M.Tech. / Purpose: This study aims to compare the effects of chiropractic adjustment to the lumbar spine and/or pelvis, and chiropractic adjustment to the lumbar spine and/or pelvis in conjunction with a muscle stability exercise programme in the treatment of chronic low back pain in former ballet and modern dancers with regards to pain, disability and lumbar spine and pelvic range of motion. These effects were based on a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Index, and on lumbar spine range of motion (ROM) readings taken using a digital inclinometer. The questionnaire was completed and the ROM readings taken prior to treatment on the first, fourth and seventh visits. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of two different groups of fifteen participants each. One group received chiropractic adjustments to the lumbar spine and/or sacroiliac joints, with an added muscle stability exercise programme. The second group received chiropractic adjustments to the lumbar spine and/or sacroiliac joints alone. 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 consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale (NPRS) as well as an Oswestry Low Back Pain and Disability Index to assess pain and disability levels. Objective data was collected at the first and fourth consultations prior to treatment, and at the seventh consultation by means of a digital inclinometer for assessing lumbar spine range of motion (ROM). Data collected was analysed by a statistician. Results: Clinically and statistically significant improvements in group 1 and group 2 were noted over the duration of the study with regards to pain and disability, however the lumbar spine range of motion results were inconsistent with regards to the expected outcome of increased range of motion. Conclusion: The results show that both chiropractic adjustment, as well as chiropractic adjustment in conjunction with a muscle stability exercise programme, are effective treatment protocols both clinically and statistically in decreasing pain and disability in former ballet and modern dancers with chronic low back pain, however, neither treatment protocol proved to be preferential over the other. The results also showed a larger decrease in lumbar spine range of motion than the expected increase in lumbar spine range of motion.

M.Ing. / Automatic classification of images has always been an important part of pattern recognition. The segmentation and classification of MRI images has always been a challenge. A segmented image is often a very important input to the classification process. Many classification techniques use segmented images as input to the classification process. Certain segments or areas of an image serve as important features that will be used for classification. Important information can be derived from the features that are present in the segmented image. Sometimes there might be a need to extract a certain object from an image to do classification on the object. In the case of MRI images, certain structures of the human body like organs and tissue can be isolated by the segmentation process. These objects of interest (001) can give vital information for the identification of medical abnormalities (anomalies) and diseases. Segmented objects can play an important role to assist medical practitioners in the diagnosis and treatment of medical problems. I would like to test the performance of the watershed segmentation algorithm on MRI images of the cervical (C) spine. Much work has been done on the segmentation and classification of MRI images. Various techniques have been generated and tested over the past decades. Segmentation techniques like thresholding, convolution, pyramid segmentation and morphological segmentation have been utilised. All these techniques have their advantages and disadvantages. The pre-processing of an image plays a very important role in the success of the segmentation process. Histogram manipulation, filtering, thresholding and edge detection are important pre-processing techniques to yield good segmentation results. Many segmentation and classification techniques have been implemented on MRI images. The latest techniques include support vector machines (SVMs), neural networks (NNs), statistical methods, threshold techniques and normalised cuts. Segmentation of bony structures plays an important role in image guided surgery of the spine [1]. Physicians have commonly relied on computed tomography (CT) images to support their decisions in the diagnosis, treatment, and surgery of different pathologies of the spine due to the high resolution and good visualization of bone offered by this medical imaging modality. CT relies on the use of ionizing radiation, and does not depict soft tissue pathology, unlike magnetic resonance imaging (MRI) [1]. While the segmentation of vertebral bodies from CT images Segmentation Of C-Spine MRI Images Using The Watershed Transform Page 6 University of Johannesburg of the spine has commonly been accomplished with seed growing segmentation techniques [1], this task is more difficult in MRI, with variations in soft tissue contrast, and with the RF inhomogeneities, which increase the level of complexity. The primary goal of this project is to develop segmentation techniques for C-spine MRI images. This method will also be compared against other methods like pyramid segmentation and morphological segmentation. The watershed segmentation will be implemented and tested as the final step of the segmentation process. This project will try to use a combination of techniques, rather than to implement and evaluate one single method. It has been learned from literature and also from experience that the pre-processing of the raw data plays a crucial role in the quality of the segmentation process. Therefore, some attention will be given to the pre-processing of the images as part of the segmentation process.

M.Tech. / This unblinded, randomised pilot study was performed to determine and compare the effect of innervation specific lumbar spine adjustments and stretching on the flexibility of the rectus femoris muscles in asymptomatic subjects. Twelve asymptomatic subjects between the ages of 20 and 30 years were recruited by the use of advertisements placed around the University of Johannesburg, Doornfontein Campus. The inclusion criteria required that the patient had decreased rectus femoris muscle flexibility (testing positive on the rectus femoris contracture test) and no history of, or any current osteoarthritis or pathology of the hips or knees. The patients were randomly placed into one of three groups by drawing a group number from a closed bag. Group 1 consisted of four subjects receiving a single lumbar spine adjustment per treatment relating to the most restricted segment in the L2-L4 area as well as bilateral proprioceptive neuromuscular facilitation (PNF) of the rectus femoris muscles; Group 2 consisted of four subjects receiving bilateral rectus femoris muscle stretches (PNF); and Group 3 consisted of four subjects who received a single lumbar spine adjustment at the L2-L4 area to the most restricted segment found. One adjustment per treatment was performed. With the subject in the rectus femoris contracture test position, a goniometer was used to measure the knee range of motion bilaterally before and after treatments. These measurements were used as objective data. Each subject was treated twelve times over a four to six week period. The objective results indicated that there was a statistically significant improvement in rectus femoris muscle flexibility in both Group 1 and Group 3. In conclusion, it was shown that specific adjustments at the spinal level of the nerve innervation for the rectus femoris muscle resulted in an improvement of the flexibility of the rectus femoris muscle and with a greater effect on the leg ipsilateral to the side of the spinal adjustment. This gives support for the effectiveness of innervation specific spinal adjustments.

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) / Please refer to full text to view abstract

M.Tech.

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.

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

The aim of this study was to establish reference data for the cervical spine’s dynamic force characteristics in a healthy adult urban South African population aged 19 to 69 years. The reference data was classified according to gender discriminate age categories. In total ten gender discriminate age categories, five male and five female, were created; 19 to 29, 30 to 39, 40 to 49, 50 to 59 and 60 to 69-year-olds. The force characteristics measured, analysed and used to generate reference data in stanine format were: absolute peak torque (P-), relative peak torque (P-/BW), peak power (Pow-), relative peak power (Pow-/BW), peak work (W-), relative peak work (W-/BW), torque acceleration energy (TAE-), maximal voluntary cervical muscle contraction range of motion (MVCR-), controlled full range of joint motion (CFR-), joint angle at peak torque (Jang@P-) and peak torque ratios for cervical flexion (-F), extension (-E), lateral flexion to the dominant (-LD) and non-dominant (-LN) sides. In addition biographic and anthropometric data was also collected. Data, grouped in the ten gender discriminate age categories were compared and statistically and practically significant differences were highlighted between the gender discriminate age categories. Inferential statistics used included ANOVA and Cohen’s d. A significance level of α = .05 was used in all inferential statistical analyses. Correlations between various anthropometric and isokinetic strength variables were also explored.