Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background : It has become practically impossible for practitioners to remain current with clinical developments. Additionally the demand from patients and third party payors for quality evidence is increasing. A systematic review is one manner in which information can be graded, summarised and presented in a succinct format for use by practitioners, patients and third party payors. Objectives : To identify the current knowledge available on the conservative management of iliotibial band syndrome (ITBS) and to evaluate the scientific and methodological rigor of that knowledge. The systematic review of these studies identified the level and type of evidence that currently exists in the support of conservative management of ITBS and the specific interventions and combinations of interventions currently employed. Method : A systematic review of ITBS studies was conducted. ITBS studies were identified using key indexing terms (iliotibial band syndrome, treatment, conservative and intervention) on several databases (EBSCOhost, Google Scholar, Metalib, Pubmed, Science Direct and Springerlink), all studies were included up until the date of ethics approval (21st May 2012) . The gathered studies were screened for compliance with the inclusion criteria, and then reviewed by blinded independent reviewers (reviewer criteria included qualification, clinical experience, academic experience, research experience and discipline). Data collection and analysis : The reviewers rated the methodological rigour of the ITBS studies utilising an appropriate scale (e.g. PEDro Scale). Feedback was collated and analysed for discordance. Studies were then analysed, ranked and followed by a discussion in the context of their clinical outcomes, thus formulating a structured summary of the known clinical data with regards to the clinical management of ITBS. Results: The identified citations (4130) were screened and sorted by study type. This resulted in 167 citations that were reviewed by abstract for compliance with the inclusion criteria. A final total of 23 studies meet eligibility criteria. Eight articles reported on a combination of interventions, four discussed biomechanical and causative factors, and the remaining eleven articles investigated individual interventions in the treatment of ITBS. After review and analysis, combination interventions were supported by the strongest level of evidence, thus advocating the use of a combination of interventions in the management of ITBS in providing better clinical outcomes. Moderate evidence favoured the use of customised orthoses, injectable corticosteroids, phonophoresis and addressing biomechanical and causative factors. However, there was moderate evidence against the use of deep tissue frictions, as no improvement was found. This outcome suggests a need for further evidence to advocate the appropriateness of these interventions in clinical care of ITBS. Hip abductor strengthening and stretch therapy were found to have limited evidence. However, no evidence was found to support the application of active release technique, corrective neuromuscular approach, custom dry floatation cushions and talar joint manipulation in the management of ITBS. This latter outcome indicated a need for studies to investigate their appropriateness or inappropriateness in clinical care. Conclusion : The systematic review of ITBS studies revealed that use of a combination of conservative therapies was found to have the strongest level of evidence, which may indicate its appropriateness in the management of patients suffering from ITBS. Specific combinations of conservative therapies and the use of individual therapies require future research in order to better delineate their contribution to the management of ITBS. Randomised controlled trials are the gold standard for research, as they have the greatest level of methodological quality, and should be used where possible when investigating the efficiency of interventions in the treatment of ITBS. Studies, which were not randomised controlled trials, but adopted the principles of a randomised controlled trial structure, contributed positively towards the methodological rigor of these studies.

A dissertation presented in partial fulfilment of the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Low -Dye taping is a method commonly used in sport participation and normal daily activity (Harradine, Herrington and Wright, 2001). It has been indicated in support of injured structures, decreasing edema and protection against re-injury (Reid, 1992:232). Contrary to these beliefs, studies have shown that low -dye anti-pronatory control is lost after relatively short episodes of exercise (Ator et al., 1991 and Vicenzino et aL, 1997). The variations in dynamic foot function with low -dye taping is not well understood, although tapin.g of the foot in low-dye type method has been advocated by many authors (Brantingham et aL, 1992, Ryan, 1995 and Chandler and Kibler, 1993). It was the purpose of this study to investigate the maximum ground reaction force and percentage contact time within 10 demarcated regions of the foot in asymptomatic patient with pes planus, cavus and normal medial longitudinal arches at four time intervals over 24 hours. Having established its baseline function it may serve as point of reference for clinical trials that wish to determine the role of taping as part of the management of symptomatic feet. This trial consisted of 60 participants with asymptomatic feet that were divided into three groups of 20. Participants were divided into three groups depending on their respective foot structures. To qualify for one of the three groups subjects had to either have flexible low, high or normal medial longitudinal arches. Maximum ground reaction forces (GRF) and Percent contact time was obtained for each of the three groups and for each of four visits. GRF were obtained with the aid of a registered orthotist who has agreed to work with the researcher on this project using the RSscan International 1m footscan plate system (Appendix L). The data was interpreted and analyzed using the RSscan Clinical Version 7.08 software package. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background CrossFit is a workout program developed in 2000 which involves high intensity interval training coupled with resistance training elements of powerlifting and gymnastics. CrossFit has grown to include competitive events and there are an ever increasing number of affiliate gyms internationally. CrossFit’s greatest criticism is related to safety. There is limited published data on the exercise program. Aims The aims of this study were: to determine a retrospective cohort analysis of the demographic, injury and treatment profiles of participants at the 2013 United We Stand CrossFit Games who presented to the Durban University of Technology’s sports treatment facility; to determine the association, if any, between demographics and injury types; and, to provide any recommendations regarding the clinical record form used. Methods This study was a retrospective, quantitative, descriptive study on the chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of the injury and treatment profiles. Persons who made use of the chiropractic treatment facility at the 2013 United We Stand CrossFit Games were required to complete an informed consent form. A sixth year chiropractic student then filled in a Chiropractic Student Sports Association report form to record participant, complaint and treatment information. The study was not limited to competitors, but all persons who had access to the chiropractic treatment facility. These forms were then collated and data captured on the complaints which presented and were treated at the chiropractic treatment facility. Results The data collected revealed that 137 participants presented to the chiropractic treatment facility in 162 visits, with 263 complaints treated. The age range of the sample was between 18 and 43 years, with a mean age of 27.49 years. The majority of participants who presented to the CTF were competing athletes and just under half of the study sample reported to not having a history of previous injury. The study found that the lumbar region (20.9%), wrist/hand (14.4%), shin/calf (11.0%) and knee (10.2%) were the most commonly presented regions of complaint. The highest presenting mechanism of injury was that of overuse (22.4%) followed by running (19.0%). Acute injuries accounted for 72.20% of all injuries. With regards to diagnoses, myofascial trigger points made up 21.6% of all injuries, followed by muscle strains (19.7%). Facet syndromes of the spinal column accounted for 13% of diagnoses.It was shown that kinesiotape, manipulation, massage and ischemic compression were the top treatment interventions utilised. It was also shown that rest, ice and referrals were types of treatment that were not utilised. Due to statistical inconsistencies no significance tests were possible between demographic and injury characteristics. Recommendations were proposed in order to maximise the quality of data captured. Conclusion: The results add insight into the injuries presented and the treatment they acquired at the chiropractic treatment facility at a national CrossFit event. The most common injuries require investigation in both training and competitive environments. Various recommendations have been proposed for the record form used at sporting events in order to facilitate the collection of high quality data. / M

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xvi, 96, [65] leaves : ill. ; 30 cm / Low -Dye taping is a method commonly used in sport participation and normal daily activity (Harradine, Herrington and Wright, 2001). It has been indicated in support of injured structures, decreasing edema and protection against re-injury (Reid, 1992:232). Contrary to these beliefs, studies have shown that low -dye anti-pronatory control is lost after relatively short episodes of exercise (Ator et al., 1991 and Vicenzino et al., 1997). The variations in dynamic foot function with low -dye taping is not well understood, although taping of the foot in low-dye type method has been advocated by many authors (Brantingham et al., 1992, Ryan, 1995 and Chandler and Kibler, 1993). It was the purpose of this study to investigate the maximum ground reaction force and percentage contact time within 10 demarcated regions of the foot in asymptomatic patient with pes planus, cavus and normal medial longitudinal arches at four time intervals over 24 hours. Having established its baseline function it may serve as point of reference for clinical trials that wish to determine the role of taping as part of the management of symptomatic feet.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xvi, 96, [65] leaves : ill. ; 30 cm / Low -Dye taping is a method commonly used in sport participation and normal daily activity (Harradine, Herrington and Wright, 2001). It has been indicated in support of injured structures, decreasing edema and protection against re-injury (Reid, 1992:232). Contrary to these beliefs, studies have shown that low -dye anti-pronatory control is lost after relatively short episodes of exercise (Ator et al., 1991 and Vicenzino et al., 1997). The variations in dynamic foot function with low -dye taping is not well understood, although taping of the foot in low-dye type method has been advocated by many authors (Brantingham et al., 1992, Ryan, 1995 and Chandler and Kibler, 1993). It was the purpose of this study to investigate the maximum ground reaction force and percentage contact time within 10 demarcated regions of the foot in asymptomatic patient with pes planus, cavus and normal medial longitudinal arches at four time intervals over 24 hours. Having established its baseline function it may serve as point of reference for clinical trials that wish to determine the role of taping as part of the management of symptomatic feet.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis. / M

Thesis (M.Tech.:Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006 22, xii, 44 leaves, Appendices 1-10 / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: A triathlon comprises of a combination of swimming, cycling and running. Triathlons are usually classified as sprint distance, Olympic distance, and Ironman or ultra-distance. Triathlon was popularized in the 2000 Summer Olympic Games and, despite this, there is insufficient data relating to injuries in the South African context. This study aimed to determine the injury profile of amateur and semi-professional Kwa-Zulu Natal triathletes. Methods: This Institutional Research Board approved, cross sectional study, included 80 active members of the Kwa-Zulu Natal Triathlon Association. All triathletes completed a questionnaire on training and injury profiles; with only those having had a musculoskeletal complaint additionally completing a clinical consultation. In order to assess associations between presence of injury and explanatory variables, binary logistic regression using backward selection based on likelihood ratios was used. Data was described using frequency tables for categorical data and summary statistics for continuous data. Odds ratios was reported and a p value <0.05 was considered statistically significant. For triathletes reporting injuries, linear regression was used for factors associated with injury severity. Results: Fifty seven triathletes responded giving a response rate of 71% (68% male, 32% female). The point and period (year) prevalence of triathlon-related musculoskeletal pain was 17.5% and 68.4% respectively. The ranking of the most common site of injury in the last 12 months included the knee (64%), low back (21%) and thigh (18%); with females having had a significantly higher risk of injury than males (p=.019). Additionally, injury risk also increased with weight (p=.055), number of triathlons undertaken in the previous year (p=.031), number of triathlons in the last 4 months (p=.009) and running distance during competition times (p=.011). Injury risk decreased with increasing distance of cycling (p=.061) and swimming (p=.030) in a competition, and length of training in- and off-season (p=.105 and p=.043 respectively). Strong trends were demonstrated between injury severity and long-slow training distance (p=.006) and weight (p=.006). By contrast to risk of injury, injury severity was negatively associated with weight, while a long-slow distance was positively associated with the severity of the injury. Of all the health professions, chiropractic was the most utilized health profession. Conclusion and recommendations: The results concur with previous research, but add insights into factors predisposing triathletes to injury. The most common injuries require investigation to develop preventative interventions to reduce injuries in triathletes. Health professionals require education about triathlon-related injuries to improve preventative and curative interventions.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: The 19th Iteration of the World Transplant Games was hosted in Durban, South Africa in 2013. This biennial, international, multisport event showcases the talents of transplant athletes, whilst demonstrating the benefits of organ transplantation. To date, limited research is available on transplant athletes. This study aimed to determine the injury profile of transplant athletes who presented to the Durban University of Technology Chiropractic Treatment Facilities during the 2013 World Transplant Games. Methods: This retrospective, descriptive cohort study analysed the data collected at the Chiropractic Treatment Facilities at the 2013 World Transplant Games. For inclusion, each WTG Form required completion, reflecting all the elements of that participant’s chiropractic consultation. The data recorded on the World Transplant Games Form generated the data analysed in this study. The data described the frequency (frequency tables), nature and management of injuries treated at the Chiropractic Treatment Facilities during the 2013 World Transplant Games. In order to determine relationships cross tabulations were used. Results: There were 964 athletes registered for the 2013 World Transplant Games, of which 153 presented to the Chiropractic Treatment Facilities (an utilisation rate of 15.9%). A total of 259 consultations by the athletes (n = 223; 86.1%) and non-athletes (n = 36; 13.9%) were recorded. The majority of the treated athletes were White (n = 91; 59.5%), males (n = 109; 71.2%), in which kidney transplant recipients accounted for 37.3% (n = 58) of the total number. Track athletics had the highest injury rate (34.5% of all reported injuries). Athletes sustained injuries to 14 different anatomical regions, with the thigh (26.9%) and shin/calf (20.5%) being the most frequently injured. The majority of injuries (n = 164; 66.4%) were “overuse” injuries, with myofasciitis, muscle strains and thoracic facet syndrome being the most frequently obtained diagnoses (25.5%, 16.6% and 6.5% respectively). The most frequently employed treatment modalities were those of massage (32.1%), ischemic compression (16.3%) and manipulation (13.4%). It was noted that the most injuries sustained (88.3%) were not severe enough to result in an inability to continue current or future participation. Conclusions and Recommendations: Transplant recipient athletes injuries concur with the literature on non-transplant athletes, indicating that solid organ transplantation does not predispose the athlete to different or more serious injuries which would require different management protocols by health care personnel treating these athletes. Further investigation into individual sports is encouraged, to develop accurate, effective injury management and preventative strategies to more appropriately diagnose and treat injuries incurred by transplant athletes and then to prevent them from recurring. An informed healthcare approach towards event organising and athlete treatment will improve preventative strategies and athlete management.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Tennis is one of the most popular sports globally with over 75 million players around the world. Most studies have focused on junior or elite level players although the majority of players around the world are presumed to be recreational/non-professional players. To date, limited research is available pertaining to the epidemiology of tennis related musculoskeletal in non-professional league tennis players in South Africa. This study aimed to determine the profile of musculoskeletal injuries amongst league tennis players in the northern eThekwini region. Methods: This was a quantitative, cross-sectional, descriptive study utilizing a self-administered questionnaire, developed specifically for this research utilizing an expert group and pilot study. The questionnaire contained sections on demographics, tennis history, training and nutrition, court surface and equipment as well as a section on tennis related musculoskeletal injuries. Risk factors for injury were first tested using chi square tests in the case of categorical variables, and t-tests in the case of continuous variables. In order to assess the relationship between injury and potential risk factors for injury, a binary logistic regression using backward selection based on likelihood ratios was used. Odds ratios and 95% confidence intervals of the variables remaining in the model at the end were reported. A p value <0.05 was used to indicate statistical significance. Results: Eighty league tennis players responded giving a response rate of 70.16%. The period prevalence, and the point prevalence of tennis related musculoskeletal injury was 68.75% and 36.25% respectively. A predominance of injuries to the upper extremity were recorded (49%) compared to the lower extremity (27.5%) and the back and trunk (23.5%). The elbow was the most common anatomical site of injury (21.4%) followed by the shoulder (19.4%), the lumbar spine (17.3%) and the knee (8.2%). Age was considered to be a risk factor for injury (p=0.049) as older players in the study (49.32 (17.547) years of age) were less likely to contract an injury than younger players (48.38 (13.210) years of age). The likelihood of injury decreased with a higher Body Mass Index (p=0.042). The relationship between consumption of spirit alcohol and injury was significant (p=0.043). Ex-smokers had a higher chance of contracting an injury (p=0.013). It was also found that those who cycled weekly were less likely to contract an injury (p=0.040). Conclusion: The results concur with other studies on recreational/non-professional tennis players and add insight into risk factors predisposing this population to injury. Health care practitioners need to understand the risk factors for injury in this population so that players can be better managed. Using the results of the study, an injury prevention strategy such as a strength and conditioning program, needs to be implemented with the goal to reduce or prevent common injuries in this population of players. / M