Submitted in partial compliance with the requirements for Master’s degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Functional dyspepsia is a chronic pain/discomfort centred in the upper abdomen in the absence of any known structural cause. Epidemiological studies have shown that functional dyspepsia is a common complaint affecting all population groups that over time places considerable financial strain on public and private resources due to frequent doctors’ visits and expensive diagnostic procedures. The development of non-surgical and non-pharmaceutical treatments of functional dyspepsia would not only make economic sense but would also provide a means to improve patients’ quality of life in the least invasive way possible. Although not traditionally seen to be within the chiropractic scope of practice, anecdotal evidence suggests that chiropractic care and management may have the ability to alleviate visceral symptomatology. Objectives The purpose of this placebo controlled pilot study was to evaluate the preliminary effects of chiropractic manipulation versus inactive laser in the treatment of adult patients suffering from functional dyspepsia. Due to the small sample size, time and budgetary constraints it was hypothesised that the dyspepsia symptoms of participants treated with active chiropractic manipulation would not respond more favourably to the treatment, nor would these patients experience a greater improvement in terms of quality of life, compared to those participants receiving placebo treatment. Method Thirty participants with pre-diagnosed functional dyspepsia were selected after being screened according to the inclusion and exclusion criteria identified by the researcher. These participants were then divided into two groups using consecutive sampling. Data was collected at the Chiropractic Day Clinic at the Durban University of Technology. Group A received an active chiropractic manipulation using diversified technique to pre-identified levels in the cervical, thoracic and lumbar spine. Group B received inactive laser to pre-identified levels in the cervical, thoracic and lumbar spine. Both groups received one treatment a week for three weeks. The fourth and final consultation consisted only of data capturing. At each visit both groups of participants filled in three validated questionnaires: The numerical pain rating scale; PAGI-SYM physical symptom assessment; Results Results were statistically analysed using IBM SPSS version 20 and a p value ≤ 0.05 was considered to be statistically significant. Repeated measures ANOVA testing was used to assess the effect of each of the treatments separately and to assess the comparative effects of the spinal manipulation vs the placebo. Conclusion and Recommendations The gathered results and analysis were statistically insignificant. Clinical improvement in their symptomotology was however noted within both groups over the trial period in terms of treatment received and their perceived quality of life, symptomatology and pain levels. Both groups tended to have reduced pain and discomfort over time, improved: emotional distress, sleep disturbance, food problems, vitality, post-prandial fullness and abdominal pain. This study should be repeated with selected outcome measurements, and perhaps objective outcome measurements, and a larger sample size in order to determine any benefit.

Dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, submitted to the Faculty of Health at the Durban University of Technology, 2009. / Although kayaking is an Olympic sport and said to be one of the top ten growth sports in America, relatively little literature has been written on it by sports scientists and there is a paucity of available literature. Previous research has described the effects of spinal manipulation on muscles at distant sites to the joint being manipulated, and there have been trends which have shown a positive increase in strength and in muscle activity at these sites. There has, however, been a lack of literature to show that these positive trends would influence sporting performance in any way. 30 volunteer kayakers, who train and compete on a regular basis, were actively recruited and randomly allocated into one of three groups. Group 1 received manipulation on a fixated cervical segment, group 2 on a non-fixated cervical spine segment, and group 3 received placebo laser to the posterior cervical area. Subjects were then required to complete two 200m sprint tests on a kayak ergometer. Measurements were taken pre and post manipulation and included maximum watts recorded for the duration of the sprint test and time taken to complete 200m. Although no statistically significant results were found between the groups, trends revealed that in group 1, which received spinal manipulation on a fixated joint, there was an increase in the mean peak watts post manipulation, as compared to the placebo and non-fixated groups which showed a decrease in peak watts post manipulation. Group 1 also demonstrated a mean decrease in time taken to complete the second 200m sprint test. Group 2 and 3 again showed an increase in time taken to complete the second sprint test post manipulation. iv It is, therefore, concluded that manipulation of a fixated cervical joint in asymptomatic kayakers results in an increase in performance, although it must be noted that these were only trends and that there was no statistical significance in these results. This research has, furthermore, opened the door to future studies which may test the performance enhancing benefits of competitive sports such as kayaking. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Chronic Idiopathic Constipation (CIC) is a common patient complaint (Browning 1999) and as such is defined as : “Constipation” being the infrequent or difficult evacuation of faeces, “idiopathic”, denoting the condition occurs in the absence of any known cause and “chronic”, implying a problem that has persisted for a long time (Anderson 1989). It has been suggested that the bony subluxation or motion segment dysfunction in the spine, could produce these symptoms (e.g. altered visceral function) in the segmentally related visceral structures (Korr 1976, Nansel and Slazak 1995, Budgell 2000). In support of this three case reports in the literature suggest that spinal manipulative therapy to effect removal of these bony subluxations or motion segment dysfunctions, may relieve chronic idiopathic constipation (Hewitt 1993, Marko 1994, Redly 2000). However all three cases involved a single patient case analysis, where patients received spinal manipulation and a vast improvement in bowel function within three weeks of the initiation of the intervention was noted. Only one case report measured global wellbeing outcomes and was able to document a steady increase in the patient’s sense of wellbeing (Redly 2000). As a result of the above evidence in the literature, the researcher was led to the following hypotheses regarding spinal manipulation and chronic idiopathic constipation: • That spinal manipulation would affect a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. • That placebo would affect an increase in the subject’s abdominal pain intensity and level of constipation and a decrease in the subject’s sense of wellbeing and spinal range of motion. • That spinal manipulation would be more effective than placebo in bringing about a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of post-natal mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, 2008. / Objectives: To compare trunk flexion and lateral flexion range of motion (ROM) pre-post intervention. To compare the bowling speed of Action Cricket fast bowlers pre-post intervention. To determine the correlation between change in bowling speed immediately post-intervention to change in trunk flexion and lateral flexion ROM immediately post-intervention. To determine the association between change in bowling speed immediately postintervention and the subjects' perception of change in bowling speed. Methods: Forty asymptomatic Action Cricket fast bowlers were divided into four groups of ten each. Group 1 received lumbar spine manipulation, Group 2 received thoracic spine manipulation, Group 3 received combined thoracic and lumbar spine manipulation and Group 4 received the sham laser intervention (placebo). Pre- and post-intervention trunk flexion and lateral flexion ROM and bowling speed were measured using a digital inclinometer and a SpeedTrac\x99 Speed Sport Radar. The subjects' perception of a change in bowling speed post-intervention was also recorded. SPSS version 15.0 was used to analyse the data. Twotailed tests were used in all cases. Results: Trunk flexion and lateral flexion increased significantly (p < 0.05) post-spinal manipulation. There was a significant increase in bowling speed post-thoracic (p = 0.042) and postcombined manipulation (p < 0.000). A significant yet weak positive correlation (p = 0.003; r = 0.451) was seen in change in bowling speed and change in thoracic flexion and lateral flexion. There was no significant difference in the percentage subjective change by intervention group (p = 0.217). Conclusions: Spinal manipulation is a valid intervention for short-term increase in bowling speed. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of postnatal and mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

Submitted in partial compliance with the requirements for Master’s degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Functional dyspepsia is a chronic pain/discomfort centred in the upper abdomen in the absence of any known structural cause. Epidemiological studies have shown that functional dyspepsia is a common complaint affecting all population groups that over time places considerable financial strain on public and private resources due to frequent doctors’ visits and expensive diagnostic procedures. The development of non-surgical and non-pharmaceutical treatments of functional dyspepsia would not only make economic sense but would also provide a means to improve patients’ quality of life in the least invasive way possible. Although not traditionally seen to be within the chiropractic scope of practice, anecdotal evidence suggests that chiropractic care and management may have the ability to alleviate visceral symptomatology. Objectives The purpose of this placebo controlled pilot study was to evaluate the preliminary effects of chiropractic manipulation versus inactive laser in the treatment of adult patients suffering from functional dyspepsia. Due to the small sample size, time and budgetary constraints it was hypothesised that the dyspepsia symptoms of participants treated with active chiropractic manipulation would not respond more favourably to the treatment, nor would these patients experience a greater improvement in terms of quality of life, compared to those participants receiving placebo treatment. Method Thirty participants with pre-diagnosed functional dyspepsia were selected after being screened according to the inclusion and exclusion criteria identified by the researcher. These participants were then divided into two groups using consecutive sampling. Data was collected at the Chiropractic Day Clinic at the Durban University of Technology. Group A received an active chiropractic manipulation using diversified technique to pre-identified levels in the cervical, thoracic and lumbar spine. Group B received inactive laser to pre-identified levels in the cervical, thoracic and lumbar spine. Both groups received one treatment a week for three weeks. The fourth and final consultation consisted only of data capturing. At each visit both groups of participants filled in three validated questionnaires: The numerical pain rating scale; PAGI-SYM physical symptom assessment; Results Results were statistically analysed using IBM SPSS version 20 and a p value ≤ 0.05 was considered to be statistically significant. Repeated measures ANOVA testing was used to assess the effect of each of the treatments separately and to assess the comparative effects of the spinal manipulation vs the placebo. Conclusion and Recommendations The gathered results and analysis were statistically insignificant. Clinical improvement in their symptomotology was however noted within both groups over the trial period in terms of treatment received and their perceived quality of life, symptomatology and pain levels. Both groups tended to have reduced pain and discomfort over time, improved: emotional distress, sleep disturbance, food problems, vitality, post-prandial fullness and abdominal pain. This study should be repeated with selected outcome measurements, and perhaps objective outcome measurements, and a larger sample size in order to determine any benefit. / M

A dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Although studies of manipulation-induced peripheral changes in the muscles have been done, inconsistencies noted by the author’s call for further investigation into the reflex effects of manipulation. Additionally, according to the literature, no effective treatment protocol for the painful shoulder has been found. Therefore this research aimed at addressing these discrepancies by quantifying the immediate effect of cervical spine manipulation in terms of peak torque on rotator cuff musculature in asymptomatic patients with both a cervical spine dysfunction and without. And thus by investigating cervical manipulation to the C4-C7 spinal segment, as a possible added intervention for improving rotator cuff muscle peak torque, a more efficient and effective management protocol for the painful shoulder could be attained. Thus the aims for this study included: 1) To evaluate whether manipulation has an effect on rotator cuff peak torque or not, utilizing the Cybex Orthotron II Isokinetic Rehabilitation System; 2) To ascertain whether manipulation of the specific levels has an effect on the rotator cuff peak torque or not and 3) To ascertain whether the presence or absence / M

Partial Dissertation in compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Aims and Objectives: The aim of this study was to determine whether spinal manipulation affects the perceived performance of runners with low back pain. More specifically, the objective was to determine whether any relationships existed between spinal manipulation, a runner’s perceived performance and their low back pain. Method: Twenty subjects who ran thirty kilometers a week and had LBP were selected for a pre- post- cohort study according to criteria set out beforehand. The subjects received spinal manipulation applied to their lower back twice a week for a period of two weeks. At each consultation, they were requested to fill out a “Perception of Running Performance” questionnaire prior to each treatment, and one week following the final consultation. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background The electromyographic response post-spinal manipulation may support the elucidation of the underlying neurophysiological mechanism of spinal manipulation on motor activity as well as on arthrogenic muscle inhibition. The literature shows conflicting evidence regarding the excitatory or inhibitory nature of the reflexive electromyographic response and the excitability of the homonymous motor neuron pool post-spinal manipulation. The current study investigated whether the electromyographic response post-spinal manipulation is affected by a facilitated golgi tendon organ Ib inhibitory di-synaptic spinal reflex as part of the convergent input on the homonymous motor neuron pool excitability. Objectives The objectives of this placebo-controlled, single-blinded, repeated measures design were: 1) to determine electrical activity and muscle force of the biceps brachii muscle immediately before and after an Activator Adjusting II Instrument placebo spinal manipulation, 2) to determine electrical activity and muscle force of the biceps brachii muscle immediately before and after a C5/C6 spinal manipulation, 3) to compare the electrical activity and muscle force of the biceps brachii muscle between the control and intervention groups pre- and post-test. Method Each participant performed three sets of modified stretching of the biceps brachii muscle with two minute rest intervals between each set in a single appointment, of which at a standardized fourth second during each set an intervention was applied to the ipsilateral C5/C6 segment. The first intervention (AAI 1) entailed the application of an Activator II Adjustment Instrument placebo spinal manipulation; the second intervention (AAI 2) entailed the application of an Activator II Adjustment Instrument placebo spinal manipulation; and the third intervention (SMT) entailed the application of spinal manipulation. One-second electromyography (EMG) segments were taken during the force plateau of each set; the EMG signal was processed through Root Mean Square (RMS) analysis and the muscle force data were obtained by using the Biopac - MP 150 Data Acquisition system and AcqKnowledge analysis software. Results The objective data analysis revealed a noteworthy scientific finding of a medical anomalous inverse relationship between the muscle force and EMG RMS immediately post-spinal manipulation. The immediate post-SMT intervention revealed an increase in the biceps brachii muscle force by 4.76 % and a decrease in the biceps EMG RMS by 9.03 % with a summation of percentage difference between the muscle force and EMG RMS of 13.79 %. The immediate post-placebo AAI 1 intervention showed a decrease in the biceps EMG RMS by 1.86 % and a decrease in the biceps brachii muscle force by 0.85 % with a summation of percentage difference between the muscle force and EMG RMS of 1.01 %. The immediate post-placebo AAI 2 intervention showed a decrease in the biceps EMG RMS by 0.05 % and a decrease in the biceps brachii muscle force by 1.97 % with a summation of percentage difference between the muscle force and EMG RMS of 1.92 %. Conclusion Further research is warranted to add statistical significance to the inverse relationship between muscle force and EMG RMS observed immediately post-spinal manipulation. This knowledge obtained, may have clinical relevance for rehabilitation practitioners and physical therapists by providing evidence based support for the suggestion that optimal management of patients with muscle weakness suspected to be of arthrogenic nature could include the application of spinal manipulation to the segmentally innervated facet joints before traditional strength training is initiated. / M