A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal,1997. / Asthma, one of the most frustrating medical conditions known to man, has been a thorn in the side of physicians world wide. A condition that seems to consist of all exceptions and no rules has resulted in endless debates regarding the correct treatment protocol for its management, which at present only seem to subdue the patient's symptomatology rather than eliminate them. The ever increasing number of asthmatic sufferers and the increasing number of deaths related to asthma are both reflections of the inadequacy of present treatment protocols and therefore demonstrate the need for their revision. It is thus the aim of this study to ascertain the therapeutic efficacy of spinal adjustive procedures a n the management of asthma. Patients were obtained for this study by consecutive sampling, whereby any patients presenting to the Chiropractic Clinic at Technikon Natal, as a response to the newspaper adverts and pamphlets placed ln the greater Durban area, were considered for the study. Of these patients, only those who conformed to the specified delimitations and diagnostic criteria were accepted. The study was divided into 3 distinct periods. The first, called the baseline study, required the entire sample of 30 patients to undergo subjective and objective tests, whilst receiving no chiropractic treatment, in order to establish the patients' astrunatic condition. The second period, called the initial treatment period, required the entire sample to undergo further subjective and objective testing while receiving chiropractic treatment, which comprised soft tissue therapy and adjustments of fixations in the CO-C2 and T2-T7 areas. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2004. / Arthrogenic muscle inhibition (AMI) is the reflex inhibition of the muscles that surround an injured joint in consequence to disturbed afferent feedback originating from the receptors of that joint. The resultant altered afferent innervation of the motor neuron pool leads to a decrease in recruitment ability within the motor neuron pool, a decrease in contraction force of the muscles that fall within the motor neuron pool, and hence the clinical manifestation of AMI as a decrease in muscle strength. Spinal manipulation has been proposed to activate mechanoreceptors and proprioceptors within and around the manipulated joint. The altered afferent input arising from their stimulation is thought to cause changes in motor neuron excitability. In this respect, sacroiliac manipulation has been shown to effectively reduce muscle inhibition and increase muscle strength of the quadriceps muscle group in patients with anterior knee pain. The focus of AMI has been aimed primarily at the quadriceps muscle group whereas little information is available on the functional properties of the muscles moving the hip joint. Thus, the purpose of the present cohort study was to determine the short - term effect of sacroiliac manipulation on ipsilateral hip muscle strength and subjective low back pain intensity in thirty male subjects presenting with low back pain, attributable to chronic sacroiliac syndrome. The first objective of the study was to evaluate the short - term effect of sacroiliac manipulation on the strength of the musculature of the ipsilateral hip joint for the actions of flexion, extension, adduction and abduction by means of the Cybex Orthotren II Isokinetic Rehabilitation System, with respect to objective clinical findings. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban Institute of Technology, Durban, 2006. / The purpose of this study was to evaluate the immediate and short term effects of spinal manipulative therapy on the club head velocity of amateur golfers suffering from mechanical low back pain. This purpose was identified as low back pain which has been noted as the most common musculoskeletal problem affecting amateur and professional golfers. In the right handed golfer the golf swing produces a distinctly asymmetric trunk motion, involving a combination of left axial rotation and right lateral bending. The significant lateral bending, shear, compression and torsional forces that the lower back contends with during the golf swing causes a peak compression load of more than eight times the body weight. In addition it is found that at the end of the follow through phase the golfer's lumbar spine is rotated and hyperextended. This is known as the reversed C position, in which the facet joints approximate and in addition torsional stress is placed on the annular fibers of the disc. With repetitive swings and incorrect form the lumbar facets bear the brunt of the abnormal forces on the lumbar spine. IV In addition to this, during the downswing phase of a golf swing the role of the multifidus is to limit flexion whilst the external oblique muscle induces rotation of the lumbar spine. Together both muscles produce rotation in the lower lumbar spine. Thus the golf swing, particularly during the downswing phase, places a tremendous burden on the multifidus muscle and may cause; o muscle injury which will contribute to the golfer's low back pain and I or o joint injury as a result of muscle fatigue. Furthermore the resultant uncontrolled contractions of the multifidus muscle produces torsion to the facet joints and disc. It is therefore likely that facet syndrome may be the main cause of low back pain in golfers, as modern golf publications urge golfers to use a maximum state of spinal rotation to generate a high club head velocity. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 1998. / The aim of this study was to determine the effectiveness of adjustments versus the use of ultrasound in the treatment of mechanical neck pain. It was hypothesized that treatment with adjustments over a four week period, with a further four week follow-up period, would be more effective than ultrasound in terms of improving patients' cervical ranges of motion and their perceptions of pain and disability. Thirty consecutive patients suffering from mechanical neck pain were randomly assigned to either the adjustment or ultrasound groups. An experimental design was employed, whereby both groups received treatment twice a week for four weeks. After a follow-up period of a month, the patients were re-assessed. Measurements of the cervical spine ranges of motion with the CROM goniometer, algometer readings, and the completion of the Numerical Pain Rating Scale-101, CMCC Neck Disability Index and the Short Form McGill Pain questionnaires were performed before the first, fourth and final treatments as well as at the one month follow-up consultation. The data were then transferred to spreadsheets and underwent statistical analyses, using a 95 % confidence level. Analyses within each group were performed, using the Wilcoxon Signed Rank test and various readings were compared. The reading taken before the first treatment was compared to the reading taken before the final treatment. The initial reading was then again compared with the reading taken at the one month follow-up consultation. Comparison of the results of both treatment groups was statistically evaluated, using the Mann-Whitney U-Test. The comparison was made using the readings of the first, fourth and final treatments, as well as the one month follow-up consultation. This was done for all measurement parameters. / M

M.Tech. (Chiropractic) / The purpose of this study was to establish whether cervical spinal manipulation induces an appreciable and sustainable alteration in muscle torque performance regarding the elbow flexor muscles. Forty asymptomatic individuals participated in this study. Twenty individuals were randomly assigned to either an experimental or control group. Participants selected had to be between 18 and 40 years of age and had to present with cervical motion restrictions involving the fourth to sixth cervical vertebrae, as determined by motion palpation assessment. Participants were randomly recruited from the University of Johannesburg and surrounding areas, based on their response to information pamphlets and word of mouth. The experimental group received cervical spinal manipulation involving the lower cervical segments on three separate occasions. The control group received no intervention. Elbow flexion torque assessments were conducted using the Biodex System 3, isokinetic dynamometer. Two assessments were done prior to intervention and one test following one week of intervention, to ascertain whether cervical manipulation can provoke a sustainable improvement in elbow flexion performance. Cervical range of motion (CROM) assessment was used as a secondary objective evaluation to assess the effectiveness of the manipulation procedures, considering that improvement in cervical range of motion following spinal manipulation is well documented. Minimal improvement in elbow flexion torque involving both arms was observed in the experimental group following one weeks‟ intervention however, no statistical significance was reported. Gender relations regarding the elbow flexion torque performances revealed and improvement in strength in the male participants and a reduction in performance in the female participants. Statistical significance was reported although the significance regarding intervention remains unclear. No sustainable improvement in elbow flexion torque was revealed following spinal manipulative therapy and therefore does not provide conclusive evidence to substantiate the motor neuron excitability theory. The contradictory results with regards to the female participants bring into context an indefinite and unfamiliar neuromusculoskeletal paradigm which requires additional research to clarify these anomalous findings.

Thesis (M.Tech-: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 x, 57 leaves, Annexures 1-10 / To determine if serum cortisol levels are increased following Spinal Manipulation Therapy (SMT) to the low back region and to determine the effect of a short rest interval on the cortisol levels

Thesis (M.Tech.: Chiropractic)-Durban University of Technology, 2008. xviii, 83, [29 ], 25 leaves / Golfing literature today recommends to both the amateur and professional golfers to try and achieve maximum performance with each golf club (Seaman, 1998 and Bulbulian, Ball and Seaman, 2001). This encourages golfers to use a state of maximum spinal rotation in their golf swing in order to achieve optimal performance (Seaman, 1998), thus resulting in back pain becoming endemic in the golfing population. Thus if it is considered that performance, in terms of the golf swing, is mainly influenced by; • the strength and power of the torso, i.e. the low back and abdominal muscles (Chek, 2003), • as well as muscle balance and flexibility, i.e. those muscles which are responsible for the static and dynamic postural stability of the golf swing (Chek, 2003). It then stands to reason that any decrease in the range of motion of the lumbar or thoracic spine of the amateur golfer, in terms of biomechanics, could affect their performance (Nordin and Frankel, 2001). In this regard it is hypothesised that altered biomechanics could be that of asymptomatic segmental joint dysfunction . In terms of interventions Kirkaldy-Willis and Burton (1992) explained the effect of SMT in the treatment of low back pain, similarly Bergmann et al. (1993) and Vernon and Mrozek (2005) further proposed the following effects of spinal manipulative therapy (SMT): • SMT may stretch or break intra-articular adhesions that form from immobilised facet joints due to acute synovial reactions. • SMT allows entrapped menisci to exit the facet joint in which it became entrapped. • If the capsule of the facet gets lodged between two adjacent articular surfaces, the process of SMT could allow this to be freed. • SMT re-aligns misaligned spinal segments to conform to the centre of gravity. It was thus assumed that if these mechanical and reflex mechanisms occur in the symptomatic amateur golfer, they should also occur in the asymptomatic amateur golfer. Currently however very little is known about the effects of spinal manipulative therapy (SMT) on asymptomatic segmental joint dysfunction. Objective: Therefore, the purpose of this study was to evaluate the immediate and short term effect of spinal manipulative therapy (SMT) on asymptomatic amateur golfers in terms of performance indicators. Methods: Forty three asymptomatic participants were randomized to four equal groups consisting of ten participants each (and three drop outs). Three of the groups received a single intervention, i.e. spinal manipulative therapy (SMT) while the last group acted as a placebo control group and received no intervention. Objective measurements were taken using the EDH Sports-FlightScope Pro Electronic Swing Analyser. All objective data collection took place pre and post SMT. Statistical analysis included various statistical methods and correlation analyses, by means of the latest version of SPSS. Results and conclusions: The main findings were that certain outcomes seem to be better with lumbar manipulation alone (smash, horizontal azimuth) and others better with thoracic manipulation alone (CHV, vertical azimuth, distance), but none are better with both lumbar and thoracic manipulation. Therefore in terms of future studies of this nature the treatment groups should be analysed separately and the research powered for such analyses (e.g. larger sample sizes).

Mini-dissertation in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, in the Department of Chiropractic at the Durban University of Technology, 2009 / The aim of this study was to investigate the relative effectiveness of Transeva and spinal manipulative therapy for mechanical low back pain. The objectives evaluated the effectiveness of only administering Transeva therapy alone, or Spinal manipulative therapy alone as well as Transeva therapy with Spinal manipulative therapy on mechanical low back pain with respect to the patients’ subjective and objective responses to the respective treatment group. The final objective was to correlate the subjective and objective data collected to determine the effectiveness of each of the therapies in comparison with another. Design: A sample of thirty patients diagnosed with mechanical low back pain were accepted into the study. These patients were randomly divided into three groups of 10, which received different treatment protocols for mechanical low back pain. Outcome Measure: The following outcomes were measured; a decrease in pain (measured with the Numerical Pain Rating Scale (NRS), a decrease in disability (measured with the Roland-Morris Questionnaire), a decrease in local tenderness (measured with the pressure Algometer) and an increase in lumbar range of motion (measured with the Inclinometer). The data was collected prior to treatment one, prior to treatment four and at the sixth follow-up visit. Results and Conclusion: All groups improved with the treatments they received; however, no single treatment was statistically better than any other treatment intervention tested. However, the Spinal manipulative therapy group had a statistically significant faster reduction in pain on the NRS readings with p=0.048.

Dissertation submitted in partial compliance with the requirements for the Masterà ¢ s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / Objectives: To determine the short-term effect of an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of spinal manipulation (SMT) and ribcage mobilisation on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of a combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. Methods: Forty-five chronic moderate asthmatics who met all the inclusion criteria of the study were divided into three groups of fifteen each. Group A received a short-acting 2-agonist bronchodilator, Group B received SMT and ribcage mobilisation and Group C received a combination of SMT, ribcage mobilisation and a short-acting 2-agonist bronchodilator. Baseline measurements and testing included chest wall expansion and the lung function parameters FEV1, FVC and FEV1/FVC%. These measurements were repeated 15 minutes post-intervention. Data was analyzed using SPSS version 15.0. Results: There were no statistically significant changes between pre- and post-intervention in the short-acting 2-agonist bronchodilator group with respect to any of the chest wall expansion measurements. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group (p = 0.008). There was a statistically significant increase in the mean pre- and post-intervention axillary chest wall expansion (p = 0.014) as well as the mean of the half-way measurement (p = 0.014) and the overall mean chest wall expansion value (p = 0.001) following SMT and ribcage mobilisation. There were no statistically significant changes in any of the lung function parameter values following SMT and ribcage mobilisation. There was a significant increase for the half-way measurement in chest wall expansion (p = 0.018) in the combination of SMT, ribcage mobilisation and the inhaled, short-acting 2-agonist bronchodilator group. There were no statistically significant changes in any of the lung function parameter values in the combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator. For FEV1, the effect in the short-acting 2-agonist bronchodilator group vs. the SMT and ribcage mobilisation group was statistically significant (p = 0.018). There was no statistical difference in any of the chest wall expansion measurements and FVC and FEV1/FVC% parameters between all three groups. Conclusions The results did not point specifically to one intervention over another for all outcomes. SMT and rib mobilisation had no effect on the lung function parameters, at least in the short term. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2008. / 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 post-intervention 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 SpeedTracTM 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. Two-tailed 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 post-combined 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.