M.Tech. (Chiropractic) / OBJECTIVE: The aim of this study was to determine the effectiveness of a single treatment approach of flexion distraction or diversified lumbar adjustments, compared to the combined treatment of flexion distraction in conjunction with diversified lumbar adjustments. STUDY DESIGN: A total of 30 participants were used, they all presented with chronic low back pain (LBP) of mechanical origin. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: The participants were divided randomly into one of 3 groups: Group 1 was treated with diversified lumbar adjustments. Group 2 was treated with flexion distraction directed at the lumbar spine. Group 3 was treated with a combination of diversified lumbar adjustments and flexion distraction. Each participant was treated 6 times over a 3 week period, with a 7th consultation where subjective and objective measurements were taken with no treatment. METHODS: Group 1 was adjusted on a chiropractic table in a seated or side lying posture. Group 2 was treated lying prone on the Cox Flexion Distraction Table. Group 3 was treated with a combination of the above treatments. Flexion distraction was applied to all participants in group 2. It was applied over the segments that were found to be restricted during motion palpation. One set of 10 repetitions was performed under distraction in each range of motion (ROM). Mobilisation of the restricted joints was executed until full and complete ROM was detected. To ensure that the participant was comfortable and received the best treatment possible Velcro straps were used to secure them onto the flexion distraction table. Diversified chiropractic adjustments were done on the flexion distraction bed or the chiropractic tables in the University of Johannesburg Chiropractic Day Clinic. Spinous Hook (Pull), Thigh-Transverso-Deltoid, Transverso-Deltoid and Push-Pull Technique were the names of the adjustments used to treat participants in group 1 or group 3. PROCEDURE: Subjective data was collected using the Oswestry Low Back Pain and Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS), which were completed by the participants prior to the 1st and 4th consultations and then again on the 7th consultation. Objective data was collected using the Digital Inclinometer. The ROMs measured were forward flexion, extension, left lateral flexion, right lateral flexion left rotation and right rotation of the lumbar spine. This data was collected by the researcher prior to the 1st and 4th consultations and then again on the 7th consultation. RESULTS: This study was done to try and establish the most effective approach in the management of chronic mechanical LBP using the different treatment approaches. When comparing the results obtained from the study it can be seen that all 3 groups were effective at reducing pain levels using the NPRS. There was a significant change that occurred on the 7th consultation when looking at the NPRS values. The statistics were then further analysed and a statistically significant difference was shown to have occurred between groups 1 and 3. This indicates that the chiropractic adjustment used alone, was the best treatment protocol compared to groups 2 and 3. The ODQ values showed that the treatments for all 3 groups were effective at getting the participants back to normal activities of daily living over the treatment protocol, with no preference between any of the treatment protocols. Statistically significant changes were found to have occurred in only some ranges of motion of the lumbar spine within certain groups. Clinical improvements regarding ROM were evident in group 1 concerning flexion, left rotation and right rotation. A clinical decrease was found in extension, left and right lateral flexion with group 1. Clinical improvements concerning group 2 were found in extension, left rotation and right rotation. Flexion showed a clinical decrease in ROM values of group 2. Statistically significant improvements were found with left and right lateral flexion in group 2. Group 3 showed positive clinical results with left and right rotation. Flexion and left and right lateral flexion ROM showed decreased values clinically in group in group 3. Extension showed a statistically significant decrease in group 3. These results indicate that chiropractic adjustments used alone, were the best treatment protocol compared to group 2 and 3 when using the NPRS. The ODQ values showed that there was no preference between either of the treatment protocols with regards to normal activities of daily living.

M.Tech. (Chiropractic) / To compare the effectiveness of biomechanical pelvic blocking to segmental drop piece adjustments in the treatment of sacroiliac joint dysfunction. Method: Thirty participants were randomly divided in two equal groups. Group A (n = 15) received biomechanical pelvic blocking and Group B (n = 15) received segmental drop piece adjustments. The trial consisted of seven treatment visits over a period of three weeks, of which the first six were treatment sessions, with the final seventh session serving the purpose of obtaining final post-treatment data. Data was obtained only at the first, fourth, and seventh visits. Subjective data was obtained by having each participant complete a numerical pain rating scale and the oswestry low back pain and disability questionnaire. Objective data consisted of pain pressure threshold over the posterior superior iliac spine by using a pressure algometer. Results: The subjective results showed that there was a decrease in the numerical pain rating scale (NPRS) reading scores over the treatment visits for both groups. Group A had a statistically significant decrease (p = 0.000) in the NPRS reading scores between visit 1 and 4, and a statistically significant decrease (p = 0.000) between visit 4 and 7. Group B showed that there was a statistically significant decrease (p = 0.001) from visit 1 to 4, and a statistically significant decrease (p = 0.002) between visit 4 and 7. According to the Mann-Whitney test both groups showed a statistically significant decrease in their NPRS readings over the treatment period (p = 009), however Group A had a greater decrease in pain than Group B when looking at the mean score values. This indicates that both biomechanical pelvic blocking and segmental drop piece adjustments delivered to the dysfunctional sacroiliac joints are effective in decreasing pain. Over time, statistical analysis showed that there was a decrease in oswestry pain and disability for both groups A and B when looking at the Friedmann and Wilcoxon-signed rank test. Group A showed a statistically significant decrease (p = 0.012) from visit 1 to 4, and a statistically significant decrease (p = 0.002) for visit 4 to 7. Group B also showed that from visit 1 to 4, there was a statistically significant decrease (p = 0.001), and from visit 4 to 7 there was a statistically...

M.Tech. (Chiropractic) / This study aims to compare full spine manipulation versus cervical spine manipulation in the treatment of acute cervical facet syndrome with regards to pain, disability, cervical spine range of motion and pain threshold. This study was a comparative study that consisted of two groups of fifteen participants each. The participants were between the ages of eighteen and forty with an equal male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria for the study. The method of treatment that was administered was determined by group allocation. Group 1 received Chiropractic manipulative therapy delivered to restriction(s) throughout the different regions of the spine and Group 2 received Chiropractic manipulative therapy delivered to restriction(s) of the cervical spine only.

M.Tech. (Chiropractic) / Purpose: The aim of this study was to compare the effects of chiropractic adjustment versus mobilization to the cervical spine in participants with chronic cervical facet syndrome with regards to neck pain, cervical spine range of motion and position sense. Method: Thirty participants, male or female between the ages of 18 and 45 years, diagnosed with cervical facet syndrome were used in the study. The thirty participants were divided into two groups consisting of fifteen individuals each, ensuring equal male to female and age ratios. Group 1 received chiropractic adjustments over the restricted joints to the cervical spine. Group 2 received mobilization over the restricted joints to the cervical spine. The trial consisted of seven visits over a treatment period of three weeks, of which the first six visits the participants received treatment and the seventh visit served the purpose of obtaining the final data. The data was gathered on the first, fourth and seventh visits. Subjective data was obtained by using the Vernon-Mior Neck Pain and Disability Index and the Visual Analogue Scale for pain intensity. Objective data consisted of measuring cervical spine range of motion with a CROM instrument and Laser Pointer Device to measure head repositioning accuracy (position sense). Results: Subjective results indicated that group 1 (chiropractic adjustment) proved to be the most effective treatment protocol in decreasing neck pain intensity by 92%, and neck pain disability index by 65.7%. Group 2 (mobilization), also showed good results with a decrease in neck pain intensity by 53.9%,and neck pain disability index by 23.8%. Subjective results produced statistically significant results with VAS score (p= 0.000) for both groups and NDI score (p=0.000) for group 1 and (p=0.002) for group 2. Objective results also proved that chiropractic treatment was most effective in increasing cervical spine range of motion by 21.9% (right rotation) and 21.07% (left rotation). In group 2 by 9.93% (right rotation) and 12.72% (left rotation). Results were statistically significant for both groups with CROM score (p=0.002) for group 1 (right rotation) and (p= 0.000) (left rotation). Group 2 CROM score (p=0.040) (right rotation) and (p= 0.007) (left rotation). Objective results also proved that chiropractic adjustment was most effective in improving position sense by 76.54% (right rotation) and 72.06% (left rotation). In group 2 by 38.01% (right rotation) and 13.03% (left rotation). Results were statistically significant for group 1 with Kinesthetic Sensibility Test score (p=0.000) (right rotation) and (p=0.002) (left rotation). In group 2, the result for right rotation was statistically significant with (p=0.019) and not statistically significant for left rotation with (p=0.167). Both subjective and objective results showed that although group 2 produced statistically significant results, group 1 showed the best clinical results overall. Thus it was noted that in order to obtain a vii lasting increase in range of motion of the cervical spine, a decrease in neck pain and disability and an improvement in position sense, the treatment protocol used for group 1 should be the treatment of choice. Conclusion: Based on the results of the study, it was concluded that chiropractic adjustment was more effective than mobilization in the treatment of cervical facet syndrome. This conclusion is based on the results that chiropractic adjustment was more effective in all the objective and all the subjective measurements. However, this does not rule out mobilization as a treatment for neck pain, because mobilization treatment did show improvement in cervical spine ROM, a decrease in pain and slight improvement in position sense although not as efficiently as chiropractic treatment.

M.Tech. (Chiropractic) / PURPOSE: The aim of the study was to compare the effectiveness of treating inter-scapular pain with either chiropractic adjustments delivered to the costovertebral joints, with ischaemic compression of the myofascial trigger points of the rhomboid muscles, or using a combination treatment protocol in order to determine which of the three treatment protocols was superior. DESIGN: This study was a comparative study consisting of three groups of ten participants each. Participants were between the ages of eighteen and forty-five and there was an equal male to female ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. A McGill Pain Questionnaire, numerical pain rating scale, a clinical case history, full physical examination, a cervical regional examination were completed. The method of treatment for each participant was determined by random group allocation. Group 1 received chiropractic adjustments to the costovertebral joints, Group 2 received ischaemic compression to the myofascial trigger points of the rhomboid muscles. Group 3 received a combination treatment involving both chiropractic adjustments to the costovertebral joints together with ischaemic compression of the rhomboid trigger points. Subjective and objective readings were based on the above treatment protocols. All participants received a total of six treatments over a three week period. MEASUREMENTS: Subjective measurements were obtained by the Numerical Pain Rating Scale and the McGill Pain Questionnaire. Objective measurements were obtained using the hand-held pressure algometer. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the McGill Pain Questionnaire for the intragroup analysis indicated that the ischaemic compression group showed the greatest improvement over time (84.06%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the adjustment group showed the greatest improvement over time (78.70%). The intergroup analysis indicated that there were no statistically significant differences. With regards to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the ischaemic compression group showed the greatest improvement over time (35.44%). Once again, there were no statistically significant differences with the intergroup analysis. CONCLUSION: Based on the results of this study, it showed that all three treatment groups were effective in decreasing inter-scapular pain and disability. Although all three treatment protocols have shown to be effective, and have shown similar improvement, intergroup analysis indicates that statistically there is no treatment protocol that is seen to be more superior or more effective in treating inter-scapular pain.

M.Tech. / It has been reported that the sympathetic nerve fibres coursing with the vertebral arteries may potentially be irritated by cervical pathology such as cervical dysfunction causing vasoconstriction of the vertebro-basilar arterial system leading to an ischaemic state in particular areas in the brain (Wingfield and Gorman, 2000). This arterial insufficiency to the brain has been shown to effect higher level complex brain functions (Terrett, 1995). The purpose of this research was to determine whether atlanto-occipital joint as well as atlanto-axial joint adjustments had an immediate effect on mental rotation ability in individuals with asymptomatic cervical facet joint dysfunction. Sixty male and female asymptomatic patients took part in this study. These patients were recruited by means of word of mouth and through the use of advertisements placed in the University of Johannesburg Chiropractic Day Clinic, Doornfontein Campus. Inclusion criteria required for patients to participate in the study included the patients (both male or female) be between the ages of 18 and 30 years, they presented with an asymptomatic cervical facet joint dysfunction at the atlantooccipital and or atlanto-axial joints, not have had either Chiropractic or any other form of treatment to the cervical spine for at least six days prior to involvement in the study, had normal or corrected to normal vision and no contraindications to cervical adjustments. vi Objective data was collected by means of a mental rotation reaction time test installed on a laptop computer which measured the patients mental rotation reaction time ability in both accuracy and time to complete each test. The objective results demonstrated that there was no statistically significant increase in mental rotation ability following the Chiropractic adjustments. In conclusion, it was shown that Chiropractic adjustments performed on patients presenting with asymptomatic cervical facet joint dysfunction at the atlantooccipital and/or the atlanto-axial joint complexes brought about no improvement in mental rotation ability.

M.Tech. / The most common cause of chronic cervicogenic headache is believed to be mechanical pain from the muscles, ligaments and joints of the upper cervical spine (Hubka and Hall, 1994). Much controversy and debate surrounds all aspects of cervicogenic headache, including the aetiology and treatment of these headaches. The purpose of the study was to determine the effectiveness of chiropractic spinal manipulation of the upper cervical spine alone as a treatment form for cervicogenic headache, with regards to pain, disability and cervical spine range of motion. Method: This study consisted of a single group of thirty participants between the ages of eighteen and thirty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The only method of treatment administered to each participant was chiropractic manipulation, delivered to restrictions of the upper cervical spine, from which the objective and subjective findings were based. Procedure: Treatment consisted of seven consultations, with two consultations being performed per week. Objective data and subjective data was taken at the beginning of the first, fourth and seventh consultations. Objective data consisted of cervical range of motion readings taken using a Cervical Range of Motion measuring instrument (CROM). The subjective data collected was in the form of a Vernon-Mior Neck Pain and Disability Index and a Numerical Pain Rating Scale. Spinal manipulative therapy based on restrictions identified during motion palpation was applied at the first six consultations with the seventh consultation consisting of data gathering only. Results: Clinically and statistically, significant improvements in the entire group were noted over the course of the treatment with regards to cervical range of motion, pain and disability. Conclusion: The results show that upper cervical spine manipulation is effective, both clinically and statistically, in decreasing pain and disability and increasing cervical spine vi range of motion in those with cervicogenic headache. As the study consisted of a small group of participants treated as a single group, further study is needed in the form of randomised, controlled clinical trials.

M.Tech. / Purpose: To determine the effect of Chiropractic spinal manipulative therapy (SMT) compared to that of fascial treatment on Superficial back line (SBL) fascial line restrictions. It has been suggested that a fascial line restriction can cause a decrease in performance and lead to over – use injuries. Methods: A randomised study design with thirty asymptomatic male participants, which were moderate to highly active as indicated by the International Physical Activity Questionnaire (IPAQ). Participants were divided into two equal groups, group A (n=15) received Chiropractic SMT of the lumbar spine and Sacroiliac joints, group B (n=15) were treated with Direct Release Myofascial Technique to the restricted SBL. The study design consisted of seven consultations, with intervention being applied at each consultation. Objective data was obtained by the Bunkie test and Range of Motion testing which determined the participant‟s level of endurance and fascial line restriction. Objective data was obtained before and after the first intervention, after intervention on the fourth consultation and on the seventh consultation, which did not include intervention. The short term effect was represented by comparing the before values of consultation one (baseline) to consultation seven. The immediate effect of intervention was represented by the before versus the after measurements of consultations. Results: The objective results showed that there was a short term and immediate improvement in Lumbar range of motion for both groups and a short term and immediate improvement in Bunkie test times of both groups, except for the immediate effect of group B, which decreased the Bunkie test time. With the Bunkie test group A showed an immediate mean improvement of 2.4 seconds (11.3%) on the right and 2.3 seconds (4.9%) on the left. With the Bunkie test group A showed a short term mean improvement of 9 seconds (41.8%) on the right and 10.1 seconds (44.1%) on the left. Group B showed no immediate mean improvement for the Bunkie test and a short term mean improvement of 3.3 seconds (19%) on the right and 2 seconds (10.9%) on the left.

M.Tech. / The aim of this study was to determine whether Chiropractic cervical spine and/or upper thoracic adjustments had an effect on eye-hand co-ordination in asymptomatic participants presenting with cervical and/or upper thoracic spine dysfunction. Forty eight asymptomatic participants took part in this study. The participants were divided into three groups of sixteen participants each, each group consisting of eight male and eight female participants. Group 1 participants received Chiropractic adjustive therapy to dysfunctional segments in the C0-C3 spinal segments and C5-T1 spinal segments. In Group 2 the participants received Chiropractic spinal adjustive therapy to dysfunctional spinal segments in the C0-C3 region. Group 3 acted as the control group and participants received detuned ultrasound applied to the posterior cervical spine region. Two computer tests were involved in this study, namely the 2HAND test and the B19 test which had to be completed successively. The subjects were allowed to have a trial run each time they were tested to get a “hand’s-on feel” for the equipment. After the trial run the participants were tested, their respective treatment was carried out and the participants were then re-tested. Overall the study was able to show that Chiropractic adjustive therapy had no effect on eye-hand co-ordination in asymptomatic participants. Group 1 did not show any greater improvement in eye-hand co-ordination when compared to Group 2 where Group 1 received upper cervical spine and upper thoracic adjustments and Group 2 received only upper cervical adjustments. Gender was seen to play a significant role in the study, mainly during the B19 test. Overall it can be said that Chiropractic adjustive therapy had no effect on speed (OMD) or accuracy (OPED) during the test. Future research is needed on the possible effects of Chiropractic adjustive therapy on speed and accuracy as the study design showed some potential positive influences but may have been merely due to coincidence because of the small sample sizes. When testing eye-hand co-ordination it was noted that after the participants received Chiropractic adjustive therapy the length of mistakes in percent (LMP) decreased, meaning that the participants were able to correct any mistakes made at a faster rate after receiving Chiropractic adjustive therapy, but only when delivered to the spinal levels C0-C3 and/or C5-T1 (i.e. Group 1) for male participants only. Statistically significant results were noted when testing the number of mistakes made (NM) but only for male participants receiving Chiropractic adjustments to the C0-C3 levels only (i.e. Group 2). Future research needs to be done on the gender discrepancies noted for the different manner that Chiropractic adjustive therapy affected the different genders.

M. Tech.