Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1997. / There have been few studies performed to determine the combined effects of spinal manipulative therapy with other modalities known to have beneficial physiological effects, especially in terms of mechanical low back pain (Ottenbacher and Difabio 1985). / M

M. Tech. / Background: No substantiated theory exists by which chiropractic adjustments are known to correct myofascial trigger points (MTrPs). Myofascial trigger points are theorized to be either a primary muscle dysfunction or a secondary manifestation to central/ peripheral neurological mechanisms. Chiropractic adjustments are theorized to exert their therapeutic influence either primarily through biomechanical effects and/ or via neurophysiological mechanisms. Objective: The objective of this study was to investigate the effects of chiropractic adjustments on chronic, active rhomboid MTrPs, by comparing the clinical effects attained with rhomboid attachment-segment (C7-T5) relative to rhomboid innervation-segment (C4 and/ or C5) chiropractic adjustments. Setting: University of Johannesburg Chiropractic Day Clinic in Johannesburg, Gauteng. Participants: Thirty female subjects selected from the general population (from 18 to 40 years) were randomly divided into two different treatment groups of 15 each. Methods: The subjective information required the completion of the Subjective Pain and Discomfort Questionnaire, including the Numerical Pain Rating Scale (NPRS). The objective measures collected were pressure-pain threshold (PPT) and range of motion measurements using the algometer and digital inclinometer, respectively. Additionally, the change in the number of active MTrPs over the treatment period was recorded. All measurements were recorded at the first, third and fifth consultations, over a 3 to 4 week period. The data gathered were then statistically analyzed with the use of a 95% confidence interval. The nonparametric Friedman and Wilcoxon Signed Rank tests were used for the intragroup comparisons, and the Mann Whitney- U test was used for the intergroup comparisons. Interventions: Treatment group 1 received upper-thoracic/ attachment- segment chiropractic adjustments, and treatment group 2 received mid-cervical/ innervation-segment chiropractic adjustments. The research project was carried out so that both groups received 5 treatment sessions over 3 to 4 weeks. Results: There were no statistically significant results obtained for intergroup comparisons. Attachment-segment chiropractic adjustments revealed statistically significant changes in NPRS values (p=0.000), PPT values (p=0.000), cervical spine right lateral flexion range (p=0.004), thoracic spine extension (p=0.005) and left rotation range (p=0.003) over time. Innervationsegment chiropractic adjustments revealed statistically significant changes in NPRS values v ii (p=0.001), cervical spine right rotation (p=0.003), thoracic spine flexion (p=0.001) right lateral flexion (p=0.001) and left rotation (p=0.005) over time. Conclusions: This study does not suggest that attachment-segment or innervation-segment chiropractic adjustments possess greater clinical efficacy relative to one another in terms of improving the clinical picture associated with chronic, active rhomboid MTrP activity. In a further study, a larger sample size will be necessary to identify subtle changes in measurement parameters.

M.Tech. / Purpose: This study aims to compare the effects of chiropractic manipulation versus mobilisation on Pressure Pain Threshold in chronic posterior mechanical cervical spine pain sufferers with regards to pain, disability and cervical spine range of motion. These effects were evaluated using a questionnaire consisting of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire, and by measuring cervical spine range of motion using a Goniometer as well as Algometer readings over the restricted facet joint/s in the cervical spine. The questionnaires were completed and the range of motion readings and algometer readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were divided into two groups of equal size (15 participants each). Group one received spinal manipulation to restricted cervical spine joint/s. The second group received spinal mobilisation to restricted cervical spine joint/s. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a Goniometer and Algometer in order to assess cervical spine range of motion and to measure the Pressure Pain Threshold at the restricted facet joint/s in the cervical spine. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and cervical spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 and group 2 with v reference to certain cervical spine range of motions as well as algometer readings to measure the Pressure Pain Threshold at the restricted facet joint/s. Conclusion: The results show that both spinal manipulation and mobilization are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing cervical spine range of motion and most importantly Pressure Pain Threshold at the restricted facet joint/s in patients with chronic posterior mechanical cervical spine pain. Although the study did not allow for a definite conclusion to be drawn, the results suggest that Chiropractic manipulative therapy is an effective treatment protocol to increase the Pressure Pain Threshold in chronic posterior mechanical neck pain sufferers. The advantage of this is that the treatment modality is used to its full potential, thereby providing the patient with the best results in terms of lasting benefits. It also shows that in cases where manipulation is contra-indicated mobilization will have a similar effect, but the long term benefits are questionable.

M. Tech. / Abstract Purpose: The purpose of this study was to assess the effects of Diversified Chiropractic adjustments versus Flexion-Distraction Technique in the management and treatment of chronic Lumbar Facet Syndrome. Method: This study consisted of two groups, Group A and Group B, each consisting of 15 participants with chronic Lumbar Facet Syndrome. The participants were between the ages of 20 and 45 years. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Group A received Diversified Chiropractic Adjustments and Group B received Flexion-Distraction Technique to the lumbar facets. Procedure: Each participant was treated eight times over a period of four weeks. Before the commencement of treatment one, four and eight, the participants completed the Oswestry Low Back Pain and Disability Index questionnaire and the Visual Analogue Scale. A Digital Inclinometer was used to measure lumbar spine ranges of motion. Diversified Chiropractic adjustments were then administered to Group A based on the restrictions obtained during motion palpation. Flexion-Distraction Technique was administered to Group B based also on the restrictions that were obtained during motion palpation. Results: Objective statistically significant differences were noted on flexion and left lateral flexion ranges of motion before treatment, and clinically significant differences we noted on flexion and right lateral flexion after treatment, in favour of Group A. Subjective readings also showed statistically significant differences with regards to Oswestry Low Back Pain and Disability Index and Visual Analogue Scale in favour of both Group A and Group B. Conclusion: The results of the study indicate that both Diversified Chiropractic adjustments and Flexion-Distraction Technique have a positive effect on patients suffering from chronic Lumbar Facet Syndrome. However, Diversified Chiropractic adjustments proved to have a greater overall benefit compared to Flexion-Distraction Technique in the management and treatment of Lumbar Facet Syndrome.

M.Tech. (Chiropractic) / Purpose: This study aims to ascertain the extent Chiropractic manipulative therapy increases ROM beyond the joint-separation induced ROM initially experienced via the cavitation phenomenon in the absence of neck pain. Method: Sixty participants between eighteen and thirty-five years of age, thirty male and thirty female whom met the inclusion of no neck pain and perceived decreased ROM were selected for participation. There was a single group with each participant‟s pre-adjustment readings acting as a baseline. Procedure: Participants were assessed for hypomobility and joint dysfunction. Those who met the inclusion criteria underwent a detailed history, physical and cervical spine regional examination on the initial consult. A pre-adjustment objective measurement was acquired using a cervical spine range of motion (CROM) device. Once the consent form was signed participants received Chiropractic cervical spine manipulative therapy to the area/s of the cervical spine found to be restricted on motion palpation by the researcher. Post-adjustment objective measurements were taken at one, twenty, forty and sixty minutes using the CROM device. Participants were required to remain in the researcher‟s examination room for 60 minutes post-adjustment with continuation of regular day to day activity and no strenuous activity during the twenty-four hour period of the study. The participant was required to return for a single follow up visit within a time frame of twenty-four hours of the initial visit. The follow-up visit required no treatment. At twenty-four hours, the participant was objectively measured for cervical spine ROM using the CROM. The results were based on objective data in the form of cervical spine ROM measurements. Results: Clinical analysis of the percentage change in cervical spine ROM values revealed that clinically and statistically significant improvement was seen in all ranges of motion post-adjustment. General consensus showed that a peak value of improved ROM was seen post-adjustment at the one minute interval for all ranges of motion except flexion. Flexion demonstrated a peak ROM value at the twenty minute post-adjustment interval.

M.Tech. (Chiropractic) / This study aimed to compare the immediate effects of a cervical spine adjustment on gait in participants who had asymptomatic cervical spine dysfunction. Method: This study consisted of 1 group of 60 participants between the ages of 18 and 50 years of age. The group was mixed unevenly in terms of gender. The potential participants were examined and accepted according to the inclusion and exclusion criteria. Each participant underwent a pre adjustment gait analysis followed by cervical spine adjustment and then a post adjustment gait analysis. Procedure: Treatment consisted of a single treatment. The objective data was recorded via the Win FDM system pre and post cervical spine adjustment. The measurements were taken this way to give a reliable, dynamic analysis of gait in an easy to read print out. Analysis of collected data was performed by a statistician. The manipulative techniques used were directed towards dysfunction cervical spine joints which were identified via motion palpation. Results: The results of the gait analysis were obtained from the WinFDM analysis and analyzed by STATKON. Objective data was collected from 60 participants of both genders. All participants underwent a pre and post adjustment gait analysis for comparison...

M.Tech. / Purpose: This study aims to compare the effects of spinal manipulative therapy to the lumbar spine and/or pelvis, and spinal manipulative therapy to the lumbar spine and/or pelvis in conjunction with the application of transcutaneous flurbiprofen patches in the treatment of sub-acute/chronic mechanical low back pain with regards to pain, disability and lumbar spine and pelvic range of motion. These effects were based on a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Questionnaire, and on lumbar spine range of motion (ROM) readings taken using a digital inclinometer. The questionnaire was completed and the ROM readings taken prior to treatment on the first, fourth and seventh consultations.

M.Tech. / This study was conducted to investigate the efficacy of Chiropractic cervicothoracic spinal adjustment therapy in the treatment of active Trapezius myofascial trigger point dysfunction. Thirty participants were recruited and placed into one of two groups. Participants were between the ages of 18 and 30 years and selected based on the inclusion criteria being met. Participants had to present with active upper Trapezius trigger points and a restriction of the cervicothoracic junction. The experimental group received a Chiropractic adjustment to the cervicothoracic junction and the control group received detuned ultrasound as their respective treatments. The participants were treated six times over a 3-week period and measurements were taken on the first, fourth and seventh visits. A case history, physical examination and cervical regional examination were conducted at the first visit. Objective measurements included pressure algometry readings of Trapezius trigger points 1 and 2 and cervical spine goniometry readings. Subjective measurements included the Vernon Mior Pain Disability Index and the Numerical Pain Rating Scale. The results were interpreted by Statcon at the University of Johannesburg. The data was analysed using the Mann Whitney test and the Friedman test. According to the tests, the experimental group improved significantly in both the objective and subjective measurements over the seven visits. The control group showed an increase in the objective measurements and a decrease in the subjective measurements over the seven visits. This was found to be statistically insignificant. This study concluded that a Chiropractic adjustment to the cervicothoracic junction is effective in the treatment of upper Trapezius trigger points

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