M.Tech. (Chiropractic) / Introduction The aim of this study is to determine whether standard leg rubs and reassurance combined with lumbosacral manipulations have an effect on growing pain symptoms by comparing it to standard leg rubs and reassurance only. The study can possibly serve as a platform for further research. Furthermore, this will be one of the first chiropractic studies done in this field and may provide the chiropractic profession with a proven treatment for growing pains. Methodology Thirty participants with growing pains between the ages of 4 and 12 years were recruited. The participants were placed into two groups of fifteen participants each on a first come first serve basis. The two groups received different treatment protocols according to their group allocation. Group One received chiropractic manipulative therapy to the lumbar spine and sacroiliac joint restrictions combined with legs rubs and reassurance administered by the parent(s)/guardian(s). Group Two received only legs rubs and reassurance administered by the parent(s)/guardian(s). The participants completed the study over a period of three weeks. Subjective and objective readings were taken. Subjective readings from each participant were taken using the Oucher self-rating pain scale (OSRPS) and a pain diary completed by the parent(s)/guardian(s). Objective readings were taken using a pressure algometer over the anterior tibial muscles bilaterally. A six-week post study follow up was done via email. Results The statistical data was analyzed using the Friedman test, Mann-Whitney test and the Wilcoxon Signed-Rank test. The results demonstrated that both groups responded favourably to their specific treatment over time. However, Group One proved to show a quicker response to treatment over time; and the post study follow up of Group One proved to be significantly more positive than Group Two. These results highlight the positive effects of the chiropractic manipulation. Discussion The fact that the participants of Group One have improved in subjective and objective measurements and the parent(s)/guardian(s) of the participants have responded very positively to the post study follow up, one has to consider that the anatomical theory proposed by Evans and Scutter (2007), the pain referral theory supported by Cookson (2003) and the activation of pain inhibitory systems supported by Wright (1995) and Sterling et al. (2001) might all be a likely aetiologies for growing pains. However, one has to consider that the participants from Group Two, who received no spinal manipulation, have also improved in subjective and objective readings. Therefore it is possible, and cannot be excluded, that the leg rubs administered to both groups could also have played a role in relieving the growing pains. Conclusion The results of the data collected from this study, the pressure algometer and OSRPS readings, showed that spinal manipulation did not have much of a benefit. However, the pain diaries and feedback from the parent(s)/guardian(s), which are probably more reliable for growing pains, indicates that spinal manipulation does show to be beneficial.

M.Tech. / Purpose: Acupuncture has been a controversial issue in the medical world for many years before the sceptic western medicine slowly adopted its idea. Some mechanisms for pain relief were clinically researched and proven to be valid as well as effective in treating tension-type headaches (Stux, Berman and Pomerantz, 2003) The purpose of this study was to assess and compare the effects of cervical spine manipulation and needling of acupuncture points in those patients with tension-type headache and suggest another complimentary treatment to the chiropractic manipulation, especially in those patients where manipulation is contraindicated to manipulation. If found to be effective, various mechanisms have been suggested in the formation of tension headache episodes. Those mechanisms may be alterations within the spinal cord and/or brainstem gating mechanisms as a result of facet joint dysfunction, sensitization of nociceptors in the peripheral structures of the body and psychological factors. Method: This study consisted of two groups, consisting of 16 subjects in each group. All participants were screened for tension-type headaches and accepted based on the inclusion and exclusion criteria. The subjects were between the ages of eighteen and thirty-five. Group 1 received chiropractic manipulation treatment to the most restricted levels in their cervical spine. Group 2 received treatment consisting of needling of acupuncture points to specific predetermined points. Procedure: Each successful candidate was treated six times over a 3 week period which included a total of seven sessions. Before the beginning of the treatment, the successful candidate completed the Vernon-Mior Neck Pain and Disability Index Questionnaire and the Numerical Pain Rating Scale. Readings for cervical spine ranges of motion were then taken with a CROM device. In group 1, chiropractic manipulation was then delivered to the most restricted segments in the cervical spine. In group 2, needling of six predetermined acupuncture points for relieving tension-type headache was performed bilaterally. The same treatment procedure was administered at sessions one through six, the CROM readings and questionnaires were taken in sessions one, three, five and seven. Results: The results were obtained by using the Mann-Whitney U and t-test. No statistically significant differences were identified between the groups, when comparing the 2 treatment methods at the visits. However, both groups showed a statistically significant improvement over time within each group individually for subjective measurements and for right lateral flexion in the objective measurements. Conclusion: The results were inconclusive with regards to the prolonged effects of chiropractic manipulation and needling of acupuncture points on cervical spine range of motion in patients with tension-type headache. However, it was concluded that both methods of treatment had beneficial effects on how the participants perceived their pain and disability. Due to the small group of subjects and relatively short duration of the study, accurate conclusions could not be formulated. The findings obtained were insignificant and further research needs to be performed on the effects of cervical spine manipulation and needling of acupuncture points on those suffering with tension-type headache.

M.Tech. (Chiropractic) / Aim: The aim of this study was to determine if a chiropractic adjustment had an effect on muscle strength. The study then aimed to compare the effects a resistance training protocol, to a chiropractic adjustment, to a combination of these two treatments on the neck strength of individuals with cervical facet syndrome. Method: This study consisted of three groups of 10 participants each. The participants were grouped by stratified sampling to balance the groups in terms of age and gender. The participants ranged in age from 22 to 28 years. There were 18 male and 12 female participants. Participants were examined and accepted into the trail according to inclusion and exclusion criteria. Treatment was allocated according to groupings. Group 1 received a resistance training protocol, group 2 received chiropractic adjustment only and group 3 received a combination of both treatments. Procedure: Treatment consisted of 6 treatment sessions and a 7th follow up session, over a three week period. Participants in group 1 and 3 were instructed to perform the demonstrated resistance training protocol 3 times a week for 3 weeks. Participants in group 2 and 3 received chiropractic adjustments to hypomobile cervical spine segments, twice a week for three weeks. Cervical range of motion (CROM) was mesured using a CROM device and strength readings were measured using a hand held isometric dynamometer. Measurements were recorded on the 1st, 4th and 7th visits. All participants were required to fill in a Vernon-Mior Neck Disability Index (NDI) on the 1st and 7th visits. The data collected was analysed by a statistician. Results: Analysis of the Vernon-Mior NDI intra-group results showed that all three groups were effective in reducing cervical pain and disability. There was no statistical difference in improvement between the groups. CROM results indicated that all three groups successfully increased cervical range of motion. The combination group had the greatestimprovement, followed by the adjustment group and lastly the resistance training group. The combination group showed statistical improvements in all ranges of motion at visit 4 while this was only achieved by the resistance training group at visit 7. In the adjustment group statistical changes in flexion, extension and lateral flexion were only noted at visit 7, however in rotation, statistical improvements were noted at visit 4. Isometric dynamometer analysis showed that all 3 groups did show a statistically significant increase in cervical muscle strength. The combination group provided the greatest gains, followed by the adjustment group. The smallest gains were seen in the resistance training group. Statistical changes in the resistance training group were only measured at visit 7, while in the combination and adjustment group, these changes were noted by visit 4. Conclusion: Chiropractic adjustment was effective in increasing neck strength. Of the 3 groups, the combination treatment proved to be the most effective method of improving neck strength in individuals with cervical facet syndrome. Of the two individual treatments, chiropractic adjustment was more effective in terms of both strength gains and time taken to achieve these results, than the resistance training protocol.

M.Tech. / Purpose: Posterior mechanical neck pain is considered a debilitating musculoskeletal problem and is one of the most common reasons for visiting an emergency sector (Murphy, 2000). This study aims to compare the effects of Chiropractic manipulative therapy directed at the thoracic spine to that directed at the cervical spine for the treatment of chronic neck pain with regards to pain, disability and cervical range of motion. Method: This study was a comparative study and consisted of two groups of fifteen. The participants were between the ages of eighteen and forty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each participant was determined by group allocation. Group 1 received chiropractic spinal manipulative therapy to restriction(s) of the upper thoracic region only. Group 2 received chiropractic spinal manipulative therapy to restriction(s) of the cervical spine only. Objective and subjective findings were based on the above treatment protocols. Procedure: Treatment consisted of six treatment consultations with an additional follow up consultation over a three week period, with two consultations being performed per week interval. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index as well as from the Numerical Pain Rating Scale (NPRS). Objective readings were taken from measurements taken from the Cervical Range of Motion device (CROM). Analysis of collected data was 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 gathering only. Results: Clinically significant improvements in both Group 1 and Group 2 were seen over the course of the study with regards to cervical spine range of motion, pain and disability. However group 1 showed greater statistically significant improvements in their mean cervical range of motion whereas group 2 showed a greater statistically significant improvement in their subjective readings of pain and disability.

M.Tech. (Chiropractic) / Introduction: Neck pain is a common condition which affects up to 70 percent of people at some point in their lives, and at any given time about 10 to 20 percent of the population reports neck problems. Although spinal manipulation on its own is effective in the treatment of chronic neck pain, chiropractors continue to search adjunctive modalities to improve the positive outcomes of their treatment. Therefore, it is important to look for the best possible treatment protocol as well as research alternatives, should contraindications for present protocols, such as spinal manipulation, arise. One such alternative could be Kinesio® taping. The purpose of this study was to determine the efficacy of utilising Kinesio® taping, spinal manipulation or the two therapies combined, for the treatment of chronic neck pain. It will also provide further evidence on the efficacy of spinal manipulation and Kinesio® taping in isolation. Method: This study was a comparative study consisting of three groups of ten participants. The method of treatment was determined by random group allocation. Group 1 received spinal manipulation to restriction(s) of the cervical spine only. Group 2 received Kinesio® taping to the longissimus cervicis muscles only. Group 3 received a combination of spinal manipulation and Kinesio® taping as previously described. Subjective measurements consisted of the Vernon-Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (NPRS) and objective measurements was assessed in degrees by making use of the Cervical-range-of-motion (CROM) instrument. Procedure: There were seven consultations in total. There were six treatment consultations over three weeks. The seventh consultation consisted of data collection only. Subjective and objective measurements were taken prior to treatment on the first and fourth consultation, and on the seventh consultation where no treatment took place. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index and the NPRS. Objective readings were assessed in degrees by making use of the Cervical-range-of-motion (CROM) instrument. Results: It was evident from the data that all three groups responded well to their respective treatment protocols. With regards to the subjective measurements Group 1, 2 and 3 demonstrated statistically significant improvement in both neck pain severity and functional disability. As Group 1 had the highest clinical improvement with regards to the NPRS, it indicates that the Group 1 treatment protocol was more effective in decreasing the pain intensity throughout the treatment period. All three groups responded similarly with regards to the Vernon-Mior Neck Pain and Disability Index, although Group 1 responded the best clinically. With regards to the objective measurements Group 1, 2 and 3 demonstrated statistically significant improvement in all ranges of motion of the cervical spine. However, it was found that Group 3 clinically responded best to treatments in all the ranges of motion except for right lateral flexion in which Group 2 responded best to treatment. Conclusion: The study showed that the treatment protocols for Group 1, 2 and 3 were effective in treating chronic neck pain. The evidence suggests that the Group 1 treatment protocol, which received spinal manipulation, is more effective than Kinesio® taping alone and the two therapies combined in decreasing pain intensity and functional disability in the treatment of chronic neck pain. The evidence further suggests that the Group 3 treatment protocol, which received spinal manipulation in combination with Kinesio® taping, is more effective than spinal manipulation and Kinesio® taping alone in increasing all cervical spine ranges of motion in the treatment of chronic neck pain.

M.Tech. / Purpose: Heachaches are a very common complaint among society today, and as a result there are a vast number of individuals seeking medical treatment specifically for headaches (Alix and Bates, 1999). The impact that headaches have on a patients quality of life far exceeds that of other conditions such as osteoarthritis and hypertension. Primary headaches such as Cervicogenic, Cluster and Tension-type headaches have no specific underlying cause. However, it has been shown that spinal manipulative therapy (SMT) can be used as an effective tool in the treatment of these primary headaches (Brontford, Assendelft, Evans, Haas, and Bouter, 2001; Khoury, 2000 and Vernon, 1995). A Cervicogenic Headache is defined by the North American Cervicogenic Society (NACHS) as referred pain perceived in any region of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by cervical nerves. The aim of this study was to determine the efficacy of upper cervical spine manipulation in conjunction with Interferential current and Ultrasound therapy, compared to upper cervical spine manipulations alone as a treatment protocol for Cervicogenic headaches. Method: This study consisted of two groups; both Group 1 and Group 2 consisted of 15 participants with Cervicogenic headaches. The participants were between the ages of 18 and 55 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Group 2 received a combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Objective and subjective findings were based on the treatments. Procedure: The participants received six treatments in total over a three week period that is two treatments a week for three weeks followed by a seventh consultation visit where only subjective and objective measurements was taken. The participants completed a Numerical Pain Rating Scale and Headache Disability Index Questionnaire. Algometer readings were taken over the most sensitive trigger point in the Posterior Cervical muscles. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine and Group 2 received a ten minute combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine. The same treatment procedures were administered over the study; subjective and objective readings were only taken at visits 1, 4 and 7. Results: In terms of objective measurements based on the pressure Algometer readings, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in muscle sensitivity between the two groups over time was revealed. However, Group 1 showed a larger overall clinically significant difference in Posterior Cervical muscle sensitivity. In terms of subjective measurements based on the Headache Disability Index Questionnaire scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in terms of intensity, duration and frequency of the headaches between the groups over time was revealed. However, Group 1 had a greater clinical reduction in intensity, duration and frequency of headaches when compared to Group 2. In terms of subjective measurements based on the Numerical Pain Rating Scale scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. A statistically significant difference in terms of intensity of the headaches between the groups over time was revealed. The overall clinical improvement was similar for both groups however Group 1 had a slightly greater clinical reduction in headache intensity when compared to Group 1. Conclusion: Both groups showed an overall improvement in the headache symptoms as well as Posterior Cervical muscle sensitivity; however Group 1 showed a greater clinical improvement when compared to Group 2.

M.Tech. (Chiropractic) / PURPOSE: Shoulder pain has been identified to be one of the most common musculoskeletal problems found in a variety of different countries, showing characteristics of chronicity and recurrence. It is considered to be a main contributor towards nontraumatic upper limb pain. One of the identifiable causes of chronic or reoccuring shoulder pain may be attributed to myofascial pain syndrome which is caused by MTrP’s and produces symptoms that are similar to that of other shoulder pain syndromes. The infraspinatus muscle as an integral component of the rotator cuff complex is subject to high tension biomechanical strain as well as neuromuscular tension. While therapeutic interventions have been devised to treat varying degrees of biomechanical and neuomuscular tension, little evidence exists establishing which of these treatment regimes is most effective in treating myofascial trigger points. The purpose of this study was to compare different regional chiropractic adjustments relative to the attachment site and the innervation segment of the infraspinatus muscle and to identify the most effective treatment protocol with regard to chronic, active infraspinatus myofascial trigger point dysfunction. DESIGN: A selection of thirty participants were recruited for this study. The participants were divided into two groups of fifteen participants each. Group A received a chiropractic adjustment to the glenohumeral joint, the attachment site for infraspinatus muscle. Group B received a chiropractic adjustment to the cervical spine segments associated with the innervation to the infraspinatus muscle. Cervical spine restrictions specific to levels C4/C5 and/or C5/C6, and glenohumeral joint restrictions were determined using motion palpation techniques. All participants received a total of six treatments over a three-four week period. MEASUREMENTS: Subjective measurements were obtained by the Functional Rating Index Questionnaire and the Numerical Pain Rating Scale. Objective measurements were obtained using the hand-held pressure algometer and counting the number of active infrapsinatus myofascial trigger points. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the Functional Rating Index Questionnaire for the intragroup analysis indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (15.5%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (68.8%). The intergroup analysis indicated that there were no statistically significant differences. vii With regard to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (21.7%). There were no statistically significant differences with the intergroup analysis. The intragroup and intergroup analysis of the number of active infraspinatus myofascial trigger point dysfunction showed no statistically significant differences between the groups or within each of the groups over time. CONCLUSION: The results showed that both treatment groups protocols were effective in reducing chronic, active infraspinatus myofascial trigger point dysfunction. Small differences were noted between the two treatment groups with regards to the subjective and objective findings. The glenohumeral joint adjustment group showed the greatest clinical and statistical improvements over the three-four week trial period.

M.Tech. / This study was conducted to determine whether Chiropractic Spinal Adjustment Therapy (SAT) of the upper cervical spine has an effect on the normal physiological reactions that take place in the Autonomic Nervous System and Cardiovascular System whilst using the Electrocardiogram as a monitoring device. This area within Chiropractic research calls for further studies to be conducted. One hundred and twenty normotensive participants between the ages of 18 and 30 years were recruited to partake in the study via an advertisement placed in and around the University of Johannesburg Doornfontein Campus (Appendix A). Participants were assessed for exclusion criteria by completing a Full Case History (Appendix B), Pertinent Physical Examination (Appendix C), Cervical Spine Regional Examination (Appendix D) and a S.O.A.P. note (Appendix E). Participants were excluded from the study if it was revealed that they have contra-indications to Chiropractic SAT (Appendix F). The participants demonstrating upper cervical spine dysfunction were treated with a Chiropractic upper cervical SAT (Appendix J) while they were monitored for 3 minutes before, during treatment and 3 minutes after treatment by means of the Electrocardiogram to monitor the cardiovascular response. Participants were asked to read and sign the Subject Information and Consent form (Appendix G). Participants were required to complete the Patient Biographical Information Sheet (Appendix H) and the Patient Questionnaire regarding treatment experience (Appendix I)

M.Tech. / Purpose: To determine the effect of Chiropractic spinal adjustive therapy (SAT) of the lumbar spine and Sacroiliac joints on performance utilising indicators such as vertical jump height and T-test time of moderate to highly active sport participants. It has been suggested that a dysfunctional vertebral subluxation complex can cause a decrease in performance. The decreased performance may be due to dysfunctional biomechanics and altered neurological functioning of the lumbar spine and Sacroiliac joints. Methods: A randomised study design with thirty asymptomatic male subjects, which were moderate to highly active as indicated by the International Physical Activity Questionnaire (IPAQ), participated in this study. Participants were divided into two equal groups, group A (n=15) received Chiropractic SAT of the lumbar spine and Sacroiliac joints, group B (n=15) were rested for five minutes. The study design consisted of six consultations, with intervention being applied at each consultation between objective measurements. Objective data was obtained by the vertical jump test and T-test which determined participant’s explosive power and agility respectively. Objective data was obtained before and after intervention on each of the six consultations. The immediate effect of intervention was represented by the before versus the after measurements of consultations. The short term effect was represented by comparing the before values of consultation one (baseline) to consultation six. Results: The objective results showed that there was a short term and immediate improvement in vertical jump height and T-test time of both groups. With vertical jump height group A showed an immediate mean improvement of 3.845 cm (7%) and a short term mean improvement of 0.74 cm (1%); group B showed an immediate mean improvement of 1.6 cm (3%) and a short term mean improvement of 1.47 cm (3%). With the T-test time group A showed an immediate mean improvement of 0.433 s (4%) and a short term mean improvement v of 0.673 (6%); group B showed a immediate mean improvement of 0.1745 s (2%) and a short term mean improvement of 0.6 s (5%). Conclusion: Although results obtained were not statistically significant (p>0.05), it demonstrated from a clinical perspective that interventions caused an improvement in jump height and T-test time in both groups. Group A showed a greater improvement in every aspect, except in the short term effect of Chiropractic SAT on vertical jump height. It is therefore postulated that improvements noted were as a result of the adjustment providing an enhanced biomechanical and neurological advantage, and therefore in performance indicators such as the vertical jump test and T-test in the participants.

M.Tech. (Chiropractic) / Purpose: This study aims to compare the effects of spinal manipulation versus mobilization of the lumbar spine and sacroiliac (SI) joints on the contractile strength of the hamstring muscle group with regards to strength and flexibility. Method: This study consisted of 2 groups of 15 participants between the ages of 18 and 50 years of age. Males and females were first separated to ensure equal male to female ratios within each group. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each group was determined by group allocation. Group 1 received spinal manipulation directed towards restrictions located within the lumbar spine and/or SI joints. Group 2 received spinal mobilization directed towards restrictions located within the lumbar spine and/or SI joints. Procedure: Treatment consisted of 4 treatment sessions with an additional follow up visit over a 2 week period. Objective data was recorded on visit 1 before and after treatment, visit 3 before and after treatment and on visit 5 in which there was no treatment administered, its purpose was purely to obtain measurements. The measurements were taken in this way in order to determine immediate as well as medium term changes. Objective data consisted of hamstring muscle strength readings taken using a handheld dynamometer and hamstring muscle flexibility readings taken using a digital inclinometer. Analysis of collected data was performed by a statistician. The manipulation and mobilization techniques used were directed towards dysfunctional joints within the lumbar spine and/or SI regions, which were detected by motion palpation. Results: Regarding muscle strength, statistically significant results were noted in Group 1 at visits 1 and 3 on both the right and left sides when determining the immediate effects of the treatment. Medium term changes were seen during the time interval between visits 1 and 3, as well as between visits 1 and 5 bilaterally. When determining the immediate effects of the treatment, Group 2 did not demonstrate muscle strength changes at visit 1 on the right, however statistically significant results were found at visit 3 on the right as well as at visits 1 and 3 on the left. Medium term changes were seen during the time interval between visits 1 and 3, as well as between visits 1 and 5 bilaterally. Manipulation and mobilization were shown to have a statistically significant effect on hamstring muscle strength, although manipulation was shown to have a more beneficial effect on muscle strength both immediately and over time, though this was only found on the left. Regarding muscle flexibility, statistically significant results were noted in Group 1 on both right and left sides at visits 1 and 3 when determining the immediate effects of the treatment. Statistically significant changes only occurred on the left between visits 1 and 5 when determining the medium term effects of the treatment. Group 2 showed statistically significant changes at visit 3 on the right as well as at visits 1 and 3 on the left when determining the immediate effects of the treatment. When determining the medium term effects of the treatment no statistically significant changes were found over the duration of the study. There was no difference found between the groups in terms of the effect that the treatment had on hamstring muscle flexibility, although isolated improvements occurred over time in the manipulation group. Conclusion: The results show that both manipulation and mobilization have a statistically significant effect on hamstring muscle strength. However, manipulation was shown to have a more significant effect. Changes in hamstring muscle flexibility were found to occur immediately and over time in the manipulation group, however only immediate effects were noted in the mobilization group. Therefore, when compared to mobilization, manipulation appears to have a greater effect on hamstring muscle strength and flexibility.