M.Tech. (Chiropractic) / The aim of this study is to compare Chiropractic Manipulative Therapy of the lumbar spine combined with Therapeutic Ultrasound Therapy over the adjacent lumbar paraspinal muscles to ascertain the most effective protocol in the treatment of Chronic Mechanical Lower Back Pain. Thirty participants with Chronic Mechanical Lower Back Pain between the ages of 18 and 35 years were recruited. Successful participants were randomly placed in two groups, of fifteen participants each, which would receive different treatment protocols according to their group allocation. Group One received Chiropractic Manipulative Therapy to lumbar spine restrictions. Group Two received Chiropractic Manipulative Therapy to the lumbar spine restrictions as well as Therapeutic Ultrasound Therapy to the adjacent paraspinal muscles. The participants completed a total of seven visits, including 6 treatments over 3 weeks. Subjective and Objective readings were taken on the first, fourth and seventh visits. Subjective readings from each participant were recorded using the Oswestry Disability Iindex and Numerical Pain Rating Scale. Objective readings were taken and recorded three times consecutively using a Pressure Algometer over the adjacent lumbar paraspinal muscles and a Digital Inclinometer to measure lumbar spine range of motions. The statistical data was analysed using the Friedman test, Mann-Whitney test and the Bonferroni test. The results demonstrated overall that both groups responded favourably to their specific treatment protocols, however no significant differences between groups was noted, highlighting the positive effects of the manipulation alone.

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / The absence of tested theory has resulted in a continued variation in protocols for the treatment of mechanical low back pain. This study was designed in order to determine the relative effectiveness of spinal manipulation versus spinal manipulation in conjunction with a low back strapping in the treatment of mechanical low back pain in the phase of dysfunction. / M

A dissertation submitted in partial compliance with the requirements for the Masters Diploma in Technology: Chiropractic at Technikon Natal, 1996. / Lower back pain due to mechanical dysfunction is a common cause of pain and disability in mankind. Lumbar spine facet syndrome is a major aetiology in mechanical lower back pain / M

M.Tech. / Purpose: The aim of this study was to evaluate the relative effectiveness of the application of soft tissue massage to the posterior neck muscles before, and after, chiropractic adjustment to the cervical spine in the treatment of cervical facet syndrome. To determine the most effective treatment protocol; the patient‟s perceptions and objective findings were used. These findings were assessed by completing a Visual Analogue Scale, a McGill Pain Questionnaire and a Vernon-Mior Neck Pain and Disability Index, and measuring the cervical spine range of motion using a Cervical Range of Motion goniometer. The questionnaires were completed and the ROM readings taken prior to treatment on the first, fourth and seventh visits. Method: Forty participants who met the inclusion criteria were randomly allocated to two different groups of twenty each. One group received soft tissue massage to the posterior neck musculature prior to the application of chiropractic adjustments to the subluxations of the cervical spine. The second group received the chiropractic adjustments to subluxations of the cervical spine that was followed by soft tissue massage to the posterior neck. Treatment took place over a period of three weeks, and participants were treated six times out of a total of seven visits. Procedure: Subjective data was collected at the first and fourth visit prior to treatment, as well as on the seventh visit by means of a Visual Analogue Scale (VAS), McGill Pain Questionnaire as well as a Vernon-Mior Neck Pain and Disability Index to assess pain and disability levels. Objective data was collected at the first and fourth visit prior to treatment, and at the seventh visit by means of a Cervical Range of Motion goniometer (C.R.O.M.). Data collected was analysed by STATCON. Results: Both groups improved well over time subjectively and objectively but none more superior. Statistically significant improvements in group 1 and group 2 were noted over the duration of the study with regards to pain, disability, and cervical spine range of motion.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007. xii, 72, 12 leaves / 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.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005. xiii, 115 leaves / One of the most common clinical disorders known is mechanical low back pain (Painting et al. 1998:110). A significant source of low back pain is the sacroiliac joint and therefore, according to Schwarzer et al. (1995:31), it warrants further study. With respect to treatment, Gatterman (1995) states that specific manipulative therapy is the treatment of choice for sacroiliac dysfunction. This is supported by clinical studies (Cassidy et al., 1992), which have shown significant improvement with daily manipulation over a 2-3 week period in 90% of the patients suffering from sacroiliac dysfunction. Different adjusting techniques for the sacroiliac joint include side posture adjustment and prone drop piece adjustments (Bergmann, 1993). With respect to side posture, Bergmann (1993) further states that the side posture adjustment is the most common position used. However, it has been noted that side posture can produce unwanted rotation in the lumbar spine. This may be detrimental to patients who have contra-indications to torsioning such as abdominal aortic aneurisms, nerve root entrapment or disc pathology. Patients, who experience anterior catching of the hip capsule or decreased flexibility with side posture adjustments, experience more discomfort and could therefore benefit from a different technique (Gatterman, 1995). Hence the need for an effective adjustment technique that does not rely on torsioning (e.g. drop piece technique). (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Although drop table thrusting techniques were rated as being effective for the care of patients with neuromuskuloskeletal problems (Haldeman et al., 1993) as cited by Gatterman et al., (2001), it is still unknown which specific drop piece technique is the most appropriate for sacroiliac dysfunction. Therefore this study was aimed at determining the efficacy of a toggle recoil drop piece adjustment technique.

Submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / Aim: The aim of the study was to assess the effect of a single versus multiple cervical spine manipulations, over a two week period, on peak torque of the rotator cuff muscles utilizing the Cybex Orthotron II Isokinetic Rehabilitation System. This study was a pre and post experimental investigation. Method: Forty asymptomatic (in terms of neck and shoulder pain) male chiropractic students were stratified into two equal groups of twenty subjects to ensure that each group consisted of an equal number of subjects from each year of study. All subjects underwent a familiarisation session on the Cybex Orthotron II Isokinetic Rehabilitation System. Group One received a single manipulation. Rotator cuff peak torque was measured pre-manipulation, immediately post manipulation and at a two-week follow up. Group Two received four manipulations over a two week period. Rotator cuff peak torque was measured pre and immediately post the first manipulation. A third rotator cuff peak torque measurement was taken two weeks after the first manipulation. Results: There was no statistically significant effect of a single or multiple manipulations on rotator cuff peak torque (abduction, adduction, internal rotation and external rotation). Inter-group analysis revealed a trend of an effect for abduction as the single manipulation increased at the two-week follow up and the multiple manipulation group decreased; however, this was not statistically significant. Conclusion: No statistically significant results were found possibly due to small sample size and the fact that objective measurements were only taken at the beginning and the end of the research processes and not at regular intervals throughout the study.Further studies are needed to determine the effects of multiple manipulations on peripheral muscle activity, including the treatment of symptomatic patients with rotator cuff pathology. It is also recommended that EMG readings be done in conjunction with peak torque measures to determine muscle activity.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / The low back and the lower limb are generally viewed as two isolated regions, however, there are many authors who believe that these two regions are functionally related. This is due to the two regions being connected to each other through the kinematic chain of the lower extremity. The lumbar spine is the link between the lower extremities and the trunk, and plays a significant role in the transfer of forces through the body via the kinematic chain. The physical link between the low back and the lower limb is supplied by the thoracolumbar fascia, which plays an important role in the transfer of forces between the spine, pelvis and legs. Although a relationship between the lower extremity and low back pain is often assumed, little research has been published to demonstrate the association. Most of the evidence so far has been anecdotal, without scientific research to support it. This study was designed to compare the relative effectiveness of lumbar spine manipulation, compared to combined lumbar spine and subtalar manipulation for the treatment of chronic mechanical low back pain, using subjective and objective measures, for the management of chronic mechanical low back pain. The study design was a quantitative clinical trial, using purposive sampling. It consisted of forty voluntary participants with chronic mechanical low back pain. There were two groups of twenty participants each, each of whom received six treatments within a three week period. Group A received manipulation of the lumbar spine only, whilst Group B received manipulation of both the lumbar spine and subtalar joint. The outcome measures included the response of the participants to the Numerical Pain Rating Scale-101 and the Quebec Low Back Pain and Disability Questionnaire. Objective data was obtained from three digital Algometer measures. Data was collected prior to the initial, third and sixth treatment. iv Statistically both groups showed improvements, subjectively and objectively, with regards to chronic mechanical low back pain. Inter-group testing for NRS over time showed no significant effect for both treatment groups. There was a significant treatment effect for Algometer Average TP1 while the treatment effect for Algometer Average TP2 was not significant. However, inter-group testing for the Quebec LBP over time showed no significant effect for both treatment groups. Inter-group analysis demonstrated no statistical significance between the two groups for subjective and objective measurements, thus suggesting that there is no additional benefit in treating the subtalar joint in the management of mechanical low back pain. Further studies will also benefit greatly from the use of larger sample sizes to improve statistical relevance of data.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / The Effect of Cervical and Thoracic Spinal Manipulations on Blood Pressure in Normotensive Males. BACKGROUND A distinguishing feature of chiropractic is manipulation that is a load delivered by hand, to specific tissues (usually a short lever bony prominence) with therapeutic intent. Chiropractic spinal manipulation results in somatovisceral reflexes, which can affect the cardiovascular system and thereby reduce blood pressure. Areas of the spine known to cause such effects are the upper cervical region and the upper thoracic region. Increased blood pressure/hypertension is a global disorder. The incidence is increasing and leads to complications of cardiovasular disease and cerebral vascular accidents OBJECTIVES The objectives of the study were to determine whether spinal manipulation evokes somatovisceral reflexes and causes a reduction in blood pressure following an atlanto-axial (C0/C1), and Thoracic segments one to five manipulations (T1-T5). METHODS Forty, asymptomatic, normotensive males between the ages of 20 – 35 years of age participated in the study. All subjects underwent four consecutive days of intervention. Day one was sham laser. Day two was C0/C1 spinal manipulation. Day three was T1-T5 thoracic manipulation. Day four was a combination of C0/C1 and T1-T5 spinal manipulations. RESULTS The results of this study suggest that blood pressure decreases following a cervical or a thoracic manipulation, however a combination of the manipulations does not have a significant cumulative effect on the reduction of blood pressure. iv CONCLUSIONS Somatovisceral reflexes are evoked following a spinal manipulation, causing a reduction in blood pressure after an upper cervical or upper thoracic manipulation. Neurophysiological effects occurring as a result of spinal manipulation may inhibit or excite somatosomatic reflexes, which changes heart rate and blood pressure. / Aaron Bear Foundation

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology, Durban University of Technology, 2010. / Episodic Tension–type headache (ETTH), which has a high prevalence, is the most common headache. Manual therapeutic approaches towards Episodic Tension-Type Headaches (ETTHs) have not been fully explored. However, cervical spine manipulation (CSM) and dry needling are found to be successful modalities for the treatment of tension-type headache (TTH). Therefore, this study aims to determine the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in the treatment of ETTHs. Objectives The objectives of this study include: determining the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in terms of objective and subjective data for the treatment of ETTHs. Method Forty five participants suffering from ETTHs, between the ages of eighteen and fifty, were recruited through convenience sampling and were randomly allocated to one of three equal groups (15 per group). The three different groups were: (A); CSM alone, (B); dry needling alone and (C); CSM in addition to dry needling. The study took place over a period of four weeks involving six consultations. Each participant received a headache diary for the duration of the study. At the first consultation the participant received the headache diary and was monitored for one week before the treatments commenced. Thereafter, four treatments were administered over the next two weeks, depending on group allocation. Participants were also monitored with the headache diary for one week after the last treatment. The objective data for each participant consisted of cervical range of motion (CROM) and pressure–pain threshold readings, measured using a CROM goniometer and an algometer respectively. The subjective data for each participant was collected using a headache diary and a headache questionnaire/disability index. SAS version 9.1.3 was used to analyse the data. A p value of <0.05 was considered as statistically significant. Results A decrease in headache duration, frequency, intensity and severity and increases in CROM and algometer measurements were observed in all groups. However, no statistically significant differences were found between the three groups in terms of objective and subjective measurements although, a statistically significant improvement from consultation five to six was found in Group C in terms of headache disability. Conclusion CSM and dry needling, used in isolation or in combination are effective in the treatment of ETTHs although Group C did show superiority over the other groups in the long term with respect to the disability index.