Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 xvii, 148 leaves, Annexures A-L / 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.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Hamstring muscle strains are a common musculoskeletal injury amongst athletes, with a high rate of recurrence that suggests room for improvement in the treatment and management of these injuries. Cibulka et al. (1986) suggest a possible link between injuries of the hamstring muscles and dysfunction of the sacroiliac joint. A study by Fyfer (2005) found that sacroiliac manipulation alone had a positive effect in the treatment of recurrent hamstring strains, but this was not combined with or compared to conventional treatment for muscle strain. Fox (2006) found that sacroiliac manipulation added to hamstring stretching increased the resultant flexibility of uninjured hamstring muscles. Objective: The purpose of this study was to determine the relative effectiveness that manipulation may have when combined with and compared to a regime of hamstring stretching and strengthening in the treatment of chronic hamstring strains. Method: Thirty two participants suffering from chronic hamstring injuries and concomitant dysfunction of the sacroiliac joint were randomly allocated into two treatment groups. Both groups attended six consultations over a period of three weeks. Group one received treatment in the form of proprioceptive neuromuscular feedback (PNF) stretching and resisted isometric exercises of the hamstring, and were taught a home routine consisting of static stretching of the hamstring and Theraband® exercises directed at the hamstring. Group two received the same treatment and home routine as those in Group one, with the addition of Chiropractic manipulation of the dysfunctional sacroiliac joint. Outcomes were obtained by using the Numerical Pain Rating Scale (NRS-101), inclinometer testing of passive straight leg raiser test, and algometer assessment of pain threshold in the injured hamstring muscle and ipsilateral sacroiliac joint. Results: Data was analysed using the SPSS version 18.0 (SPSS Inc. Chicago, Ill, USA). Subjective and objectives outcomes were measured quantitatively. The effect of the intervention was measured using repeated measures ANOVA testing. The time versus treatment group interaction effect assessed whether the effect of the different treatment over time is the same, with a p value of <0.05 being v considered significant. Both treatment groups showed improvement of outcomes, and manipulation showed a marginally non-significant trend of greater improvement with regards to sacroiliac joint algometry. Conclusion: This study did not provide conclusive evidence of either a benefit or no benefit of manipulation, but where non-significant trends were shown, it is likely that this was due to lack of statistical power and that with an appropriate a priori analysis being done a greater sample size may have shown the same effect to be statistically significant.

Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle.We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormonedependent Cushing’s disease. The combination of adrenocorticotropic hormone-dependent Cushing’s disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors’ knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Low back pain has been shown to be associated with inhibition of the lower limb musculature. This inhibition is called arthrogenic muscle inhibition (AMI). Sacroiliac joint dysfunction has been linked with AMI of the ipsilateral and contralateral quadriceps and hamstring muscles. Sacroiliac manipulation has been shown to significantly reduce ipsilateral AMI, however no studies have been conducted to illustrate the effect of sacroiliac manipulation on contralateral AMI. Neither have their been studies to show the presence or extent of spinal dysfunction between the levels of L2-L5 and its significance on muscle inhibition in the quadriceps and hamstring muscles, nor the effect of manipulation of these levels on AMI of the quadriceps and hamstring muscles. The purpose of this study was therefore to determine whether spinal manipulation has an effect on AMI of the contralateral limb as well as that of the ipsilateral limb. / M

M.Tech. (Chiropractic) / Purpose: According to Jonhagen, Nemeth and Erikson (1994), hamstring muscle injury as a result of weakness is prevalent. Hoskins and Pollard (2005) states that a previous or recent hamstring muscle injury is the most recognized risk factor for future injury. Given the high reoccurrence rate, hamstring injuries provide a significant challenge to the treating clinician. Knowledge surrounding the optimal treatment is critical to improve hamstring muscle strength in preventing these injuries. The aim of this study is to determine the most effective treatment method, when comparing sacroiliac joint manipulation with or without dry needling and the effect it has on hamstring strength. Design: Thirty participants between the ages of 18 and 35 years old presenting with SI joint dysfunction and hamstring trigger points, were considered for this study. The participants were randomly divided into two groups of 15 participants each (group A and B). Group A received manipulation to the sacroiliac joint and group B received manipulation to the sacroiliac joint, as well as dry needling of the active myofascial trigger points in the semimembranosus muscles. Each participant was treated six times over a period of three weeks. Measurements: All measurements were collected at the first, third and fifth consultation prior to treatment and on the seventh consultation where no treatment was performed. Subjective measurements included the McGill questionnaire and a visual analogue pain scale. Objective measurements included algometer, readings of pressure pain threshold of the hamstring muscle trigger points and hamstring muscle strength recorded using a dynamometer instrument. Results and Conclusion: Group A and group B proved to have a statistical and clinical improvement overall. Group A had a better improvement in both subjective tests and in the objective tests. In comparing the statistically significant data for hamstring muscle strength in this study, it would appear that Group A responded better to treatment than Group B. Although both groups did improve, it suggests that Group A achieved the greatest overall improvement. Therefore it can be suggested that myofascial dry needling of the hamstring muscle was found not to have an additive effect for improving vii hamstring muscle strength, it actually appears to have done worse. The reason for this might be due to the post treatment soreness after needling. This may cause muscle inhibition and decreased muscle contraction, due to the pain or tenderness, which could have affected the muscle strength. In conclusion, the results in this study show that chiropractic manipulation combined with dry needling did not have better results in improving hamstring strength.

Foram examinados 192 pacientes consecutivamente com o objetivo de alcançar 50 pacientes com diagnóstico de DASI (26% incidência). Dos 50 pacientes submetidos ao bloqueio intra-articular sacroilíaco com dexametasona e lidocaína; 41 pacientes (82%) relataram melhora da dor e da qualidade de vida; e um menor consumo de analgésicos de resgate nos 6 meses subsequentes. O bloqueio trouxe uma melhora da dor imediata de forma segmentar nas regiões dos dermátomos, havendo uma queda do nível médio de dor de 8 para 3 (p<0.001). O consumo de analgésicos de resgate também foi significativamente reduzido (p<0.01). Entretanto, 9 pacientes (18%) não relataram melhora duradoura no terceiro mês de avaliação e foram submetidos a ablação por radiofrequência de resfriamento dos ramos sacrais e do ramo mediano de L4-L5. Ao avaliar os 9 pacientes submetidos a radiofrequência um não obteve sucesso e foi diagnosticado com cisto sacral. Outro não ficou satisfeito com nenhum dos procedimentos. Este paciente tinha um histórico de síndrome póslaminectomia, e na ocasião estava em uso de 40mg de metadona e 1200mg de gabapentina diariamente. Os outros 7 pacientes obtiveram sucesso (78%). / 192 patients were consecutively examined in order to reach 50 patients with SIJD diagnosis (26% incidence). From the 50 patients submitted to intra-articular dexamethasone plus lidocaine SIJ block; 41 patients (82%) refereed pain and quality of life improvement; and lesser rescue analgesics consumption during 6 consecutive months. The block induced a prompt onset of pain relief in a strictly segmental manner nearby the dermatomes, and there was a drop in mean pain score from 8 to 3 cm (p <0.001). Rescue analgesics consumption was also significantly reduced (p<0.01). However, 9 patients (18%) did not refer long lasting improvement in the third month of evaluation and underwent cooled radiofrequency ablation of sacral and radiofrequency ablation of L4-L5 median branch. When one evaluate the 9 patients who underwent radiofrequency, one was not successful and had diagnosis of cystic sacral formation. Other was not happy at all with any of the procedures. This patient had past history of post-laminectomy syndrome, and was at the time using 40 mg methadone and 1200 mg gabapentin daily. The other 7 patients were successful (78%).

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

M. Tech. / Purpose: To determine whether there was any improvement in proprioception by influencing the proprioceptive receptors through either manual manipulation of the Sacroiliac joint or subjecting the participants to whole body vibration by means of Powerplate training. A combination of the two was also used. Methods: This study included 45 participants divided into 3 groups of equal size. All participants were symptomatic with regard to Sacroiliac Joint pain and\or restriction and fell within the different activity categories according to the Internat ional Physical Activity Questionnaire. Participants in Group 1 were subjected to Sacroiliac Joint adjustment and Powerplate training, Group 2’s participants were subjected only to Sacroiliac Joint adjustment, and participants in Group 3 were only asked to perform training sessions on the Powerplate. The study design consisted of six consultations with intervention applied at each consultation and objective readings taken at the beginning, after the 3rd intervention and after the last intervention. Objective data was obtained by the Biodex Stability System. The initial effect of the intervention was represented by the initial Biodex Stability System reading compared to the second reading, and the short term effect was represented by the initial reading compared to the Biodex Stability System reading at the end of the six consultations. Results: Objective results from comparing intergroup Biodex Overall Stability Index readings showed that Group 3, the group that received only Powerplate training, had the most significant ef fect (p=0.016). This was followed by Group 1 (Powerplate and Chiropractic Spinal Adjustive therapy) with p=0.098. During intragroup comparison, it was found that the initial treatment , from the first Biodex reading to the second, had the biggest effect (p=0.005). iv Conclusion: Although the group that only received Powerplate training showed a significant effect especially with initial treatment, some effect was also seen at the group that received both Powerplate training and Chiropractic Spinal Adjustive therapy and the group that only received Chiropractic Spinal Adjustive therapy. Although there was an initial worsening of balance between sessions 1 and 2 in the Powerplate group, the overall effect showed an improvement in balance in this Group.

A thesis presented in partial compliance wnh the requirements for the Master's Degree in Chiropractic, Technikon Natal, 1999. / Sacroiliac syndrome is a common condition causing low back pain (Mierau et al. 1984, Guo and Zhao 1994). It is a painful, debilitating condition that may cause considerable discomfort (Haldeman 1992:220). According to Frymoyer et al. (1991:2114), sacroiliac syndrome is a frequently overlooked source of low back pain as it may mimic other well known causes of low back pain / M

M.Tech. / This study was conducted to determine the effect of Sacroiliac joint adjustment to the restricted Sacroiliac joint in combination with myofascial dry needling to the active/latent Rectus Femoris muscle trigger point and Rectus Femoris myofascial dry needling on its own on Quadriceps Femoris muscle strength. Thirty participants between the ages of 18 and 40 years were recruited through the use of advertisements placed in and around the University of Johannesburg’s Chiropractic Day Clinic. Participants were assessed for exclusion criteria by performing a Full Case History, Pertinent Physical Examination, Lumbar Spine and Pelvis Regional Examination and S.O.A.P note. The participants who conformed to the specific inclusion criteria were accepted for this study. These participants were randomly placed into two groups of sixteen participants each. Group One receive Sacroiliac joint adjustment to the restricted Sacroiliac joint and ipsilateral myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger points. Group two received myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger point on the same side as the Sacroiliac joint restriction. Each participant received five treatments over a three week period, i.e. two treatments for the first two weeks and one follow-up treatment in the third week. The subjective data of the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the Isometric Dynamometer measuring the Quadriceps Femoris muscle strength before and after each treatment. In addition the Algometer was used for measuring the pressure pain threshold of the Rectus Femoris trigger points. An analysis was performed using Repeated Measures Analysis, t-Test, Frequencis, Descriptives and Friedman’s Tests. The results of this study demonstrate that Sacroiliac joint adjustment to a restricted Sacroiliac joint with ipsilateral myofascial dry needling of the Rectus Femoris muscle showed a statistically significant, but temporary increase in Quadriceps Femoris muscle strength. Myofascial dry needling of the Rectus Femoris muscle on its own was found to be statistically insignificant for the increase in Quadriceps Femoris muscle strength.