Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Technikon Natal, 2002. 1 v. (various pagings) / McGregor et al ( 1998) stated that approximately 50 – 80 % of the population in Western society will experience low back pain at some point. According to Cibulka and Koldehoff (1999), the sacroiliac joint is a common cause of low back pain that is overlooked. This study aimed to provide insight into the relative effectiveness of three different approaches in the management of sacroiliac syndrome. Giles and Muller (1999) concluded that spinal manipulative therapy was an effective form of treatment for spinal pain syndromes whilst Burgos et al (2001) states that the use of transcutaneous non-steroidal anti-inflammatories in the management of musculoskeletal conditions is a common therapeutic strategy. This investigation aimed to determine the relative effectiveness of spinal manipulative therapy combined with transcutaneous flurbiprofen (TransAct® patches ) versus spinal manipulative therapy combined with either menthol or non-medicated placebo patches in the management of sacroiliac syndrome, in terms of objective and subjective measures.

M.Tech. (Chiropractic) / This study was conducted in order to determine if Chiropractic Spinal Manipulative Therapy (SMT) to the lumbar spine and Sacroiliac joints can accelerate the recovery process of the Hamstring and Quadriceps femoris muscle and thus enabling the athlete to sustain endurance levels for a longer period of time. Participants used were recruited from the cycling community by means of word of mouth. Thirty participants that matched the inclusion criteria were included in the study. The participants were then randomly divided into two groups, a Test Group and a Control Group, of fifteen participants each. Motion and static palpation was used to detect spinal restrictions. The Test Group received Chiropractic SMT to the restricted lumbar vertebral segments and the Sacroiliac joints after the first test was completed. The participants then underwent a 30 minute recovery period after which they were re-tested. The Control Group received no treatment after the first test, but still had a 30 minute recovery period after which they were re-tested. Objective measurements were taken by making use of Cybex Isokinetic Dynamometer. The objective measurement indicated that there was an increase in muscle endurance of the Quadriceps femoris and Hamstring muscle groups for both the test and the Control Group. When the increase in Hamstring and Quadriceps femoris muscle endurance was compared between the Test and Control Group, it was the Control Group that showed a more significant increase in Quadriceps femoris muscle endurance which was greater than the increase of the Quadriceps femoris muscle endurance in the Test Group. The Control Group also showed a greater increase mean endurance of the Quadriceps femoris and Hamstring muscle. In conclusion to the study, muscle endurance in cyclists can be increased by rest alone and does not require Chiropractic SMT to restricted spinal segments.

Dr. C. Yelverton

This unblinded, non-randomised pilot study was conducted in order to determine if diversified chiropractic manipulation and/or sacro occipital technic adjustments of the sacroiliac (SI) joint could increase the short-term strength of the gastrocnemius muscle. Ninety asymptomatic male patients between the ages of 20 and 30 years participated in the investigation. These patients were recruited by the use of posters that were placed in strategic areas around the Technikon Witwatersrand campus. The patients were randomly placed into one of three groups of thirty. Group FA (force adjustment) received force, side-lying, diversified sacroiliac adjustments to the sacroiliac joint. Group NA (non-force adjustment) received non-force sacro occipital technic (SOT) adjustments to the same area by means of SOT blocking technique. The third group. Group C (control) received detuned ultrasound over the SI joint. Each patient received only one treatment. The inclusion criteria required that the patient had to be male, fall inside the above age range, and presented with asymptomatic sacroiliac joint dysfunction. This was determined either by diversified chiropractic motion palpation or SOT category analysis. Only category one patients were used in this study. The objective data was collected using an isometric dynamometer. The gastrocnemius muscle strength was measured with the dynamometer before and after the treatment. The objective results indicated that there was a statistically significant increase in gastrocnemius muscle strength in both of the experimental groups. In conclusion, it has been shown that both force and non-force adjustments positively effect active muscle strength. In this case it was shown that these types of adjustments to the SI joint caused an increase in active gastrocnemius muscle strength. It is suspected that the inhibition of the motor neuron, via the capsular stretch reflex, plays a major role in the effect seen in this study. This gives further information about the underlying mechanisms of the chiropractic adjustments and may support the role of non-force techniques in treating patients. / Dr. Chris Yelverton Dr. Malany Moodley

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2003. xvi, 138 leaves / Knee joint pathologies, in general, are associated with a loss of knee-extensor muscle strength. This weakness has been attributed to arthrogenic muscle inhibition (AMI). Manipulation of the sacroiliac (SI) has been shown to significantly reduce AMI and increase the strength in the quadriceps muscle group. Although both the knee and SI joints have been linked to AMI of the quadriceps muscle group, no studies have been conducted showing that manipulating the tibio-femoral (knee) joint has any effect on quadriceps muscle strength or AMI. The purpose of this study was therefore to verify whether manipulation of the knee (tibio-femoral) joint is as effective as SI joint manipulation in increasing quadriceps muscle strength in PFPS patients. This study also investigated the effect of combining manipulative therapy of the tibio-femoral and SI joints on quadriceps muscle strength in PFPS patients.

Thesis (M.Tech.: Chiropractic)- Dept of Chiropractic, Durban Institute of Technology, 2005. xiii, 129 leaves :|bill. (some col.) ;|c30 cm / Research indicates the sacroiliac joint (prevalence of sacroiliac syndrome ranges from 19.3% and 47.9% (Toussaint et al., 1999)) as being the primary source of low-back pain in 22.5% of patients with back pain (Bernard et al., 1987:2107-2130). Treatment options that are available for the treatment of low-back pain include allopathic (Hellman and Stone, 2000), and manual therapies such as hydrotherapy and traction (Cull and Will, 1995). It has been found that allopathic interventions have been less effective than spinal manipulative therapy, even with spinal manipulative therapy having various modes of application (e.g. side posture and drop piece manipulations) (Gatterman et al., 2001). Drop table thrusting techniques were found to be effective for patients with neuromuskuloskeletal problems such as facet syndrome (Haldeman et al., 1993), however, it is still not known which specific drop piece technique is the most appropriate for sacroiliac syndrome. Thus it is important to ascertain the clinical effectiveness of the technique as certain conditions prevent the patient from being positioned in the conventional side posture for treatment of sacroiliac syndrome (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Therefore this study aims at determining the efficacy of a maintained contact drop piece manipulation technique.

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Research indicates the sacroiliac joint (prevalence of sacroiliac syndrome ranges from 19.3% and 47.9% (Toussaint et al., 1999)) as being the primary source of low-back pain in 22.5% of patients with back pain (Bernard et al., 1987:2107-2130). Treatment options that are available for the treatment of low-back pain include allopathic (Hellman and Stone, 2000), and manual therapies such as hydrotherapy and traction (Cull and Will, 1995). It has been found that allopathic interventions have been less effective than spinal manipulative therapy, even with spinal manipulative therapy having various modes of application (e.g. side posture and drop piece manipulations) (Gatterman et al., 2001). Drop table thrusting techniques were found to be effective for patients with neuromuskuloskeletal problems such as facet syndrome (Haldeman et al., 1993), however, it is still not known which specific drop piece technique is the most appropriate for sacroiliac syndrome. Thus it is important to ascertain the clinical effectiveness of the technique as certain conditions prevent the patient from being positioned in the conventional side posture for treatment of sacroiliac syndrome (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Therefore this study aims at determining the efficacy of a maintained contact drop piece manipulation technique. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology. Thesis, 2005. / In symptomatic sacroiliac syndrome, nociceptors located within the capsule and ligaments of the sacroiliac joint are said to be activated which in turn act on inhibitory interneurons that synapse with the motor neuron pool of the muscles of that joint (muscles responsible for hip flexion, extension, abduction and adduction fall within the sacroiliac motor neuron pool). These inhibitory interneurons relay information that decreases the recruitment ability of that motor neuron pool. This is termed Arthrogenic muscle inhibition (AMI) and it has been stated that the number of motor units innervating a muscle relates positively to the strength of that muscle and hence may have an effect on the functional ability of that muscle. However, it has been proposed that spinal manipulation activates mechanoreceptors (Wyke receptors) from structures in and around the manipulated joint causing changes in motor neuron excitability through the altered afferent input and thereby causing an increase in motor neuron recruitment and a decrease in AMI. Furthermore, it has been found that sacroiliac joint problems have often been related to reduced or asymmetric range of motion (ROM) of the hip and / or lack of proprioceptive ability in the ipsilateral limb. In light of the above, manipulation has been found to cause a re-establishment of normal muscle tone and joint kinematics, therefore relaxing the muscles in that area and restoring normal ROM of the involved joint. This study presents the results of sacroiliac manipulation on objective hip measures (including peak torques, ROM and proprioception). / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2004. / Arthrogenic muscle inhibition (AMI) is the reflex inhibition of the muscles that surround an injured joint in consequence to disturbed afferent feedback originating from the receptors of that joint. The resultant altered afferent innervation of the motor neuron pool leads to a decrease in recruitment ability within the motor neuron pool, a decrease in contraction force of the muscles that fall within the motor neuron pool, and hence the clinical manifestation of AMI as a decrease in muscle strength. Spinal manipulation has been proposed to activate mechanoreceptors and proprioceptors within and around the manipulated joint. The altered afferent input arising from their stimulation is thought to cause changes in motor neuron excitability. In this respect, sacroiliac manipulation has been shown to effectively reduce muscle inhibition and increase muscle strength of the quadriceps muscle group in patients with anterior knee pain. The focus of AMI has been aimed primarily at the quadriceps muscle group whereas little information is available on the functional properties of the muscles moving the hip joint. Thus, the purpose of the present cohort study was to determine the short - term effect of sacroiliac manipulation on ipsilateral hip muscle strength and subjective low back pain intensity in thirty male subjects presenting with low back pain, attributable to chronic sacroiliac syndrome. The first objective of the study was to evaluate the short - term effect of sacroiliac manipulation on the strength of the musculature of the ipsilateral hip joint for the actions of flexion, extension, adduction and abduction by means of the Cybex Orthotren II Isokinetic Rehabilitation System, with respect to objective clinical findings. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban institute of Technology, 2003. / Low back pain is a significant health problem that has had a major impact on quality of life and on health care costs (Weiner, et al. 2000:450). Schwarzer, et al. (1995) established the sacroiliac joint to be a significant source of pain in patients with chronic low back pain. Bernard and Kirkaldy-Willis (1987:2107-2130) established the sacroiliac joint to be the primary source of low back pain in 22.5% of 1293 patients presenting with back pain. According to a review article by Hendler, et al. (1995:169), “manipulation provides dramatic relief” in cases of sacroiliac syndrome. Little research, however, has been done regarding instrument manipulation and it’s effect on acute, chronic or acute on chronic sacroiliac syndrome. Osterbauer and De Boer, et al. (1993) found a significant decrease in Visual Analogue Scale and Oswestry scores following treatment using instrument manipulation for sacroiliac joint syndrome. They also noted a reduction in the number of pain provocation tests applied to the research subjects. “Unless reliability and validity of assessments and effectiveness of treatment procedures can be demonstrated, clinicians should temper their claims of measurement of, and direct effects on, the sacroiliac joint” (Walker 1992:914). The study design was a randomised, omparative clinical trial. Sixty voluntary subjects were accepted onto the trial; each diagnosed as having acute on chronic sacroiliac joint syndrome, and divided into two groups of thirty subjects. Each subject received five treatments within a three-week period. The subjects in group one received manipulation using the Diversified Technique of manipulation and those in group two received instrument manipulation using the “Activator Adjusting Instrument”. / M