Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Through the literature review it has become apparent that low back pain is a very real problem in most societies. It has been suggested that there is enough evidence to prove the relationship between low back pain and local muscle dysfunction and that focus in management of these patients should be the rehabilitation of these muscles by exercise. Literature suggests that optimal core muscle strength, control and endurance working synergistically with the rest of the neuromusculoskeletal system is necessary for lumbar spine stability . Arthrogenic Muscle Inhibition is caused by distension and/or damage of a joint and is thought to disable the muscle from contracting all its muscle fibres. When a joint is injured it is thought that AMI causes muscle weakness, which in turn hampers the rehabilitation process of that joint despite complete muscle integrity. Spinal manipulative therapy has been shown to alter the excitability of spinal muscle motor neurons due to the stimulation of mechanoreceptors in the joint capsules suggesting that SMT could be a means to remove this inhibitory action. The literature supports the hypothesis that a decrease in the neurological deficit caused by AMI may result in a faster recovery rate. Aims The aim of this study is to determine the immediate effect of thoraco-lumbar spinal manipulation compared to lower lumbar spinal manipulation on core muscle endurance and activity in patients with mechanical low back pain by assessing the correlation between the objective and subjective measures. Method A prospective, convenience sample with purpose allocation (pre /post) clinical trial was used as the sampling method. Thirty participants where placed in two groups, group one and group two, of fifteen people each. Group one underwent spinal v manipulative therapy between L4 and S1 spinal levels. Group two underwent spinal manipulative therapy in between T8 and L1 spinal levels. The objective and subjective testing was done pre- and post-intervention. The objective data was that of a surface EMG attached bilaterally over the internal oblique as well as a prone abdominal draw in biofeedback test. The subjective data included a pain numerical rating scale (0-100). Results The results showed to partially favour group two (thoraco-lumbar), in both increased endurance time that would prove that AMI does in fact inhibit the transversus abdominis and obliques internus, thus it would hinder the rehabilitative process. Some of the statistics where not in favour of the aims, as there was no difference in the effect of group one or two on the NRS, as both improved consistently. It would be recommended that use be made of fine-wire EMG for testing the activity in both the obliques internus and the transversus abdominis, which would allow for more consistent readings, thus adding strength to the research.

Thesis (M.Ost.)--Unitec New Zealand, 2008. / Includes bibliographical references (leaves 75-83).

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Practitioners are required to practice evidence-based medicine. The availability of large volumes of information make this practice style difficult for the practitioner. However, a systematic review allows literature to be organised, rated and allows current, abbreviated research resources for practitioner in clinical practice. Objectives: The effectiveness of the Gonstead Chiropractic Technique (GCT) was evaluated to present current evidence available for various conditions for which the GCT is utilised in clinical practice. Thus, the aim of the study was to systematically review, collate and evaluate the research evidence in the literature to determine the effectiveness of the GCT. Method: A literature search was conducted, based on key terms including: Gonstead and manual, Gonstead and technique, and Gonstead and manipulative/manipulation. Databases searched were: CINAHL Plus, Google Scholar, MEDLINE, Metalib, Pubmed, Science Direct, Springerlink and Summons. The articles were screened according to inclusion and exclusion criteria, after which secondary hand and reference searches were done. Thereafter the articles were reviewed by six independent reviewers. Appropriate scales were used to rate the methodological rigour of each article (e.g. PEDro). The results were analysed and ranked, before these outcomes were classified and contextualised in the clinical conditions on which the included studies were based. Results: A total of 477 citations were identified; after screening 26 English articles remained. Two articles were added through the secondary hand-search. Limited to no evidence existed for the effectiveness of GCT for neck pain / headache / face pain and limited evidence existed for gynaecological issues, scoliosis, neurological disorders, fractures, blood pressure and physiological presentations. Consensus was evident for gynaecological issues, neurological disorders, fractures (with the exception of the undiagnosed fracture) and physiological presentations, whereas the neck pain / headache / face pain and scoliosis were conflicting. Conclusion: Limited evidence shows a need for future studies with stringent methodological rigour, so as to investigate the appropriateness / inappropriateness of the use of the GCT. The lack of evidence for GCT may compromise appropriate informed consent and treatment. Therefore practitioners are encouraged to use appropriate and validated tools to measure the patient’s clinical progress

M.Tech. (Chiropractic) / Aim of this study was to compare which treatment either Proprioceptive Neuromuscular Facilitation or chiropractic manipulation, whether by itself or in combination, was more effective and beneficial in the treatment of mechanical neck pain. The effectiveness was measured by the use of a Visual Analogue Scale, Vernon- Mior Neck Pain and Disability Index questionnaire and the measurement of cervical spine range of motion using an analogous cervical spine range of motion inclinometer (CROM). The questionnaire and the measurements were taken prior to the treatments at the first, fourth and seventh consultations.Thirty participants who met the inclusion criteria were randomly placed into three groups of equal size (10 participants each). Group one received a Proprioceptive Neuromuscular Facilitation (PNF) stretching protocol to the cervical spine. Group two received a chiropractic manipulation to the cervical spine. Group three received a combination treatment, first receiving chiropractic manipulation and then a PNF stretching protocol to the cervical spine. Participants were treated six times out of a total of seven sessions, over a maximum of a three week period.Subjective data was collected at the beginning of the first, fourth and seventh consultations. This was done by means of a Visual Analogue Scale and a Vernon-Mior Neck Pain and Disability Index Questionnaire, in order to assess pain and disability levels. Objective data was collected by means of measuring cervical spine range of motion using a cervical range of motion (CROM) inclinometer. Analysis of collected data was performed by a statistician from STATKON, a department of the University of Johannesburg.Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with reference to pain and disability. Statistically significant changes were seen in all three groups with reference to pain and disability. Group 3 was shown to improve the most with regard to pain and disability. Group 1 had statistically significant improvement with regard to cervical range of motion in the ranges of left and right rotation. Group 2 experienced a decrease range of cervical motion with regard to extension. As the study consisted of a small group of participants further, more extensive studies are needed...

M.Tech. / OBJECTIVE: The aim of this study was to determine the extent of the benefit of combining psychological intervention, in the form of guided imagery, with spinal manipulative therapy, in the treatment of mechanical chronic lower back pain. The guided imagery functioned to address the psychosocial factors playing a role in the experience, maintenance and exacerbation of chronic pain (Turk, Swanson & Tunks, 2008), while the chiropractic spinal manipulative therapy functioned to address the dysfunctional biomechanics which cause the biological and neurological aspects of the chronic pain. DESIGN AND METHODOLOGY: 30 subjects between the ages of 18 and 40, presenting to the University of Johannesburg Chiropractic day clinic with chronic lower back pain, participated in the trail. They were randomly divided into 2 groups, which both underwent 6 treatments. During the initial consultation, both groups had their lumbar range of motion measured with the digital inclinometer, and were asked to complete the Oswestry Pain and Disability Index (Appendix G), Numerical Pain Rating Scale (Appendix H), and Perceived Stress Scale (Appendix I). This was followed for group A by spinal manipulative therapy to the restricted segments. Group B was treated with spinal manipulative therapy and a guided imagery session, performed by a registered psychologist. The participants were instructed on how to perform the guided imagery on their own, and were asked to perform it at home 3 times per week for the duration of the treatment. During the 2nd consultation, both groups received spinal manipulative therapy, and their progress was noted throughout on a SOAP note. During the 3rd consultation, both groups again had their lumbar range of motion measured, and were asked to complete the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. Treatment followed as per the initial consultation for both groups. During the 4th and 5th consultations, both groups received spinal manipulative therapy. During the final consultation, both groups were again treated with spinal manipulative therapy, followed by lumbar range of motion measurements, and final completion of the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. RESULTS: There was a statistically significant improvement in overall lumbar range of motion for both groups throughout all degrees of freedom respectively. It is interesting to note that both in extension as well as rotation the inter-group measurements were statistically significantly different at treatment outset, but due to greater improvement in group B over group A, became statistically comparable on completion of the trials. There was also a significant overall improvement and decrease in subjective symptoms of perceived pain, disability and stress for both groups, and the Numerical Pain Rating Scale also demonstrated a statistically significant improvement in results, due to greater improvement of group B over group A. CONCLUSION: The subjective and objective results between participants of the same group, demonstrated that both spinal manipulative therapy alone, as well as spinal manipulative therapy in conjunction with guided imagery was effective in treating chronic mechanical lower back pain. When comparing results between the two groups, the combined protocol group showed statistically significant improvement above the purely chiropractic group in 3 out of 6 objective measures, and 1 out of 3 subjective measures. There is thus limited evidence as to the advantage of combining guided imagery with the chiropractic treatment protocol of chronic mechanical lower back pain, however unfortunately not sufficient evidence to draw a definitive conclusion.

M.Tech. / Purpose: This study aims to determine whether adjusting the area of nerve root supply, or adjusting the attachment site of the latissimus dorsi muscle, will have an effect on the latissimus dorsi muscle and to which extend, with regards to strength and electromyographic (sEMG) activity. These effects were evaluated by measuring the latissimus dorsi .muscle strength using a Jamar dynamometer as well as sEMG readings of the latissimus dorsi muscle using a Neuro Trac ETS unit. Readings were taken prior to treatment on the first, third, and fifth consultations. Method: Forty five participants who met the inclusion criteria were stratified in number and gender between three groups of equal size (15 participants each). Group 1 received lower cervical adjustments (C5 - C7), group 2 received lower thoracic and lumbar adjustments (T6 - L5) and group 3 received detuned ultrasound therapy on the latissimus dorsi muscle. Group three served as the control group. Participants were treated four times out of a total of five sessions, over a maximum three week period Procedure: Objective data was collected at the beginning of the first and third session, as well as on the fifth consultation by means of a Jamar dynamometer and a Neuro Trac ETS unit in order to assess the functionality of the latissimus dorsi muscle. Analysis of collected data was performed by a statistician. Results: Statistically significant improvement in the dynamometry readings of both the experimental groups were noted when compared to that of the control group. The results of the sEMG activity were variable. Conclusion: The results show that adjusting the area of nerve root supply as well as adjusting the attachment site of the latissimus dorsi muscle are effective treatment protocols (as demonstrated statistically) in increasing strength of the latissimus dorsi muscle. The results suggest that adjusting the attachment site of the latissimus dorsi muscle is most effective in increasing the strength of the latissimus dorsi muscle. The results of the sEMG activity were variable and there were no evidence supporting the effectiveness of adjusting the area of nerve root supply versus adjusting the attachment site ofthe latissimus dorsi muscle on sEMG activity.

M.Tech. / Purpose: This study aims to compare the effects of lumbar spine and/or pelvic manipulation, and lumbar spine and/or pelvic manipulation in conjunction with the application of subcutaneous parenteral Traumeel® in the treatment of chronic mechanical low back pain with regards to pain, disability and lumbar spine range of motion. These effects were evaluated using a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Questionnaire, and by measuring lumbar spine range of motion using a digital inclinometer. The questionnaire was completed and the range of motion readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were stratified in number and gender between two groups of equal size (15 participants each). Group one received spinal manipulation to restricted lumbar spine and/or sacroiliac joints followed by the administration of subcutaneous parenteral Traumeel®. The second group received spinal manipulation to restricted lumbar spine and/or sacroiliac joints. 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 Numerical Pain Rating Scale (NPRS) and an Oswestry Low Back Pain 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 digital inclinometer in order to assess lumbar spine range of motion. 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 lumbar 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 with reference to lumbar spine range of motion. vi Conclusion: The results show that both spinal manipulation, as well as spinal manipulation in conjunction with subcutaneous parenteral Traumeel® are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing lumbar spine range of motion in patients with mechanical low back pain. However, neither treatment protocol proved to be preferential. The results carry a possible suggestion that chiropractic manipulation (common to both groups) is effective in ameliorating participant-rated pain and disability, and increasing lumbar spine range of motion in the case of chronic mechanical low back pain.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology in Chiropractic at Technikon Natal, 2002. / The purpose of this study, was to investigate and determine what role the treatment of nocturnal bruxism, in conjunction with spinal manipulative therapy, would play in the management of tension-type headaches. / M

Submitted in partial compliance with the requirements for the Master’s degree in technology in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2017. / Background: According to Picavet and Schouten (2003) the incidence of neck pain is increasing at a greater rate than other spine problems (Hoving et al. 2004). Furthermore, chronic neck pain is a substantial burden to society with chronic neck pain being the fourth leading cause of disability worldwide (Hoy et al. 2014). Chronic mechanical neck pain (CMNP) has been defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). Treatments for those suffering with chronic pain, which are non-surgical, appear to be the most beneficial for patients according to Haldeman et al. (2008). Giles and Müller (1999) have stated that spinal manipulation is the most effective method of treating spinal pain on its own. However, the literature suggests that there is benefit in combining manipulation with an “anti-inflammatory type” drug (Crawford 1988; Oberbaum 1998; Serrentino 2003). Many studies have been successfully conducted on Homoeopathic complexes to treat neck pain (Fisher 1986; Bohmer and Ambrus 1992; Hepburn 2000; Soeken 2004) however no study has yet to been carried out on the combination of Homoeopathic Simillimum (single remedy) and spinal manipulation for CMNP. Objective: The aim of this study was to determine if spinal manipulation and Homoeopathic Simillimum in combination are more relatively effective than spinal manipulation alone in the treatment of chronic mechanical neck pain. Methodology: This study was a randomised, blinded placebo controlled quantitative trial with a comparative clinical trial design. Thirty consenting participants with CMNP who met the inclusion criteria were randomly distributed between two treatment groups. Group A received spinal manipulation as well as Homoeopathic Simillimum and group B received spinal manipulation with placebo medication. Each participant received three treatments over a period of a week; with subjective and objective readings taken at every consultation. The subjective tools included the Numerical Pain Rating Scale and Canadian Memorial College of Chiropractic Neck Disability Index. Objective tools included the Algometer and CROM-II Goniometer. All data captured was analysed using SPSS version 24.0. Inferential and non-parametric analysis of the data were also be performed. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of ANOVA subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that no statistical or clinically significant changes were noticed between the groups and therefore the Homoeopathic Simillimum added no statistical significant improvements in those who received it over those participants who received placebo in the treatment of chronic mechanical neck pain. / M

M.Tech. (Chiropractic) / Purpose: The trapezius muscle is thought to be the muscle most commonly associated with the presence of active myofascial trigger points (MFTP’s). Studies of the trapezius muscle clearly show that muscular activity significantly increases in response to psychological stress. Cervical spine manipulation has been proven to be highly effective in the treatment of active MFTP’s and muscular tension. Progressive muscle relaxation (PMR) therapy is frequently utilized as a relaxation technique in subjects complaining of increased levels of muscular tension, possibly due to an increased perception of psychological stress. Although cervical spine manipulation alone is effective in the treatment of active MFTP’s and muscular tension, chiropractors often search for adjunctive therapies to improve current treatment protocols. The purpose of this study was to determine whether the combination of cervical spine manipulation and PMR therapy is a more efficient, and possibly effective, treatment protocol for active MFTP’s of the trapezius muscle. Method: This study was a comparative study and consisted of two groups of fifteen participants each. All participants were between the ages of eighteen and thirty-five years of age, with a male to female ratio of 1:1. Potential participants were examined and accepted according to the inclusion and exclusion criteria. Group A received chiropractic spinal manipulative therapy of the cervical spine. Group B was the combination group and therefore received chiropractic spinal manipulative therapy of the cervical spine together with the application of PMR therapy. Subjective measurements consisted of a Perceived Stress Scale (PSS) Questionnaire, Visual Analog Pain Scale (VAS) and the Vernon-Mior Neck Pain and Disability Index Questionnaire. Objective measurements consisted of pressure pain threshold algometry readings taken from active trigger points one (TP1) and/or trigger point two (TP2) on the right and/or left side of the upper trapezius muscle.