Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2004. xvi, 155 leaves / The aim of this investigation was to investigate whether an immediate objective increase in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome. The actions of hip flexion, extension, abduction and adduction were assessed. The study also investigated the patients’ subjective perception of pain due to the chronic sacroiliac syndrome before and after the manipulation. The proposed increases in strength would have been as a result of a reduction in arthrogenic muscle inhibition. Stimulation of nociceptors caused by the chronic sacroiliac syndrome would have lead to the presence of the arthrogenic muscle inhibition within the joint. Arthrogenic muscle inhibition has been described as an inability of a muscle group to utilise all its muscle fibres when performing a maximum voluntary contraction of that muscle group. Arthrogenic muscle inhibition is a joints natural response to pain, damage or distension within the joint. The response is an ongoing reflex inhibition of the muscles surrounding the joint in order to protect the joint. The inhibition of the surrounding musculature clinically manifests itself as a decrease in strength of the affected muscles. The decreased strength levels hampers rehabilitation of the affected joints as active exercise forms a vital role in the rehabilitation process. Current treatment options used to reduce arthrogenic muscle inhibition include lidocaine injection into the joint, cryotherapy and transcutaneous nerve stimulation. These treatments are aimed rather at the reduction of pain, joint effusions and atrophy of the related musculature than at the reduction of arthrogenic muscle inhibition. Recent studies have proposed that manipulation reduced arthrogenic muscle inhibition by causing excitation of the joint receptors, called the Wyke receptors. Stimulation of these joint receptors is thought to cause an alteration in the afferent input to the motorneuron pool resulting in a reduction of arthrogenic muscle inhibition. This study aimed to investigate whether sacroiliac manipulation could reduce arthrogenic muscle inhibition at the hip by assessing the immediate gains in hip muscle strength. The problem statement was to evaluate if an immediate subjective or objective change in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 1 v. (various pagings) / In recent years, sacroiliac syndrome has been widely accepted by many different health professions as one of the major contributors to mechanical low back pain. Manipulation to effect the relief of the condition has thus far proven to be one of the most effective methods. However, comparatively little research has been done on the different forms of physical therapy that can be used in conjunction with a manipulation so as to maximise its effect. This study focussed on the use of ischaemic compression (a well-accepted technique for the treatment of myofascial trigger points) of the gluteus medius muscle.

Thesis (M.Tech.:Chiropractic)- Dept. of 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”.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2004. xvi, 155 leaves / The aim of this investigation was to investigate whether an immediate objective increase in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome. The actions of hip flexion, extension, abduction and adduction were assessed. The study also investigated the patients’ subjective perception of pain due to the chronic sacroiliac syndrome before and after the manipulation. The proposed increases in strength would have been as a result of a reduction in arthrogenic muscle inhibition. Stimulation of nociceptors caused by the chronic sacroiliac syndrome would have lead to the presence of the arthrogenic muscle inhibition within the joint. Arthrogenic muscle inhibition has been described as an inability of a muscle group to utilise all its muscle fibres when performing a maximum voluntary contraction of that muscle group. Arthrogenic muscle inhibition is a joints natural response to pain, damage or distension within the joint. The response is an ongoing reflex inhibition of the muscles surrounding the joint in order to protect the joint. The inhibition of the surrounding musculature clinically manifests itself as a decrease in strength of the affected muscles. The decreased strength levels hampers rehabilitation of the affected joints as active exercise forms a vital role in the rehabilitation process. Current treatment options used to reduce arthrogenic muscle inhibition include lidocaine injection into the joint, cryotherapy and transcutaneous nerve stimulation. These treatments are aimed rather at the reduction of pain, joint effusions and atrophy of the related musculature than at the reduction of arthrogenic muscle inhibition. Recent studies have proposed that manipulation reduced arthrogenic muscle inhibition by causing excitation of the joint receptors, called the Wyke receptors. Stimulation of these joint receptors is thought to cause an alteration in the afferent input to the motorneuron pool resulting in a reduction of arthrogenic muscle inhibition. This study aimed to investigate whether sacroiliac manipulation could reduce arthrogenic muscle inhibition at the hip by assessing the immediate gains in hip muscle strength. The problem statement was to evaluate if an immediate subjective or objective change in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome.

Thesis (M.Tech.: Chiropractic)--Dept. of Chiropractic, Durban Institute of Technology, 2006. / Brunarski (1984) says that philosophically and historically, chiropractic has been uniquely orientated toward an emphasis on preventative care and health maintenance with a mechanistic and hands-on model for treatment. Instead of reductionism, chiropractors focus on holism, non-invasiveness and the sharing of the responsibilities for healing between doctor and patient. As stated in a Canadian report by Manga et al. (1993), lower back pain is a ubiquitous problem and there are many epidemiological and statistical studies documenting the high incidence and prevalence of lower back pain (Manga et al., 1993). Evans and Oldreive (2000) revealed in a study of the transversus abdominis that low back pain patients had reduced endurance of the transverses abdominis and that its protective ability was decreased. In addition, it was noted that wasting and inhibition of the other core stabiliser and co-contractor, multifidus, was present (Hides et al.,1994), both of which have been linked to the presence of low back pain (Evans and Oldreive, 2000 and Hides et al., 1994). Thus, it stands to reason that manipulation, as an effective treatment for low back pain (Di Fabio, 1992), could be effective in restoring the strength and endurance of the core stability muscles. This is theoretically supported by the fact that a restriction in motion and pain due to mechanical derangement in the low back can be effectively treated by manipulation (Sandoz, 1976; Korr (Leach, 1994); Herzog et al., 1999; Homewood, 1979; Vernon and Mrozek, 2005 and Wyke (Leach, 1994)). Homewood (1979) described that a subluxation may interfere with the nerve supply and result in a decrease in muscular activity. He hypothesized that removal of the subluxation could restore: normal physiological processes, increase muscle activity and; improve functional ability and normalize the torque ratios (Herzog et al., 1999; Korr (Leach, 1994); Nansel et al., 1993 and Rebechini-Zasadny et al., 1981). In terms of an intervention, Rebechini-Zasadny et al. (1981) and Naidoo (2002) demonstrated and inferred that manipulation to the cervical spine could affect the muscular activity supplied by those levels. They, however, suggested further studies of manipulation-induced peripheral changes in the muscles are needed, due to unaccounted for variables and small sample sizes in their respective studies This research aims to address the questions posed by the above literature, hence by investigating a high velocity low amplitude manipulation as a possible added intervention for improving local core stabilizer muscle strength, a management protocol for the chronic mechanical lower back pain could be developed. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / One of the most common clinical disorders known is mechanical low back pain (Painting et al. 1998:110). A significant source of low back pain is the sacroiliac joint and therefore, according to Schwarzer et al. (1995:31), it warrants further study. With respect to treatment, Gatterman (1995) states that specific manipulative therapy is the treatment of choice for sacroiliac dysfunction. This is supported by clinical studies (Cassidy et al., 1992), which have shown significant improvement with daily manipulation over a 2-3 week period in 90% of the patients suffering from sacroiliac dysfunction. Different adjusting techniques for the sacroiliac joint include side posture adjustment and prone drop piece adjustments (Bergmann, 1993). With respect to side posture, Bergmann (1993) further states that the side posture adjustment is the most common position used. However, it has been noted that side posture can produce unwanted rotation in the lumbar spine. This may be detrimental to patients who have contra-indications to torsioning such as abdominal aortic aneurisms, nerve root entrapment or disc pathology. Patients, who experience anterior catching of the hip capsule or decreased flexibility with side posture adjustments, experience more discomfort and could therefore benefit from a different technique (Gatterman, 1995). Hence the need for an effective adjustment technique that does not rely on torsioning (e.g. drop piece technique). (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Although drop table thrusting techniques were rated as being effective for the care of patients with neuromuskuloskeletal problems (Haldeman et al., 1993) as cited by Gatterman et al., (2001), it is still unknown which specific drop piece technique is the most appropriate for sacroiliac dysfunction. Therefore this study was aimed at determining the efficacy of a toggle recoil drop piece adjustment technique. / M

Dissertation submitted to the in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / Sacroiliac syndrome is a painful, debilitating condition that may cause considerable discomfort (Haldeman 1992), it is a common condition causing low back pain (Mierau, et al 1984, Guo and Zhao 1994), it is also believed by Bernard and Cassidy (1991) to be a frequently overlooked source of low back pain. Between 9 and 19.5 % of all sickness absence days are due to low back pain (Andersson 1981) / M

A dissertation presented in partial compliance with the requirements of the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / In recent years, sacroiliac syndrome has been widely accepted by many different health professions as one of the major contributors to low back pain. Manipulation to effect the relief of the condition has thus far proven to be one of the most effective methods. Comparatively little research has however been done on the different forms of physical therapy that can be used in conjunction with a manipulation so as to maximise its affect / M

M.Tech. / It has been well documented in literature that at least 80% of the general population will suffer from lower back pain or dysfunction at one stage in their lives. Recent literature suggests Sacroiliac joint dysfunction to be a common cause of lower back pain. Clinical interest in the dysfunction and the consequences of this joint being a major cause of lower back pain is growing, as more biomechanical clinicians are finding Sacroiliac joint disorders to be a common occurrence in clinical practice (Pool-Goudzwaard, Vleeming, Stoekart, Snijders and Mens, 1998). Sacroiliac syndrome is characterised by loss of joint play or altered mobility in the Sacroiliac joint‟s range of motion, and is usually associated with altered structural relationships in the region of the Sacroiliac joint (Grieve, 2001). This loss of normal movement is often adjusted by Chiropractors to regain normal mobility, however the correct diagnosis of the loss of mobility is required to induce the correct treatment. Motion palpation has been scrutinised by many researchers who widely questioned its inter-tester reliability. As yet there has been no consensus as to a „gold standard‟ for motion palpation of the Sacroiliac joint. This study aims to reconfirm the inter-examiner reliability of two such motion palpation tests, i.e. Gillet‟s motion palpation and the Standing Flexion test. One hundred participants underwent a double blind experimental study where the results from eight different examiners were recorded to obtain the reliability of the tests. Four examiners tested the participants using Gillet‟s motion palpation and four examiners used the Standing Flexion test. The results were recorded as either right, left or no restriction. The results were then compared and correlated. There was no statistically significant reliability found in either of the two tests. The mean reliability for the Standing Flexion test was found to be 59.31% while the Gillet‟s Motion Palpation produced a mean reliability of 56.38%. These two values are considerably lower than the expected 80% indicating low reliability between the two tests.

M.Tech. (Chiropractic) / Purpose: The pelvis, femur, tibia, fibula, ankle and foot form a closed kinematic chain during gait. According to biomechanical principles any restriction or tension in one part of the kinematic chain will create increased load on the other parts of the same chain (Comerford and Mottram, 2001; Sahrmann, 2000). This increased load can lead to dysfunction and compensation along the chain and also lead to gait anomalies. A chiropractic adjustment is utilised for the treatment of sacroiliac joint restrictions. There has not been research conducted to establish the effects that a chiropractic adjustment has on lower limb biomechanics and gait. The purpose of this study was to determine whether a sacroiliac adjustment had an effect on gait by looking at the gait parameters. Method: Sixty participants who were between the ages of 18 and 40 years were recruited. The participants were asked to sign a consent form and then a thorough history and physical examination was performed to ensure that participants did not have any disease or pathology that may have excluded them from the study. These included foot pathologies, knee pathologies, hip pathologies, structural leg length discrepancies, or any contraindications to chiropractic adjustment. A lumbar spine regional examination as well as motion palpation of the sacroiliac joints was performed to determine which joints were restricted. Each participant then underwent a gait assessment before and after they received a chiropractic adjustment to the restricted sacroiliac joint. Procedure: Participants only received one adjustment. Objective measurements were obtained using the Zebris FDM gait analysis system. This system uses high-quality capacitive force sensors that are arranged in matrix form. As a result, each sensor produces its own calibration curve. The measuring plates enable the static and dynamic force distribution to be analysed under the feet while standing and walking. The measuring plate is integrated in a level walking area. The measuring parameters are automatically calculated in the WinFDM program and a printable, easy to read report of the measuring results is then available (Zebris Medical GmbH, Germany). Each participant walked over the measuring plate for 4 times. This was done before and after the adjustment.Results: Statistically significant changes were seen between the pre and post treatment measurements of foot rotation on the treatment side, the step length on the treatment side, the stride length, the stance phase on both the treatment and non-treatment sides, the swing phase on the treatment and non-treatment side and the total double support. Conclusion: This study shows that a chiropractic adjustment to the sacroiliac joint does change certain gait parameters and it should therefore be part of any treatment regime for gait abnormalities. Podiatrists, biokineticists and chiropractors should work together when treating patients with gait abnormalities. As the study only recruited asymptomatic participants, further studies are necessary to determine the effect a chiropractic adjustment has on the gait of symptomatic patients.