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Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Blood pressure, defined as the force per unit area exerted on the wall of a blood vessel by its contained blood, is expressed in terms of millimeters mercury (mm Hg). Hypertension is a common problem in Westernised nations, including South Africa. The nervous system's role in the induction of hypertensive disease is the least understood; however, it is postulated that chiropractic adjustment normalises raised blood pressure via modification of the tonicity of the autonomic nervous system. The treatment of organic-type disorders with manipulative therapy is a controversial topic within and outside the chiropractic profession. However, research has indicated that manipulation may affect blood pressure, and the literature does propose a number of hypotheses on how this may be achieved. The purpose of this study was to determine the effect of spinal manipulative therapy to the atlanta-occipital and atlanta-axial articulations on the blood pressure of normotensive Caucasian male subjects. This prospective controlled clinical trial consisted of a total of sixty normotensive Caucasian male subjects who were recruited by canvassing for volunteers from the Durban Institute of Technology campus as well as the general Durban area. By simple consecutive randomisation, 30 subjects were entered into a control group, and another 30 were entered into an experimental group. Both groups followed the same procedure with the exception that the control group did not receive any manipulation. Phase one of the study, which covered two visits, was / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / Objectives To investigate the efficacy of spinal manipulative therapy (SMT) in the management of mechanical thoracic spine pain. It was postulated by the researcher that with manipulation of the affected thoracic spinal segment, there would be a significantly greater improvement than by only applying placebo treatment. Summary of background data There have been no substantiated studies performed up to this date to investigate the efficacy of SMT on thoracic syndromes. Study design A single-blind, randomised, comparative, controlled pilot study. Methods Thirty subjects selected from the general population, diagnosed as having mechanical thoracic spine pain, were randomly divided into two different treatment groups. Each group consisted of fifteen patients between the ages of 16 and 60 years. The first group received thoracic spine manipulation. The second group received placebo treatment only. iii The research project was carried out where both groups received a maximum of six treatments over a minimum period of two weeks. Thereafter a follow-up appointment / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1998. / Currently, no scientific evidence exits to demonstrate that radiolucent cavities, or an increase in joint space in the cervical zygapophyseal joints, occur following the manipulation of these joints. However, previous studies have demonstrated the presence of these phenomena in the metacarpophalangeal joints following the application of linear traction to these joints to the point of cavitation ('cracking'). This study was designed to determine whether such phenomena occurred in the cervical spine. Plain film and computed tomographic imaging were used for this purpose. It was hypothesized that an increase in joint space and a decrease in joint density (radiolucent cavity) would be demonstrable following the application of the manipulation in the non-traction and particularly the traction positions of the neck. Volunteers were screened for conformity with the inclusion criteria. Of these, 22 asymptomatic subjects were selected. The subjects were then assigned to one or two of 6 possible experimental groups. The subjects of each group were radiographically imaged before and immediately after the manipulation. In all cases except for Experiment 1 the subjects received : o a pre-manipulation X-ray and/or CT scan, o a pre-manipulation plus traction X-ray and/or CT scan, a post-manipulation X-ray and/or CT scan and o a post-manipulation plus traction X-ray and/or CT scan. A total of 83 CT scans consisting of 1660 images and 36 fluoroscopy-assisted plain-film radiographs were performed. / M

Dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 2002. / This comparative, randomized, controlled clinical trial consisted of sixty patients, suffering from low back pain (LBP) attributable to sacroiliac and/or lumbar facet syndrome. The aim of the study was to determine the relative effectiveness of frequent and infrequent chiropractic treatments in the management of mechanical low back pain. It was hypothesised that the Frequent Treatment Group would produce better results than the Infrequent Treatment Group. Treatments consisted of spinal manipulative therapy (SMT) using diversified techniques to dysfunctional sacroiliac (SI) and or lumbar facet joints. All treatments were preceded with 5 minutes soft tissue therapy to the lumbar region. The study population was randomly divided into two treatment groups. The Frequent -Treatment Group received 9 treatments over a three-week period and the Infrequent Treatment Group received 3 treatments over the same treatment period. Data was collected before the treatment commenced and again at the beginning of the second and third weeks of the trial and finally the week following the last treatment. Subjective data gathered included results from the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain Disability Questionnaires. Objective data included an orthopedic rating scale used to assess the sacroiliac and lumbar facet joints and lumbar spine range of motion (ROM) as measured with the BROM II goniometer. Data obtained during the trial period was statistically analysed. No significant difference between the two treatment groups was found at the 95% level of confidence. These findings imply that once weekly treatments are as effective as three treatments per week in terms of the clinical measure employed in this study. The results from this study suggest that patients who receive treatments more than once a week could be receiving excessive treatments, which would make the cost of chiropractic treatment unnecessarily expensive. Intra-group analysis of the results indicated that both treatment groups improved significantly (0 =0.05) between the first and final consultation, for all measures. These findings demonstrate that chiropractic treatment is beneficial to patients with mechanical LBP. The mean values obtained for each group for the levels of pain intensity, disability, ROM and joint dysfunction show the Frequent Treatment Group to have improved slightly more than the Infrequent Treatment Group, however not significant at the 95 % level of confidence. The cost of more frequent treatment needs to be justified with superior long-term effects. Research into factors such as whether or not more frequent treatments maintain productivity and avoid chronicity may provide support for more frequent treatments. / M

Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines. Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying anti-rheumatic drug (bDMARD) therapy on spinal fractures related to AS. Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS. Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved.  It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS. Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no well-established cadaver models exist. Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.

M.Tech.