction range of motion (MVCR-), controlled full range of joint motion (CFR-), joint angle at peak torque (Jang@P-) and peak torque ratios for cervical flexion (-F), extension (-E), lateral flexion to the dominant (-LD) and non-dominant (-LN) sides. In addition biographic and anthropometric data was also collected. Data, grouped in the ten gender discriminate age categories were compared and statistically and practically significant differences were highlighted between the gender discriminate age categories. Inferential statistics used included ANOVA and Cohen’s d. A significance level of α = .05 was used in all inferential statistical analyses. Correlations between various anthropometric and isokinetic strength variables were also explored.

Total hip replacements are being used to relieve pain and restore the hip function of unhealthy hip joints. The various sizes and geometries of the modular femoral neck implants allow the surgeon to optimize the range of motion and patient’s leg length. However, some in vivo modular femoral neck retrievals have shown early fatigue and advanced wear-corrosion at the neck-stem taper interface, which can lead to adverse tissue reactions and failure of the implant. The overall objective of this study was to simulate in vivo fatigue fracture, wear, and corrosion of modular necks at the neck-stem taper interface in a laboratory setting (in vitro) to better predict the failure mechanisms and implant limitations. More specifically, after optimizing the laboratory setup and the testing conditions, this study aimed to compare the effects of the modular neck material (Ti6Al4V and CoCrMo) and the implant assembly technique (hand and impact assembly) on fatigue life, wear-corrosion resistance, and distraction force. The PROFEMUR® Modular Neck System with CoCrMo femoral heads and Ti6Al4V stems was used in this study. The in vitro simulation was divided into two types of tests: fatigue tests (high compression load for a short cyclic loading duration) and corrosion tests (low compression load for a long cyclic loading duration). The neck-stem interface was submersed in a phosphate buffered saline solution, which was maintained at a temperature of 80 ºC to accelerate the corrosion reaction. The simulation results showed that the Ti6Al4V necks were more vulnerable to fatigue fracture than CoCrMo necks. In addition, impact assembly of the components resulted in an increased implant fatigue life compared to hand assembly, but also increased the distraction force. The observed wear-corrosion damage was higher in fatigue tests than corrosion tests, suggesting that the level of mechanical load was a major factor influencing implant surface damage and fatigue fracture. On the other hand, corrosion tests showed that longer exposure resulted in more fluid accumulation in the stem pocket. This may lead to the formation of a corrosion cell with strongly acidic conditions in the stem pocket, as well as the potential for larger metal ion release. Overall, the in vitro simulation was successful in reproducing femoral modular neck fracture and wear-corrosion damage similar to retrieved in vivo specimens. Results may play a major role in the future development of total hip replacements and international standards for implant testing.

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Rationale: The use of ultrasound as an adjuvant to conservative treatment for neck pain is common, but the evidence of its benefit remains unclear. Objective: To determine the effectiveness of ultrasound as an adjuvant to exercise or/and manual therapy for the improvement of patient-centered outcomes in adults with non-specific neck pain. Methods: Electronic databases including MEDLINE, EMBASE, AMED, CINAHL, CENTRAL, PEDro and PubMed were searched from date of inception to March 2019 for controlled trials involving ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy in adults with non-specific neck pain. Review Manager 5.3 was used to calculate mean group differences. Main results: Six studies (361 participants) examining ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy for sub-acute and chronic non-specific neck pain were included. The quality of evidence was of very low GRADE. Phonophoresis with capsaicin plus exercise improved pain immediately post-treatment (MD -3.30, 95% CI: -4.05 to -2.55) but not with diclofenac sodium plus exercise as compared to exercise alone. Continuous ultrasound plus exercise improved pain and Pressure Pain Threshold (PPT) at immediate post-treatment (pain: MD -3.42, 95% CI: -4.08 to -2.7; PPT: MD 0.91, 95% CI: 0.68 to 1.14 ) and at intermediate - term (pain: MD -2.70 95% CI: -3.62 to -1.78; PPT: MD 0.27 95% CI: 0.03 to 0.51) as compared to exercise alone. Continuous ultrasound or High Power Pain Threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD -0.75, 95% CI: -2.08 to 0.58), increase in PPT (MD -1.15, 95% CI: -2.55 to 0.25) or improved function/disability (MD -1.05, 95% CI: -4.27 to 2.17) at immediate or short-term as compared to manual therapy and exercise. Conclusion: Based on very low quality evidence, there is insufficient data to support ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain. / Thesis / Master of Science Rehabilitation Science (MSc) / Ultrasound therapy is widely used with exercise or manual therapy for the treatment of neck pain. Yet, its benefits are not clear. This review looked at the benefits of ultrasound added to exercise, manual therapy or both for the treatment of neck pain. The review contains six studies with 361 participants who suffered from neck pain. The results showed very low quality evidence. Applying capsaicin cream with ultrasound or continuous ultrasound in conjunction with exercise had some benefit for improving pain. The same treatment did not improve function as compared to exercise alone. There was no benefit in improving pain or function by adding continuous or high power ultrasound to manual therapy and exercise compared to manual therapy and exercise alone. Due to very low quality evidence, we are uncertain of whether there is a benefit to adding ultrasound to exercise or/and manual therapy for treatment of neck pain.

The purpose of this study was to examine football neck collars and determine their effectiveness at preventing transient brachial plexopathy and other neck injuries due to football impacts. Transient brachial plexopathy, commonly called a stinger or burner, is an injury to the brachial plexus. As many as 65% of collegiate football players will receive suffer such an injury. Accessory neck collars are worn to mitigate the risk of stingers, although little research has been performed to test their effectiveness. In addition to the standard shoulder pad and helmet combination, three collars were tested: the McDavid Cowboy Collar, a collar designed by a Virginia Tech physician called the Bullock Collar, and a prototype device called the Kerr Collar. This study utilized a Hybrid-III 50th percentile male outfitted with a standard collegiate football helmet and shoulder pads, and impacted with a linear pneumatic impactor. Forty eight total impacts were performed; impacts were performed at side, front, and axial loading impact locations, with low and high speed impacts, and normal and raised shoulder pad configurations. Each collar was effective at some positions, but no collar was effective at all impact locations. The Cowboy Collar reduced lower neck bending moments in the front position, but raised upper neck bending moments. It also reduced lower neck bending moments in the side position, but only in the raised configuration. The Bullock Collar was effective at reducing lower neck bending moment in the side position. The Kerr Collar was effective at reducing lower neck bending moments in the side impact location, and provided a larger percent reduction in impactor force in the axial loading position, compared to the shoulder pads alone. Further testing is needed at lower impact velocities that more closely represent injurious impacts in the field. / Master of Science

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Neck pain is a common complaint and a common source of disability in the general population with a point prevalence of nearly 13%. Reports indicate that industry related neck disorders (lifetime incidence of nearly 50%) account for as many days of absenteeism as low back pain; one could compare the two clinical conditions in terms of these trends on a global scale. To investigate whether similar trends do exist, 200 participants with neck pain and 200 asymptomatic participants (stratified sampling according to age and gender) that consented to the research were clinically assessed. These participants also completed a questionnaire addressing the factors that have been identified as related to neck pain at the consultation where they were assessed. This research did not involve the treatment of the participants, although a free treatment was given for patients that opted for one or to those that required it post participation in the study. If treatment was outside the scope of the chiropractic clinic, the participants were referred to the appropriate health care provider. The aim of the study was to investigate factors associated with neck pain in the indigenous African population in the greater Durban area. Data was analysed according to the following: Descriptive statistics were interpreted by means of frequency tables, pie charts, bar graphs and / or in a tabular format in order to describe the sample characteristics of the population under study. Inferential statistics included regression analysis in order to determine any relationships between the patient‟s neck complaint characteristics and factors associated with the complaint. SPSS version 11.5 was used for data analysis (SPSS Inc, Chicago, Ill, USA). A p value of <0.05 was considered as statistically significant. Descriptive analysis involved presenting or graphing categorical variables as counts and percentages, and quantitative variables as medians and interquartile ranges due to the skewness of the data. Associations between factors and neck pain were examined bivariately using Pearson‟s chi square or Fisher‟s exact tests as appropriate for categorical factors, or Mann-Whitney tests in the case of quantitative non-parametric data. Finally in order to examine the adjusted independent effects of all factors which were found to be individually significant in the bivariate analysis, multivariate binary logistic regression analysis was done. A backwards elimination modelling technique was used, based on likelihood ratios, with entry and exit probabilities set to 0.05 and 0.010 respectively. Results were reported as odds ratios, 95% confidence intervals and p values. Chi squared analyses was utilised to assess the strength of the relationship and the degree of significance of the relationship. All statistics were analyzed at a confidence interval of 95% and a level of significance where α ≤0.05 (pvalue). The symptomatic participants seemed to be less well educated than the controls. The cases seemed to be less in full time employment, less unemployed, and more self employed than the controls. Income was unevenly distributed among cases and controls. The cases who were working seemed to earn less than the controls who were working. The duration of having neck pain was mainly 1 month. The majority of cases classified their pain as mild. Most participants felt that their pain was worst in the afternoons or related to activities, while they felt their pain was least in the mornings. Frequency of neck pain was mainly constant (36.5%), followed by frequent (32.5%) and seldom (25%). Symptomatic participants mostly reported that their pain began without injury, gradually in 67.5% and abruptly in 13.5%. Fewer symptomatic participants reported pain beginning after an injury (n=22 gradually and n=7 abruptly). The majority reported their neck pain to be stable (38%), while 34% felt it was getting worse and only 19% getting better. More than half of the cases reported difficulty with work due to neck pain. Fewer reported difficulties with daily activities such as washing (30%), sleeping (26%), and lifting (24%). Almost half of the cases rated their disability as none (48%). Only 16% reported severe disability. Thirty-three percent (n=66) reported having been absent from work due to neck pain. The duration of absence in those who were absent was mainly 0-1 week (89.4%). 59 (29%) reported being bed-ridden with neck pain. The most frequent duration was also 0-1 week (81.4%). Ninety three point five percent reported no change in occupational status, while 6 (3%) were demoted, 5 (2.5%) boarded, and 2 (1%) fired. With respect to associated signs and symptoms, 156 (78%) reported to suffer from headaches. In addition, symptomatic participants were asked if they associated their neck pain with any other activities. The most commonly reported factor was stress (22%), followed by bad posture (17%). The other reported factors were reported infrequently. Participants who worked in occupations that involved driving, turning neck, answering the telephone, working in an air-conditioned room, and bending over a desk were significantly more at risk of being cases than controls. Non-occupational factors which were associated with neck pain were worrying a lot, motor vehicle accident, not enough bed support, not using arms to support a book, sitting without back or arm support, not watching TV a lot, and exercising. The results of the study suggest that neck pain within the indigenous African population is associated with the level of education, income, stress levels, bad posture, repetitive movements of the neck, and motor vehicle accidents. It was also found that most of neck pain patients do suffer from headaches. The findings show that neck pain is mostly classified as mild in nature with 1 month duration. Although neck pain was reported to be responsible for at least 7 days of absenteeism from work, causing difficulty with daily activities, most patients reported no disability as a result of neck pain.

Background: Previous investigations on the epidemiology of neck pain in South Africa were limited to the White and Black populations to the exclusion of Indians. Thus the purpose of this study was to create a profile of neck pain and provide an overview of risk factors with particular interest to the Indian population. Objectives: These included the investigation of neck pain prevalence, neck pain clinical characteristics and risk factors for neck pain in the Indian population in the greater Durban area. Method: The first criterion for sample selection the establishment of suburbs within the greater Durban area. Secondly the three most densely populated Indian suburbs were chosen and ranked according to income potential, to ensure a balanced sample. An equal number of residents in each suburb were targeted, with a minimum of 600 respondents. Statistical Program for the Social Sciences (SPSS) version 15.0 was used to analyse the data. Results: The demographics indicated that the respondents were predominantly matriculated (40.3%), married (57.9%), men (55.7%) of active (94%) Hindu or Christian religion (43%) with a mean age of 36.7 years and a BMI of 24.8 kg/m2. The prevalence of neck pain was 36.83%, with an annual incidence of 28.83%. Original neck pain lasted 8.56 years with a Numerical Rating Scale reading of 4.97. The seldom experienced pain was affected by lifting, sleeping and concentration. In contrast recent neck pain lasted 50.4 days with a Numerical Rating Scale reading of 4.02. The more frequently experienced pain was equally affected by sleeping and lifting. Common risk factors identified for neck pain generally were stress, cycling, favouring one side when carrying a heavy object and suffering from headaches, shoulder pain and / or back pain. The findings of this study supported previous studies, although there were some significant differences. These included males having had a higher prevalence (55.7%) than females (44.3%), as well as watching television being a preventative factor to neck pain. v Conclusions and Recommendations: Thus the prevalence and risk factors of neck pain in the Indian population were comparable to international norms. It was however noted that stratified gender sampling should perhaps have been utilised to strengthen this study and causality of factors in relation to neck pain could not be determined. Both these limitations allow for future research opportunities.