Thesis (M.Tech.:Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006 22, xii, 44 leaves, Appendices 1-10 / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: The most common shoulder complaint seen by physicians is shoulder impingement syndrome. There has been limited success with the current conservative treatment that has been provided for this condition. Thoracic spine and rib manipulation is purported to aid in the treatment of this condition; however there is a paucity of controlled investigations. The purpose of this study was to determine the short term efficacy of thoracic and prone rib manipulation on shoulder impingement syndrome. Methods: A randomised, placebo controlled pre-test post-test experimental design was used. Informed consent was obtained and 30 participants were recruited according to inclusion criteria and allocated to either a placebo or intervention group. Intervention consisted of thoracic spinal and rib manipulation. Data was collected, pre and post the first treatment and at a 48 hours follow up. SPSS was used to analyse the data with a p value of 0.05. Results: No statistically significant differences were seen between the groups for pain rating, range of motion of the glenohumeral joint, lateral scapula slide test or scapula isometric pinch test. The shoulder pain and disability index (SPADI) showed significant (p = 0.04) differences between the groups in terms of disability scores, with the intervention group having a great improvement in disability. No clinically significant differences were observed between the groups. Conclusion: Thoracic spine and rib manipulation appears to improve the disability associated with shoulder impingement syndrome, however further research is required with a larger sample size.

M.Tech. / Purpose: This randomised, controlled, comparative pilot study was undertaken in order to investigate the effectiveness of the chiropractic manipulation alone, the chiropractic manipulation followed by heat therapy or the chiropractic manipulation followed by cryotherapy in the treatment of cervical facet syndrome. It was hypothesised that all three treatment protocols would be effective, but that applying chiropractic manipulation followed by heat therapy would be the most effective protocol in the treatment of cervical facet syndrome. Method: Forty-five participants were recruited by means of advertisements posted around the University of Johannesburg Doornfontein campus and surrounding businesses. Only those participants who conformed to the inclusion criteria were accepted to form a part of the study. The forty-five participants were randomly placed into three groups of fifteen each. Procedure: Group 1 received chiropractic manipulation only as their treatment protocol. Group 2 received chiropractic manipulation followed by heat therapy as their treatment protocol and group 3 received chiropractic manipulation followed by cryotherapy as their treatment protocol. Each participant received six treatments over a two week period and attended a follow-up consultation in the third week. The follow-up consultation was used to assess the lasting effects of the treatment protocol. Results: The objective data in the form of cervical range of motion was obtained by means of the Cervical Range of Motion instrument. The subjective data was collected by means of the Vernon-Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale. At the end of the trial, statistical analysis was performed to determine whether one treatment protocol was more effective compared to the other treatment protocols. The results indicated that group 2 (Chiropractic manipulation followed by heat therapy) proved to be the most effective treatment protocol. Although the other treatment protocol as well as the control group showed good objective results. Subjective results showed that although all three groups showed statistically significant results, group 2 showed the best results. Thus it is noted that in order to achieve a potentially lasting increase in range of motion and a decrease in pain and disability, the treatment protocol used for group 2 should be the treatment of choice. Conclusion: Trends indicate the most effective treatment protocol in the treatment of cervical facet syndrome is when chiropractic manipulation is followed by heat therapy. The advantage of this combination is that each treatment modality is used to its full potential, thereby providing the patient with the best results in terms of lasting benefits.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xii, 72, Annexures 1-10, [19] leaves / The purpose of this research was to conduct a descriptive study of cervical cases recorded at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 as there is a paucity of information on the recorded cases of neck pain in South Africa.

Submitted in partial compliance with the requirements fo the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background Competitive swimming, as with most other sports that are participated in at more than a recreational level, involves a substantial amount of training. Training excessively results in the overuse of muscles. The overuse of muscles commonly causes the production of myofascial trigger points (MFTPs) within the overworked muscles. The presence of MFTPs is a condition known as myofascial pain syndrome (MPS). Myofascial trigger points may be active or latent. Either way, they produce a wide range of effects. This study focuses on the effect of reduced muscle strength. Muscle strength is essential to athletes as it determines performance. Swimmers with MFTPs will not perform at their full ability. Dry needling is an effective form of treatment for MFTPs as it produces immediate relief from the effects of MFTPs. There is not enough information on the immediate effects of dry needling on athlete performance. Since dry needling brings about the immediate relief of MFTPs, this study aims to restore a swimmer’s muscle power and hence improvement of their swimming performance post-intervention. Aim The aim of this study was to determine the immediate effect of dry needling common myofascial trigger points (MFTP) found in four muscles of the shoulder girdle on competitive swimmers’ 100m freestyle lap-times. Methods The design was a pre-test post-test quasi-experimental study. Thirty five competitive swimmers between the ages of 16 and 30 years old participated in this study. Each participant underwent one assessment. Participants’ lap-times were taken using a Sportline Econosport Stopwatch. The pre- and post-intervention lap-times were compared to each other using statistical analysis. The intervention for the purpose of the study was trigger point dry needling. Myofascial trigger points were assessed using manual palpation and the Myofascial Diagnostic Scale (MDS). Results The median lap time was slightly longer post intervention (0:01:16.10) than pre-intervention (0:01:16.03), and was highly statistically significant (p=0.001). The results of the study were inconclusive, however, as there were too many confounding variables (for example, fatigue due to repeatedly swimming laps, swimmers of a lower caliber and hence quicker fatigue rate being included in the study)which negated the effect of dry needling and so the poorer performance of the participants post-intervention could not be attributed entirely to the intervention. A small number of participant’s lap-times decreased post-intervention i.e. they performed better post-intervention. These individualswere predominantly sprint-swimmers. Conclusion Dry needling negatively affects immediate lap-time performance. Future studies should reduce the number of variables affecting the study, for example, having a sprinter versus long-distance swimmer group, testing the outcome of dry needling after the swimmer has had sufficient time (for example, a day) to rest post-intervention. / M

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology / M

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / INTRODUCTION: Neck pain is considered to be one of the most disabling conditions, with a universal prevalence among youth, adult and elderly populations. However, despite its disabling nature and its high prevalence there is still much uncertainty surrounding the aetiology of the pain and the extent to which the condition is influenced by the intrinsic and extrinsic characteristics of an individual. While there is growing evidence to support the notion that marked bio-psychosocial associations exist with neck pain, this literature is heavily weighted toward an adult and a developed nation context leaving developing nations and the student population largely under-researched in comparison. Moreover, while a high prevalence of neck pain and its associated risk factors exist in the student population among health sciences and non-health sciences programmes, across many levels of study, the literature is ambivalent about which faculty and level of study is more at risk, if any. The first year of university stands out among the rest in that the students undergo a significant transition and are required to adapt to a new environment and style of learning compared to what they have been used to. Furthermore, students have been observed to exit first year with higher levels of distress than were present in the beginning of the year, suggesting that this unique environment may influence the psychosocial well-being of students. The extent and strength of this relationship is yet to be determined in a South African tertiary educational context and this is even more true of the first year student population at the Durban University of Technology. Research on the unique bio-psychosocial factors of these students would provide a more holistic understanding of the extent to which these factors exist and the role they play in the general well-being of the students and in the development of neck pain. AIMS AND OBJECTIVES: This study aimed, firstly, to determine the prevalence and psychosocial risk factors of neck pain in registered first year Faculty of Health Sciences students at the Durban University of Technology and, secondly, to determine the association between neck pain presentation, demographic characteristics, socio-demographic and psychosocial risk factors. The outcomes of this study could possibly have a threefold benefit (for the student, the institution, and the chiropractic profession at large). RESEARCH DESIGN: A quantitative, descriptive, cross-sectional survey design was adopted in this research. This design was chosen as it was believed to be the best suited to achieving the aims and objectives of the study. RESEARCH METHODOLOGY: Neck pain questionnaires were administered to the first year Faculty of Health Sciences students at the Durban University of Technology towards the end of the academic year in order to determine the prevalence of neck pain and its associated demographic, socio-demographic, and psychosocial risk factors. There was a final sample size of 135 participants achieving a response rate of 54.7% for the study. Data was captured by the researcher and sent to a statistician for statistical analysis. RESULTS: A high prevalence of neck pain was found among the students (72%) with symptoms of depression (59.8%), anxiety (68.1%), and stress (53.6%) also being highly prevalent among this group. However, when neck pain was quantified by its characteristics the related impact was comparatively low. There was a common theme observed in the results highlighting the association between stress and neck pain, with stress furthermore being determined as an independent risk factor for neck pain (p = 0.023) with an odds ratio of 1.1. This result was not surprising, however, considering the stressors which emerged in the results highlighting factors such as transport protests, student protests, upcoming tests and financial aid as stress causing factors among the participants. The results provided valuable insight which enabled recommendations to be made about the direction of future research as well as recommendations for the Institution and the Chiropractic profession in the approach and management of students enrolled in tertiary education and with neck pain. / M