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.

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.

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.

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.

M.Tech. / The aim of this research study was to determine the most effective way of treating sacroiliac joint dysfunction with associated gluteus medius trigger points, using adjusting of the sacroiliac joint or needling of the gluteus medius muscle or both. The participants were recruited randomly and placed in 3 different groups. Participants in group 1 were treated with an adjustment of the sacroiliac joint, as well as needling of the most prominent gluteus medius trigger point. Participants in group 2 were adjusted only and participants in group 3 were needled only. The treatment of the participants took place at the University of Johannesburg’s chiropractic day clinic. The objective data was acquired using a Digital Inclinometer to measure the ranges of motion at the spinal levels of the 5th lumbar vertebra and the first sacral vertebra (L5/ S1). An Algometer was used to measure the amount of pressure required to evoke pain, within the most prominent trigger point being treated. The subjective data was acquired using the Oswestry Pain and Disability Questionnaire, as well as the Numerical Pain Rating Scale. The results of the trial were of no statistical significance, but clinical improvement in both objective and subjective data was found. Group 2’s mean value percentage improvement was the greatest, when looking at range of motion. Group 1’s mean value percentage improvement was the greatest, with the Algometer and the subjective readings. The outcome of this study was that overall all three treatment protocols had a positive effect on the participants. Group 1 and group 2 had a slightly greater overall improvement. Thus it is suggested that when treating sacroiliac joint dysfunction with associated gluteus medius trigger points, the doctor can use an adjustment or adjusting with needling, both are effective. It is important to take the patients preference into account in order to make them feel at ease with the treatment they are receiving.

M. Tech. / Purpose: Trigger points in the paraspinal muscles are commonly associated with lameness or stiffness in horses, and unless they are “released”, muscle power and flexibility are impaired and athletic performance is reduced (Rogers, Fischer, Pontinen, and Janssens, 1996). The aim of this study was to determine the immediate and the prolonged effects of Sacroiliac mobilization on spot tenderness within the Erector spinae muscles of performance horses. Method: Horses from a selected stable yard underwent a screening process under the supervision of a qualified Chiropractor and Veterinarian to identify horses suitable for the study. Thirty horses were selected for the study based on the inclusion and exclusion criteria. The sample was divided into two groups of fifteen horses. The experiment group received mobilization therapy for SI joint restrictions, while the control group did not receive any treatment intervention. Procedure: Horses received an initial treatment and two follow ups, totaling three treatments. The first follow up treatment was two days after the initial and the second was four days post initial treatment. During these treatment sessions, trigger points in the Erector spinae muscles were located in each horse and algometer measurements were taken. Sacroiliac restrictions were then identified using motion palpation and passive range of motion as indicators. The researcher performed a mobilization technique on the Sacroiliac joints of horses in the experiment group only, and thereafter both groups were reassessed two minutes later, via an algometer, for spot tenderness within the same trigger points. The Sacroiliac restrictions and trigger points were re-assessed without treatment two weeks later. Conclusion: The results indicated that low-velocity Sacroiliac mobilization was effective in increasing the pain-pressure tolerance within the Erector spinae muscles of performance horses immediately and over the treatment period of two weeks.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Sacroiliac joint syndrome is diagnosed in patients who complain of various painful symptoms associated to their lower back, for example: hip and groin pain, sciatica pain, and / or a need to frequently urinate. They further report that their pain is further intensified when standing from sitting, stair walking, bending forward or from sitting or standing too long. Sacroiliac joint syndrome has been widely accepted by health professions as a contributor to low back pain. Spinal manipulation has shown to be an effective method for pain relief of this condition. Studies have been done using physical therapy in conjunction with manipulation in treating sacroiliac joint syndrome. However, little research has been done on the effects of static stretching and manipulation combined. The posterior oblique sling group of muscles is created by the biceps femoris, gluteus maximus, erector spinae and latissimus dorsi muscles. The sacroiliac joint can be affected by the functional relationship of the posterior oblique sling muscles. These muscles are involved in forces across the sacroiliac joint. Tightness of muscles can affect the sacroiliac joint. Flexibility is an essential element of normal biomechanical functioning. Flexibility of muscles, tendons and ligaments can influence a joints range of motion. There is evidence that suggests that stretching could increase a joint’s range of motion which was evident one or more days after the stretching protocol in people without clinically significant contractures. Upon review of the related literature, it appears that there is insufficient literature assessing the clinical effectiveness of static stretching of the posterior oblique muscle sling group with respect to sacroiliac joint syndrome. Therefore this study is aimed at providing insight into the role of the posterior oblique muscle sling group in participants with and chronic sacroiliac joint syndrome. It is hypothesized that effective treatment of these muscles will allow for a more effective outcome of symptoms. The study design chosen was a randomised, clinical trial consisting of thirty voluntary participants’ between the ages 18 to 45 years suffering from chronic sacroiliac joint syndrome. There were two groups of fifteen participants, who received four treatment consultations within a two week period. Participants placed into Group One received sacroiliac joint manipulation only, while participants in Group Two received static stretching of the posterior oblique muscle sling and sacroiliac joint manipulation. Subjective and objective readings were taken at the first, third and fourth (final) consultations. The Numerical Pain Rating Scale (NRS) and the Oswestry Low Back Pain Disability Index (OSW) questionnaires were used to assess the subjective findings whilst the objective measurements were collected from results of algometer and inclinometer readings. The intra-group analysis revealed there was a statistically significant improvement within both groups for NRS, OSW, and inclinometer results. It appeared that Group Two fared better in terms of the algometer (pressure) results. The inter-group analysis revealed that all comparisons apart from the algometer readings had no statistically significant improvement between the two groups. From the intra-group comparisons of the objective data, participants in both groups experienced a statistically significant improvement. However, Group Two fared better in terms of the algometric pressure readings (p = 0.001). This study confirms that both treatment protocols were effective in reducing the signs and symptoms associated with sacroiliac joint syndrome. Although the readings were not statistically significant, there is evidence that Group Two responded better than Group One in terms of the algometer readings (Figure 4.13). There is insufficient literature on studies related to the posterior oblique sling muscles, and therefore, comparisons are needed with respect to the posterior oblique muscle sling group and its effects on the sacroiliac joint. This study concludes that overall there was no statistically significant difference between the two groups and recommends that further studies be undertaken with a greater number of participants to gauge if a more significant result can be achieved. / M

Objective : Low back pain (LBP), and in particular sacroiliac joint syndrome, is a significant health concern for both patient and their chiropractor with regards to quality of life and work related musculoskeletal disorders. Therefore, chiropractors often utilise mechanical aids to reduce the impact on the chiropractor’s health. It is, however, important to establish whether these mechanical aids are indeed clinically effective, therefore, this study evaluated the Activator Adjusting Instrument (AAI) against an AAI placebo to determine whether this adjusting instrument is an effective aid for both the chiropractor and the patient. Method : This randomised, placebo controlled clinical trial consisted of 40 patients (20 per group), screened by stringent inclusion criteria assessed through a telephonic and clinical assessment screen. Post receipt of informed consent from the patients, measurements (NRS, Revised Oswestry Disability Questionnaire, algometer) were taken at baseline, prior to consultation three and at the follow consultation. This procedure occurred with four interventions over a two week period. Results: The AAI group showed clinical significance for all clinical measures as compared to the AAI placebo group which attained clinical significance only for the Revised Oswestry Disability Questionnaire. By comparison there was only a statistically significant difference between the groups in terms of the algometer readings (p= 0.037). Conclusion : Therefore, it is evident that the AAI seems to have clinical benefit beyond a placebo. However this is not reflected in the statistical analysis. It is, therefore, suggested that this study be repeated with a larger sample size in order to verify the effect on the statistical analysis outcomes.