M.Tech.

The sacroiliac joints are a source of low back pain (1) and sacroiliac joint disorders are a common occurrence in clinical practice (2). Sacroiliac dysfunction is considered to be the most common cause of sacroiliac joint pain and subsequent lower back pain (3). However, the anatomical location of these joints and the lack of a satisfactory criterion standard (the “gold standard”) make the diagnosis of sacroiliac joint dysfunction difficult (4). Nevertheless, many different sacroiliac joint tests have been described to detect the sacroiliac dysfunction however none have been validated against any independent criterion standard (5). Furthermore, numerous invalidated tests attempt to diagnose the type of sacroiliac joint dysfunction although they also lack that satisfactory criterion standard (4, 5). The Sacral Base Pressure Test has been shown in a previous study to have good validity as an indicator of sacroiliac dysfunction (6). This study aimed to reconfirm the validity of the Sacral Base Pressure Test in diagnosing sacroiliac joint dysfunction. It also determined the predictive powers of the test in determining which type of sacroiliac joint dysfunction was present. Sixty-two participants underwent a double-blind experimental study where the results from the Sacral Base Pressure Test were compared against a cluster of previously validated tests of sacroiliac joint dysfunction. The cluster of tests gave the diagnosis against which the Sacral Base Pressure Test’s validity and predictive powers were determined. The cluster of tests included Standing Flexion Test, the Iliac Springing Test, Spine Test and Supine Long-Sitting Test. The former two tests only determined the presence of the sacroiliac joint dysfunction, whilst the latter tests also determined the type of dysfunction present. The results occurring in the Sacral Base Pressure Test, namely the external rotation of the feet, were measured using a digital inclinometer. There was no statistically significant difference in the results of the Sacral Base Pressure Test between the types of sacroiliac joint dysfunction. Only when the Sacral Base Pressure Test was performed on the right of the patient and when it analysed right-sided dysfunction types, was there a slight statistically significant difference (P = 0.0529) evident in the results. In terms of the results of validity, the Sacral Base Pressure Test was useful in identifying positive values of sacroiliac joint dysfunction but was not useful in identifying the negative values. The Sacral Base Pressure Test did not accurately diagnose patients with positive test results, however it was fairly helpful in correctly diagnosing patients with negative test results. The Sacral Base Pressure Test had only a “slight” agreement with the diagnosis according to the Landis and Koch Guidelines for Kappa interpretation. At this stage of research into the Sacral Base Pressure Test, the results are varied. In this study, the test was not a clinically useful test for determining the presence of sacroiliac joint dysfunction or the type of dysfunction present. Further research comparing the agreement of the Sacral Base Pressure Test or other sacroiliac joint dysfunction tests with a gold standard of diagnosis is necessary. / Dr. E.K. Urli Dr. J. Breitenbach Dr. C. Yelverton

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.

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

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 Degree in Technology: Chiropractic, Durban University of Technology, 2013. / The lifetime incidence of low back pain is between 48% to 79% in South Africa. Globally, chronic Sacroiliac Joint Syndrome occurs in 13% to 63% of the world’s population. Therefore, chronic Sacroiliac Joint Syndrome is a significant health problem that has the potential to have a major impact on quality of life. Chronic Sacroiliac Joint Syndrome is described as an alteration in normal motion or mechanics. The Sacroiliac Joint fibrous capsule contributes to proprioceptive and nociceptive output, which may be exacerbated when the joint is in a dysfunctional state. Chronic Sacroiliac Joint Syndrome may be effectively treated by spinal manipulative therapy. Spinal manipulative therapy is professed to have four therapeutic effects – mechanical correction, pain reducing effects, circulatory increase and neurobiologic effects. Similarly, Kinesio Tex® Tape therapy is professed to have comparable therapeutic effects – circulatory increase, pain reduction and stimulation of proprioceptive systems. Spinal manipulative therapy and Kinesio Tex® Tape therapy may, therefore, have similar therapeutic effects which, if used in adjunction, may produce enhanced therapeutic effects and accelerated results regarding reduction of symptoms in patients with chronic Sacroiliac Joint Syndrome. This investigation aimed to determine whether Kinesio ® Taping methods would have any relative effect on the Sacroiliac Joint, and whether it would be appropriate to use as an adjunct to spinal manipulative therapy in the treatment of chronic Sacroiliac Joint Syndrome. The study was a prospective stratified clinical trial with three intervention groups, twenty participants in each (n = 60). All participants were 18-50 years of age and suffering from chronic Sacroiliac Joint Syndrome. Subjective measurements included the Numerical Rating Scale and Oswestry Low Back Pain Disability Index. Objective measurements included the Algometer Scores. Numerical Rating Scale and Algometer measurements were taken before and immediately after treatment at the first consultation and at the second consultation. Oswestry Low Back Pain Disability Index measurements were taken at the first and second consultation. Group One underwent spinal manipulative therapy alone, Group Two underwent Kinesio Tex® Tape therapy alone and Group Three underwent both spinal manipulative therapy and Kinesio Tex® Tape therapy in combination. Comparisons were made using the Unpaired and Paired t-tests. The results for the Inter-group analyses suggested that most comparisons were statistically insignificant (p ≥ 0.05) which indicated that all treatment groups appeared to improve to a similar degree. The results for the Intra-group analyses suggested that most comparisons were statistically significant (p < 0.05) which indicated that Kinesio Tex® Tape therapy was effective as an adjunct to spinal manipulative therapy, however not statistically more or less effective that spinal manipulative therapy or Kinesio Tex® Tape therapy alone. In conclusion, it was found that some differences did occur, however these differences were not sufficient enough to conclude that one treatment was more effective than the other. Further research with a larger sample size, more frequent treatments and follow-ups, a more homogenous stratification of age, ethnic group, gender, side of diagnosis and categorizing participant occupation is needed in order for the power of the study to be amplified and, therefore, any results would carry more weight.