Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / Neck pain is a common condition that has become a serious health concern. Since there is controversy regarding the most effective management of this condition, further research needs to be executed. The purpose of this investigation was to compare manipulation combined with a cervical pillow to manipulation alone in the management of mechanical neck pain. The rationale behind this, was that manipulation is one of the most common treatments for spinal conditions and has shown significant results in alleviating mechanical neck pain. Cervical pillows have been investigated by various researchers. They have concluded that cervical pillows are effective in treating mechanical neck pain. Thus, using the pillow as an adjunct to manipulation should attain superior results to manipulation alone. This study consisted of 40 patients who were randomly divided into 2 equal groups. The average age of the patients was 34 years old and the average duration of neck pain was pain of greater than 6 months. The patients received 6 treatments over a 4 week period. Group1 were manipulated and given a cervical pillow to sleep on, while group 2 received manipulation alone. / M

A dissertation presented to in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1996. / The aim of this study was to determine the effectiveness of adjustments versus mobilisation in the treatment of mechanical neck pain. It was hypothesized that treatment with adjustments over a three week period, with a further three week follow-up period, would be more effective than mobilisation in terms of improving the patients' cervical ranges of motion and their perceptions of pain and disability. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background : A lack of peaceful sleep and adequate neck support during sleep has been described as a significant contributing factor to the development of chronic non-specific neck pain. Health-care practitioners often prescribe a cervical pillow for the treatment of chronic non-specific neck pain despite the ambivalent findings of several studies. Recently Simmons South Africa introduced the Simmons Beautyrest® pillow which it claims is able to support the cervical spine and promotes a restful sleep. This study, therefore, set out to determine the potential of the Simmons Beautyrest® pillow in alleviating chronic non-specific neck pain. Objective : This study aimed to determine the effectiveness of the Simmons Beautyrest® pillow compared to the participant’s usual pillow (the control) in terms of objective and subjective findings in the management of chronic non-specific neck pain. Methods : Forty individuals, aged 18 to 45 years of age, experiencing chronic non-specific neck pain were recruited via convenience sampling. The study was a single-blinded, cross-over interventional study. All participants underwent a case history, physical and cervical orthopedic examination. Objective (algometer and Cervical Range of Motion measurements) and subjective (Numerical Pain Rating Scale, Neck Disability Index, Sleep and pain diary) outcome measures were obtained at each of the five consultations over a four week period, with the cross-over occurring after two weeks. SPSS version 18.0 was used to analyze the data. Demographic data was analyzed using the Chi square tests and t-tests. The consultations were averaged for each phase of the cross over design to result in a two treatment, two period cross over design. Repeated measures ANOVA testing was used to evaluate the effect of the intervention on subjective and objective measurement according to the method of Dallal (Esterhuizen, 2011). The sleep and pain diary data was analyzed using repeated measures ANOVA and Wald chi square test. Results : A significant difference in the perceived comfort levels between the two pillows (p < 0.001) was observed with the Simmons Beautyrest® pillow having a higher comfort rating. A significant decrease in NRS scores (p = 0.018); NDI scores (p < 0.001); and NRS scores on awakening (p < 0.001); neck stiffness rating on awakening (p < 0.00); headache rating on awakening (p = 0.043) was observed in relation to the Simmons Beautyrest® pillow. A significant improvement (p = 0.001) in algometer readings was observed when using the Simmons Beautyrest® pillow when compared to participants usual pillow. A significant increase in mean right lateral flexion measurements was observed in both groups when using the Simmons Beautyrest® pillow (p = Conclusions : The Simmons Beautyrest® pillow was effective in improving chronic non-specific neck pain. It was regarded as comfortable and provided relief with regards to the clinical features of non-specific neck pain. / Simmons South Africa Company

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / Mechanical neck pain is an extremely common condition. At any specific time, as many as 12% of the adult female population and 9% of the adult male population experience pain in the neck, with or without associated arm pain, and 35% of people can recall an episode of previous neck pain (Bland 1994:3). However, to date little research has been conducted to investigate which treatment protocolIs may be the most effective in the management of mechanical neck pain syndromes. The aim of this study was to investigate whether the combination of chiropractic manipulative therapy and intermittent, mechanical cervical traction would be more effective in the treatment of mechanical neck pain than chiropractic manipulative therapy alone. It was hypothesized that chiropractic cervical manipulative therapy and the combination of chiropractic cervical manipulative therapy and intermittent, mechanical cervical traction would both be effective in the treatment of mechanical neck pain. Moreover, with reference to objective and subjective clinical findings, it was hypothesized that the combination of chiropractic cervical manipulative therapy and intermittent, mechanical cervical traction would be more effective in the treatment of mechanical neck pain than chiropracic manipulative therapy alone. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1998. / Purpose: The purpose of this study was to determine the relative effectiveness of two seemingly different approaches to manipulation of the cervical spine in the treatment of cervical spine dysfunction. The researcher postulated that a manual manipulation would have a greater effect in reducing pain and increasing range of motion that accompanies cervical dysfunction than an instrumental, low force, high velocity thrust delivered by means of an Activator Adjusting Instrument. The reason for this is that it provides greater joint movement. Methods This randomised controlled trial consisted of two treatment groups. Each group consisted of 15 subjects, between the ages of 16 and 65 years, selected from the general population and randomly allocated to treatment group A or B. Group A received instrumental thrusts delivered by an Activator Adjusting Instrument (AAI), while group B received standard diversified manual manipulations to the dysfunctional joints in the cervical spine. Each subject was assessed by using subjective measures of the CMCC Neck Disability Index, Numerical Pain Rating Scale and McGill Short- Form questionnaire; and the objective measure of degrees of cervical range of motion obtained using a cervical goniometer (CROM). Two tailed statistical analysis was conducted at a = 0.05, using the non-parametric Wilcoxin Signed Rank Test and the Mann-Whitney U Test comparing intra-group and inter-group data respectively. Further assessment of the data was conducted using power analysis. This data as well as the descriptive statistics were presented in tables and bar charts. / M

M.Tech. (Chiropractic) / The aim of this study was to determine the most effective treatment protocol for cervical spine facet syndrome, with regards to treatment frequency. Group one was treated three times weekly, and group two was treated once weekly. Both groups were treated with chiropractic manipulation of the cervical spine over a period of six treatments with a two week follow-up consultation. It was hypothesised that the group treated three times weekly would respond better compared to the once weekly treatment group. The study was a clinical trial involving two experimental groups of fifteen patients each (n=15), total sample size N=30. Volunteers responded to advertisements placed in the local press. Those who met the criteria, in other words suffered from cervical spine facet syndrome, were included in the study. Objective data was acquired using a goniometer to measure cervical spine range of motion. Subjective data was obtained by participants recording their progress on the Vemon-Miorneck pain and disability index and the Numerical pain rating scale. Data obtained from the range of motion testing showed that both groups responded with statistical significance to the treatment, but no statistically significant difference was obtained when the two respective groups were compared to each other. It was also noted that specifically rotation bilaterally for both groups, and left lateral flexion for group 1 (treated three times weekly), showed no statistically significant improvement at all. Statistical analysis of the data obtained from the questionnaires indicated that both groups responded with statistical significance to the treatment, but when group was compared to group 2, no statistically significant difference was noted between the two groups. This rejects the hypothesis that three times weekly chiropractic treatment is more beneficial to the patient, than once weekly chiropractic treatment. This study concluded that there was no statistical difference between the two above mentioned groups and no difference in response to different treatment frequencies. Therefore it shows that less frequent treatment is not to the detriment of the patients' progress and might be of benefit for achieving cost effectiveness.

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.

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.