M.Tech. (Chiropractic) / Introduction: The most common chronic pain condition in modern society is neck pain (Jensen and Harms-Ringdahl, 2007). Chronic neck pain is a common complaint for many, from young patients to older patients with stressful work situations. According to Graham, Gross and Goldsmith (2006) neck disorders are common, disabling to various degrees and costly. Various structures in the cervical spine capable of transmitting pain include facet joints, intervertebral discs, nerve root dura, ligaments, and muscles (Manchikanti, Singh, Rivera and Pampati, 2002). According to Rochester (2009) chiropractors treat patients with chronic neck pain by using spinal manipulative therapy (SMT) to address a segmental joint hypomobility within the cervical spine as determined by joint motion palpation and endplay assessment. Traction is commonly used for the treatment of the spine by various physical therapists. It may be included as part of a chiropractic treatment protocol. According to Hooper (1996) traction involves the application of both manual and mechanical forces to draw adjacent body parts away from each other resulting in decompressed irritated tissues, realign parts, and relaxing tight structures. There are several types of cervical traction. The short and medium term improvement for chronic neck pain as well as the comparative effect of manual cervical traction versus mechanical cervical traction in combination with spinal manipulative therapy has not yet been established. Aim: This particular research study aimed to compare the short to medium term efficacy of manual cervical traction with mechanical cervical traction combined with spinal manipulative therapy with regards to decreased pain and improvement of cervical spine ranges of motion in patients with chronic neck pain. Methodology: Participants who met the inclusion and exclusion criteria were eligible to participate in this study. Advertisements were placed on notice boards around the campus of the University of Johannesburg and participants were recruited from the use of advertisements as well as word of mouth to partake in this research study. Thirty participants who suffered from chronic neck pain, volunteered for this comparative research study. This study was a randomized comparative study, where participants were randomly selected to be either in Group 1 or in Group 2. Group 1 received manual cervical traction whereas Group 2 received mechanical cervical traction. Both groups received spinal manipulative therapy to the restricted motion segments found in the cervical spine. Participants received seven trial sessions, with six treatments, over a period of two weeks. At the final 7th visit, one month after the sixth visit, no treatment was performed. Subjective and objective measurements were recorded at each visit. The subjective measurements of this particular study consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon-Mior Neck Disability Index to evaluate the participants’ sensitivity to pain and disability. The objective measurements of this study included the Cervical Spine Range of Motion instrument to assess the participants’ cervical spine movement. Results: Both groups demonstrated a statistically significant improvement over time with regards to pain and disability, as well as increased range of motion to the cervical spine. The greatest percentage improvement with regards to range of motion was in lateral flexion and rotation of the cervical spine. Conclusion: According to the results of this study, it could be concluded that either manual cervical traction or mechanical cervical traction in combination with spinal manipulative therapy can be used effectively in the treatment of chronic neck pain as part of a chiropractic treatment protocol. Both groups proved to have a statistically significant improvement with regards to pain and disability as well as increased cervical spine range of motion...

M.Tech. (Chiropractic) / The aim of this study was to compare the effects of chiropractic manipulative therapy with and without stripping massage of the sternocleidomastoid, with regards to pain, disability, cervical range of motion and head repositioning accuracy in the treatment of chronic mechanical neck pain. The aim was determined by using the Vernon-Mior Neck Pain and Disability Index, Numerical Pain Rating Scale and the Cervical Range of Motion measuring instrument (CROM).The study consisted of thirty participants that had an equal male to female distribution. An age range was set and individuals had to be between eighteen and fourty. Participants were chosen according to inclusion and exclusion criteria that were set before the study commenced. Treatment received by the participants was dependent on which group they were allocated to. Group One received just chiropractic manipulative therapy to three restricted segments of the cervical spine. Group Two also received chiropractic manipulative therapy to three restricted cervical segments and had stripping massage of both sternocleidomastoid muscles.Treatment consisted of six treatments sessions and with the seventh visit only readings were taken. Treatments were carried out twice weekly so that the treatment time period fell over a three week study period. Participants were asked to complete the subjective data before the first, fourth and seventh visit. Subjective data was gathered by using the following: Numerical Pain Rating Scale and a Vernon-Mior Neck and Pain Disability Index Questionnaire. The objective data that was recorded by the researcher consisted of the cervical range of motion that was gathered by using the Cervical Range of Motion (CROM) machine and the head repositioning accuracy. Participants then received either chiropractic manipulative therapy to the restricted cervical spinal segments or a combination of stripping massage to the sternocleidomastoid muscles as well as chiropractic manipulative therapy, depending on their groupallocation. All data gathered by the researcher and then analysed by a statistician at the University of Johannesburg...

M.Tech. (Chiropractic) / Mechanical neck pain is the general term that refers to any type of pain within the cervical spine caused by placing abnormal stress and strain on muscles of the vertebral column. This is a very common musculo-skeletal disorder within the population, with 45% to 54% reporting neck pain at any given time of their lives (Martinez-Segura, Fernandez-de-las-Penas, Ruiz-Saez, Lopez-Jimenez and Rodriguez-Blanco, 2006). A vast majority of individuals do not experience a complete resolution of symptoms and as such often becomes a chronic pain (Cote, Cassidy, Carol and Kristman, 2004). Chronic pain by definition is one which is present for a period longer than six weeks (Segen, 2002). Accompanying the neck pain is often a limited or reduced range of motion within the cervical spine. Some studies suggest that hyper-tonicity and strain of the supporting muscles within this region due to an altered biomechanics also contributes to the pain and dysfunction (Armstrong, McNair and Williams, 2005 and Dall’Alba et al. 2001). One of the major muscle groups involved in this is the posterior cervical musculature. This is a general term used to describe the muscles located on the posterior aspect of the neck and includes longissimus capitis, semispinalis capitis, semispinalis cervicis, rotatores and multifidus (Dalley and Moore, 2006). Chiropractic adjustment therapy has been shown to have many effects of the body and especially the cervical spine including a decrease in pain perception and muscle hypertonicity (Kirkaldy-Willis and Cassidy, 1985), an increase in cervical range of motion (Bergmann, Peterson and Lawrence, 1993) as well as an increased skin pain tolerance level (Terrett and Vernon, 1984). Dry needling therapy has also been proven to have similar effects, including, a reduction in pain perception, an increase in range in motion of the specific linked biomechanical section, and most importantly a reduction of muscle tension (Travell and Simons, 1993). The purpose of this study was to see if a synergistic effect of the two above mentioned treatments would occur when combined under one treatment protocol. The aim of this study was to determine how effectively cervical adjustment therapy, dry needling of the posterior cervical muscles and a combination of the two treatments was in treating chronic mechanical neck pain with regards to pain, disability and cervical spine range of motion over a three week period. Participants were recruited from the University of Johannesburg Chiropractic Day Clinic. They were eligible to participate in the study once they met the inclusion and exclusion criteria. Participants were recruited by means of word of mouth as well as with the use of advertisements that were placed around the respective campuses of the University of Johannesburg. Thirty participants who presented with chronic mechanical neck pain, volunteered for this comparative study. This trial is a randomised controlled clinical trial which used convenience sampling. Group A received a combination treatment of dry needling and cervical manipulation. Group B received cervical adjustment only while group C received dry needling of the posterior cervical musculature alone. participants were treated for a total of 6 visits. Subjective and objective measurements were done at visits 1, 4 and a final visit 7 during which only measurements were taken. These effects are based on Vernon-Mior Pain and Disability Index, Numerical Pain Scale Rating, Pressure Algometer as well as Cervical Spine Range of Motion measuring instrument (CROM). The results of this trial indicated that all three treatments were effective in treating chronic mechanic neck pain. While one treatment was not statistically more effective than the other the dry needling and cervical manipulation alone produced a superior result. While combining these treatments was effective the synergistic effect one would expect was not as evident.

La cervicalgia es un problema de salud ocupacional en los odontólogos y está presente desde las prácticas del pregrado. Se realizó un estudio cuasi experimental para evaluar el efecto de un programa de gimnasia laboral en todos los estudiantes de cuarto año de un escuela de odontología de Lima para reducir la prevalencia de cervicalgia. El programa duró seis semanas, consistía en dos charlas para que realicen ejercicios de estiramiento de 5 minutos 3 veces por día y un recordatorio diario por mensaje de texto. 31 estudiantes fueron evaluados al inicio y final de la intervención, 13/31 manifestaron no haber realizado los ejercicios. Se encontró que la prevalencia de cervicalgia en las últimos 4 semanas se redujo de 90,3 % a 71,0 % (p=0,034) y la intensidad del dolor se redujo de 5,4 a 3,6 (p=0,009). El programa demostró reducir la cervicalgia, futuras intervenciones deben buscar alternativas para incrementar la adherencia. / The neck pain (Cervicalgia) is an occupational health problem in dentists and is present from the practices of undergraduate. A quasiexperimental study was conducted to evaluate the effect of a workplace gymnastics exercise program for all students in the fourth year of a dental school in Lima to reduce the prevalence of neck pain. The program lasted six weeks, consisted of two talks to perform stretching gymnastics exercises for 5 minutes 3 times per day and a daily reminder by text message. 31 students were assessed at the beginning and end of the intervention, 13/31 they said they had not done the exercises. It was found that the prevalence of neck in the previous 4 weeks was reduced from 90,3 % to 71,0 % (p = 0,034) and the intensity of pain was reduced from 5,4 to 3,6 (p = 0,009). The program was shown to reduce neck pain, future interventions should seek alternatives to increase adherence.

M.Tech. (Chiropractic) / Purpose: This study was undertaken in order to demonstrate the effects of static magnetic field therapy on acupuncture points in the treatment of those suffering from mechanical neck pain. Isolated spinal manipulative therapy of the cervical spine was compared to spinal manipulative therapy of the cervical spine in conjunction with magnetic field therapy on acupuncture points using both objective and subjective measurements. Before the execution of this study, it was hypothesised that both treatment protocols would be effective in the treatment of mechanical neck pain, although the combined therapy would be more effective. Method: Patients were recruited by way of advertisements placed in and around the University of Johannesburg, Doornfontein campus and their health clinic. Thirty patients with mechanical neck pain were recruited and randomly divided into two groups. Group one received manipulation to the affected joints of the cervical spine and group two received manipulation to the cervical spine combined with magnetic field therapy on acupuncture points. Procedure: Each patient in each group attended six treatment sessions; three in the first week and three in the second week. The Vernon Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (subjective measurements) were completed by each patient and the Cervical Range of Motion instrument (objective measurements) was used to collect readings from each patient in both the control and experimental groups, subjective and objective measurements were taken before treatment one, three and six. Specific treatment protocols were then adhered to. Results: The results indicated that both treatment protocols were effective in reducing mechanical neck pain although not one group was more effective than the other. Both groups improved subjectively and objectively as they had cervical spinal manipulation directed at joint dysfunction. Conclusion: The experimental group who received spinal manipulative therapy to correct joint dysfunction in conjunction with magnetic field therapy on acupuncture points was not more effective than the control group who received spinal manipulation only, in the treatment of mechanical neck pain.

M. Tech. / Cervical Facet Syndrome is a condition characterised by neck pain and decreased mobility of the cervical spine (Bovim et al., 1994). It is essentially the dysfunction of the posterior joints in the neck where muscle hypertonicity causes the ligaments to shorten (Gatterman, 1995). There is a high prevalence of Cervical Facet Syndrome in industrialised countries leading to a loss in productivity and costly expenditure in terms of treatment (Jordan et al., 1998). The aim of this research study was to assess the efficacy of treatment with injectables of the Anthroposophical medicine Disci comp. cum Argento on the symptoms of Cervical Facet Syndrome. These symptoms include pain and a decrease in range of motion. Pain was assessed using two questionnaires, namely the Visual Analogue Scale for Pain (Annexure D) and the Vernon Mior Neck Pain Disability Index (Annexure E). Range of motion was measured using the Cervical Range of Motion Goniometer (Annexure F). This was a double-blind, placebo-controlled trial. Thirty participants, male and female between the ages of 18 and 40 who had been pre-diagnosed with Cervical Facet Syndrome were recruited to participate in the research study. The study was conducted over a period of three weeks. On day one, participants were requested to complete a Consent Form (Annexure B), a Participant Profile (Annexure C), and the two questionnaires used to assess pain. Range of motion was measured by the researcher. The group was then randomly divided into two groups with 15 participants per group. The experimental group received subcutaneous injections of Disci comp. cum Argento and the control group received subcutaneous injections of saline. These injections were administered by the researcher and repeated three times a week for two weeks so that each participant received a total of six injections. A final assessment without treatment was completed in the third week. The two questionnaires and range of motion measurements were repeated at the third, sixth and seventh or final assessment. . The results of this study indicated that although both the remedy and placebo groups showed improvements, there was no significant difference in these improvements between the groups for the results obtained for the Visual Analogue Scale for Pain, Vernon Mior Neck Pain Disability Index and measurements of flexion, left rotation and left lateral flexion. There was however, significant differences in improvement between the visits in favour of the remedy group for measurements of extension, right rotation and right lateral flexion.

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.

No description available.

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.