The burden of non-specific low back pain in the population is substantial. Putative sacroiliac joint pain or 'sacroiliac syndrome' is a significant subset of this condition. Localisable pain over the long posterior sacroiliac ligament (LPSL) is often described as both a clinical sign and symptom of this syndrome. The aim of this qualitative morphological investigation was to investigate a potential basis for a patho-anatomic relationship between the long posterior sacroiliac ligament (LPSL) and the posterior sacrococcygeal plexus (PSP). Twenty-two cadavers were available for study. Three methods were utilised: macro-dissection (n = 22 sides), small wax block histology (n = 3 sides), large wax block histology (n = 1 side), giant wax block histology (n = 4 sides) and a review of E12 sheet plastinated transverse and sagittal sections (n = 4 sides). The LPSL was demonstrated to have a layered structure that was penetrated by the lateral branches of the dorsal sacral rami. A segmental relationship was observed between the lateral branches of the dorsal sacral rami and the LPSL. The posterior layer of the thoracolumbar fascia was not continuous with the superficial layer of the LPSL, deep to the fibres of gluteus maximus. The LPSL was shown to have three morphologically distinct regions, the proximal, mid and distal LPSL. A confluence of three layers was observed at the mid LPSL posterior to the sacroiliac joint (SIJ) namely the erectores spinae aponeurosis (ESA), the gluteal aponeurosis (GA) and the deep fascial layer from the second and third medial dorsal sacral foramina. A region of adipose and loose connective tissue was evident deep to the deep fascial layer in which lateral branches of the dorsal sacral rami were observed. In the region of the mid LPSL between the inferior PSIS and the third sacral transverse tubercle (ST), the attachment of the ESA to sacral bone was absent. This space was occupied by the continuous underlying region of adipose and loose connective tissue. At its greatest extent, this region was observed between the central sacral canal medially and the gluteal aponeurosis laterally. This study suggests that the LPSL may be better described as a retinaculum for the lateral branches of the dorsal sacral rami. These morphological findings provide a basis for the existence of a potential patho-anatomical mechanism that may explain localised pain in the posterior sacroiliac region, usually interpreted as referred pain from the sacroiliac joint. The lateral branches of the dorsal sacral rami may have a potential vulnerability to trauma or ischaemic challenge in this region, which may account for SIJ related 'non-specific' low back pain or for pregnancy related peripartum pelvic pain. Furthermore, a morphological basis for the anatomical confounding of SIJ tests is shown.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xi, 123 leaves ; 30 cm / The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xi, 123 leaves ; 30 cm / The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.

M.Tech. (Chiropractic) / This study aims to compare sacroiliac joint adjustments versus pubic symphysis adjustments in the treatment of sacroiliac joint dysfunction with regards to pain and disability as well as alternative treatment approaches in treating sacroiliac joint dysfunction.This study was a comparative study that consisted of two groups of fifteen participants each. The participants were between the ages of eighteen and forty five with an equal male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria for the study. The method of treatment that was administered was determined by group allocation. Group 1 received Chiropractic manipulative therapy delivered to the restricted sacroiliac joint and Group 2 received Chiropractic manipulative therapy delivered to the pubic symphysis.Treatment consisted of six treatment sessions with an additional follow up consultation over a three week period. Objective and subjective data was measured at the beginning of the 1st, 4th and 7th consultations. Subjective readings were taken from The Oswestry Pain and Disability Questionnaire as well as The Numerical Pain Rating Scale. Objective measurements were taken from The Orthopaedic Rating Scale. Analysis of the data collected throughout the study were performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data collection only.

M.Tech. / Purpose: To compare the efficacy of diversified side posture adjustments and segmental drop piece adjustments in the treatment of sacroiliac joint dysfunction. Method: Thirty-two participants were randomly divided in two equal groups. Group A (n = 16) received diversified side posture adjustments and Group B (n = 16) received segmental drop piece adjustments. The trial consisted of seven sessions over a period of three weeks, of which the first six were treatment sessions, with the final seventh session serving the purpose of obtaining final post-treatment data. Data was obtained only at the first, third, fifth and seventh sessions. Objective data consisted of measuring lumbar spine range of motion using a digital inclinometer and pain pressure tolerance over the middle of the sacroiliac joint line by using a pressure algometer. Subjective data was obtained by having each participant complete a numerical pain rating scale and the Oswestry back pain and disability questionnaire.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Technikon Natal, 2000. / Sacroiliac joint syndrome represents a common cause of lower back pain (Cassidy and Burton 1992:3). However, much controversy exists regarding the most reliable method used to diagnose and determine sacroiliac joint dysfunction (Wiles and Faye 1992). / M

M.Tech. / The primary focus of this study was to compare different treatment protocols namely Chiropractic Adjustive Therapy of the Sacroiliac Joint, lschaemic Compression of Trigger Points within the Piriformis muscle and Chiropractic Adjustive Therapy of the Sacroiliac Joint combined with lschaemic Compression of Piriformis Trigger Points in the treatment of a dysfunctional Piriformis muscle, to see which of the chosen treatment protocols would be the superior choice in treating the dysfunctional muscle. It was hypothesised that all the chosen treatment protocols would be effective in treating a dysfunctional Piriformis muscle, while it was hoped that the Chiropractic Manipulative Therapy of the Sacroiliac Joint would be the superior choice in treating a dysfunctional Piriformis muscle. Participants were recruited via posters and flyers in and around the University of Johannesburg Campuses. Forty five participants were recruited and randomly divided into three groups (Groupl received Chiropractic Manipulation of the Sacroiliac joint, Group 2 received Chiropractic Manipulation of the Sacroiliac joint combined with lschemic compression of the Piriformis muscle and Group 3 received only lschemic compression of the Piriformis muscle) by drawing a number from a box marked one, two and three for the different treatment protocols. The participants were given a consent and information leaflet which they had to sign and any questions they had were answered to the best of the researcher's ability. All the participants received five treatments and Algometer measurements were taken before and after every treatment and Numerical Pain Rating Scale forms were completed by the participant before treatment one and after treatment five. The results showed a significant decrease in pain perceived by the participants in all the different groups on the Numerical Pain Rating Scale and on the Algometer measurements. When looking at the Numerical Pain Rating Scale Scores the group that received ischaemic compression (Group 2) had the most improvement and when comparing the Algometer Measurements between the groups, the group that received only the Chiropractic Adjustive Therapy of the Sacro-iliac Joints (Group 1) had the best improvement.

M.Tech. (Chiropractic) / To compare the effectiveness of biomechanical pelvic blocking to segmental drop piece adjustments in the treatment of sacroiliac joint dysfunction. Method: Thirty participants were randomly divided in two equal groups. Group A (n = 15) received biomechanical pelvic blocking and Group B (n = 15) received segmental drop piece adjustments. The trial consisted of seven treatment visits over a period of three weeks, of which the first six were treatment sessions, with the final seventh session serving the purpose of obtaining final post-treatment data. Data was obtained only at the first, fourth, and seventh visits. Subjective data was obtained by having each participant complete a numerical pain rating scale and the oswestry low back pain and disability questionnaire. Objective data consisted of pain pressure threshold over the posterior superior iliac spine by using a pressure algometer. Results: The subjective results showed that there was a decrease in the numerical pain rating scale (NPRS) reading scores over the treatment visits for both groups. Group A had a statistically significant decrease (p = 0.000) in the NPRS reading scores between visit 1 and 4, and a statistically significant decrease (p = 0.000) between visit 4 and 7. Group B showed that there was a statistically significant decrease (p = 0.001) from visit 1 to 4, and a statistically significant decrease (p = 0.002) between visit 4 and 7. According to the Mann-Whitney test both groups showed a statistically significant decrease in their NPRS readings over the treatment period (p = 009), however Group A had a greater decrease in pain than Group B when looking at the mean score values. This indicates that both biomechanical pelvic blocking and segmental drop piece adjustments delivered to the dysfunctional sacroiliac joints are effective in decreasing pain. Over time, statistical analysis showed that there was a decrease in oswestry pain and disability for both groups A and B when looking at the Friedmann and Wilcoxon-signed rank test. Group A showed a statistically significant decrease (p = 0.012) from visit 1 to 4, and a statistically significant decrease (p = 0.002) for visit 4 to 7. Group B also showed that from visit 1 to 4, there was a statistically significant decrease (p = 0.001), and from visit 4 to 7 there was a statistically...

Dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Chiropractic, Natal Technikon, 1997. / The purpose of this study is to evaluate the usefulness of the Gonstead Listing System as a reliable indicator of the direction in which to adjust the sacroiliac joint in subjects with sacroiliac joint dysfunction, in terms of their subjective and objective clinical findings. The hypothesis is that the direction of manipulation is clinically insignificant in causing a decrease in the subject's clinical findings. This information is necessary in order for chiropractors to formulate a more cost-effective treatment protocol for their patients. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to determine the relative efficacy of chiropractic manipulation used in conjunction with detuned ultrasound over the gluteal muscles compared to manipulation used in conjunction with proprioceptive neuromuscular facilitation stretching of the gluteal muscle group in the treatment of sacroiliac syndrome. It was hypothesised that both treatment groups would be effective in the treatment of sacroiliac syndrome but that manipulation used in conjunction with proprioceptive neuromuscular facilitation of the gluteal musculature would be more effective than manipulation used in conjunction with detuned ultrasound, in terms of subjective and objective clinical findings. / M