Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Neck pain is a common complaint and a common source of disability in the general population with a point prevalence of nearly 13%. Reports indicate that industry related neck disorders (lifetime incidence of nearly 50%) account for as many days of absenteeism as low back pain; one could compare the two clinical conditions in terms of these trends on a global scale. To investigate whether similar trends do exist, 200 participants with neck pain and 200 asymptomatic participants (stratified sampling according to age and gender) that consented to the research were clinically assessed. These participants also completed a questionnaire addressing the factors that have been identified as related to neck pain at the consultation where they were assessed. This research did not involve the treatment of the participants, although a free treatment was given for patients that opted for one or to those that required it post participation in the study. If treatment was outside the scope of the chiropractic clinic, the participants were referred to the appropriate health care provider. The aim of the study was to investigate factors associated with neck pain in the indigenous African population in the greater Durban area. Data was analysed according to the following: Descriptive statistics were interpreted by means of frequency tables, pie charts, bar graphs and / or in a tabular format in order to describe the sample characteristics of the population under study. Inferential statistics included regression analysis in order to determine any relationships between the patient‟s neck complaint characteristics and factors associated with the complaint. SPSS version 11.5 was used for data analysis (SPSS Inc, Chicago, Ill, USA). A p value of <0.05 was considered as statistically significant. Descriptive analysis involved presenting or graphing categorical variables as counts and percentages, and quantitative variables as medians and interquartile ranges due to the skewness of the data. Associations between factors and neck pain were examined bivariately using Pearson‟s chi square or Fisher‟s exact tests as appropriate for categorical factors, or Mann-Whitney tests in the case of quantitative non-parametric data. Finally in order to examine the adjusted independent effects of all factors which were found to be individually significant in the bivariate analysis, multivariate binary logistic regression analysis was done. A backwards elimination modelling technique was used, based on likelihood ratios, with entry and exit probabilities set to 0.05 and 0.010 respectively. Results were reported as odds ratios, 95% confidence intervals and p values. Chi squared analyses was utilised to assess the strength of the relationship and the degree of significance of the relationship. All statistics were analyzed at a confidence interval of 95% and a level of significance where α ≤0.05 (pvalue). The symptomatic participants seemed to be less well educated than the controls. The cases seemed to be less in full time employment, less unemployed, and more self employed than the controls. Income was unevenly distributed among cases and controls. The cases who were working seemed to earn less than the controls who were working. The duration of having neck pain was mainly 1 month. The majority of cases classified their pain as mild. Most participants felt that their pain was worst in the afternoons or related to activities, while they felt their pain was least in the mornings. Frequency of neck pain was mainly constant (36.5%), followed by frequent (32.5%) and seldom (25%). Symptomatic participants mostly reported that their pain began without injury, gradually in 67.5% and abruptly in 13.5%. Fewer symptomatic participants reported pain beginning after an injury (n=22 gradually and n=7 abruptly). The majority reported their neck pain to be stable (38%), while 34% felt it was getting worse and only 19% getting better. More than half of the cases reported difficulty with work due to neck pain. Fewer reported difficulties with daily activities such as washing (30%), sleeping (26%), and lifting (24%). Almost half of the cases rated their disability as none (48%). Only 16% reported severe disability. Thirty-three percent (n=66) reported having been absent from work due to neck pain. The duration of absence in those who were absent was mainly 0-1 week (89.4%). 59 (29%) reported being bed-ridden with neck pain. The most frequent duration was also 0-1 week (81.4%). Ninety three point five percent reported no change in occupational status, while 6 (3%) were demoted, 5 (2.5%) boarded, and 2 (1%) fired. With respect to associated signs and symptoms, 156 (78%) reported to suffer from headaches. In addition, symptomatic participants were asked if they associated their neck pain with any other activities. The most commonly reported factor was stress (22%), followed by bad posture (17%). The other reported factors were reported infrequently. Participants who worked in occupations that involved driving, turning neck, answering the telephone, working in an air-conditioned room, and bending over a desk were significantly more at risk of being cases than controls. Non-occupational factors which were associated with neck pain were worrying a lot, motor vehicle accident, not enough bed support, not using arms to support a book, sitting without back or arm support, not watching TV a lot, and exercising. The results of the study suggest that neck pain within the indigenous African population is associated with the level of education, income, stress levels, bad posture, repetitive movements of the neck, and motor vehicle accidents. It was also found that most of neck pain patients do suffer from headaches. The findings show that neck pain is mostly classified as mild in nature with 1 month duration. Although neck pain was reported to be responsible for at least 7 days of absenteeism from work, causing difficulty with daily activities, most patients reported no disability as a result of neck pain.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Manual therapists are susceptible to occupational low back pain. The aim of this study was to determine the prevalence and risk factors for occupational low back pain in manual therapists and to determine and compare the prevalence and risk factors for occupational low back pain among various types of manual therapists in South Africa. This study was conducted as a cross-sectional survey and a self-administered questionnaire, developed from the literature and validated prior to the study, was mailed to 1500 randomly selected manual therapists, including: physiotherapists, occupational therapists, biokineticists, chiropractors, reflexologists, aromatherapists and massage therapists. A total of 233 completed questionnaires were returned, giving a response rate of 15.53%. Results revealed that the point prevalence of low back pain in manual therapists was very high at 41%, the one-year prevalence was 59% and the career prevalence was 74%. The point prevalence of low back pain was highest in aromatherapists and biokineticists, while both the one-year and career prevalence of low back pain was highest in occupational therapists and massage therapists. The risk factors for low back pain in manual therapists were: BMI; previous abdominal surgery; previous trauma to the low back, hips, knees or ankles; a physically stressful job; not having an assistant and work in a hospital or other setting. In keeping with the literature, various workrelated factors were implicated in the development and / or exacerbation of low back pain in certain manual therapists more than others and low back pain history in the different manual therapists was also in accordance with the literature. To conclude, low back pain is prevalent among South African manual therapists and the development and implementation of preventative programs to reduce rates of occupational low back pain in manual therapists is mandatory.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / There are mechanical loads applied to the patella tendon in almost all sporting activities and as a result is commonly injured (Peterson and Renström, 2003:321). Patellar tendinopathy is a common chronic tendinopathy (Hamilton and Purdman, 2004) and occurs commonly in athletes who impose rapid eccentric loading of the knee extensor mechanism (Norris, 2004:246). Deep Transverse Friction Massage (DTFM) and soft tissue mobilization are the two most common forms of manual therapy used to treat patellar tendinopathy (Rees et al., 2006). DTFM is considered the most effective treatment for patellar tendinopathy (Brunker and Khan, 2002:487). It is theorised that DTFM causes the softening of scar tissue and the breakdown of adhesions, promoting the realignment of disrupted connective tissue fibrils within the affected tendon (Stasinopoulos and Johnson, 2007). Graston Instrument Assisted Soft Tissue Mobilization (GIASTM) consists of a set of stainless steel instruments (Carey 2003:2) and is an advanced form of soft tissue mobilization used in detecting and releasing scar tissue, adhesions and fascial restrictions (Carey, 2003:7). The controlled microtrauma created by these instruments is hypothesised to create a localised inflammatory response (Hammer, 2004) in a similar mechanism to that of DTFM. The aim of this study was to determine the relative effectiveness of GIASTM versus DTFM in treating patellar tendinopathy. The study included a total of twenty-six knees among twenty-one patients. Patients were placed randomly into either the GIASTM group or the DTFM group. Each patient received a total of twelve treatments over a three month period. Algometer and inclinometer readings were recorded at set intervals and compromised objective measures. Two questionnaires and a numerical pain rating scale (NRS) were administered at set intervals and compromised subjective measures. SPSS version 13.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyse the data. Repeated measures ANOVA was used to examine changes in quantitative outcomes over the time points (intragroup analysis) and a treatment effect (intergroup analysis). To control for the partial pairing in the intergroup analysis, a variable which classified each subject as paired (both left and right knee used in study) or non-paired (only used once in study) was used as a factor in the model. Correlations between the intragroup changes in the various outcome variables were assessed using Pearson’s correlation coefficients. Statistical analysis of both objective and subjective data revealed significant improvements for most outcome measures in the study. Findings imply that GIASTM is as effective as DTFM in treating patellar tendinopathy.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Dry needling (DN) fanning technique is an effective treatment for myofascial trigger points (MTP), however, it causes swelling and intramuscular haemorrhage which results in post-needling soreness (PNS). Kinesio ® taping space-correction-technique (KTSCT) is claimed to aid in reducing pain by decreasing inflammation, increasing circulation and lymphatic drainage. This in theory indicates that Kinesio ® taping could reduce/alleviate PNS pain after DN. Objective: The purpose of this study was to determine the effectiveness of KTSCT utilizing Kinesio ® Tex Gold tape in reducing the level of PNS associated with DN a trapezius muscle trigger point two. Method: Forty five patients with active trapezius muscle MTP two were randomly allocated into one of three treatment groups. All groups received a standardized DN treatment. Thereafter, group one received no further treatment and acted as the control group, group two received an application of KTSCT utilizing Kinesio ® Tex Gold tape, while group three received a non-proprioceptive hypoallergenic tape application. Assessments were made pre-, post-treatment and at a follow-up consultation on the following day once the taping application was removed. Assessments included numerical pain rating scale-101 (NRS-101), a pain diary and algometer readings. Results: Group three showed an improvement over the control group, however, it was not a statistically significant improvement in any of the assessments. Group two showed statistically significant improvement over the control in the pain diary and algometer readings overall. Results from the NRS-101, showed that group two had a statistically significant improvement when compared to the control group over the time interval when the Kinesio ® Tex Gold tape was applied to the patient. Conclusion: KTSCT utilizing Kinesio ® Tex Gold tape had a greater effect in reducing the level of PNS associated with DN a trapezius muscle trigger point two, when compared with either a non-proprioceptive hypoallergenic tape application or a control group.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Hamstring muscle strains are a common musculoskeletal injury amongst athletes, with a high rate of recurrence that suggests room for improvement in the treatment and management of these injuries. Cibulka et al. (1986) suggest a possible link between injuries of the hamstring muscles and dysfunction of the sacroiliac joint. A study by Fyfer (2005) found that sacroiliac manipulation alone had a positive effect in the treatment of recurrent hamstring strains, but this was not combined with or compared to conventional treatment for muscle strain. Fox (2006) found that sacroiliac manipulation added to hamstring stretching increased the resultant flexibility of uninjured hamstring muscles. Objective: The purpose of this study was to determine the relative effectiveness that manipulation may have when combined with and compared to a regime of hamstring stretching and strengthening in the treatment of chronic hamstring strains. Method: Thirty two participants suffering from chronic hamstring injuries and concomitant dysfunction of the sacroiliac joint were randomly allocated into two treatment groups. Both groups attended six consultations over a period of three weeks. Group one received treatment in the form of proprioceptive neuromuscular feedback (PNF) stretching and resisted isometric exercises of the hamstring, and were taught a home routine consisting of static stretching of the hamstring and Theraband® exercises directed at the hamstring. Group two received the same treatment and home routine as those in Group one, with the addition of Chiropractic manipulation of the dysfunctional sacroiliac joint. Outcomes were obtained by using the Numerical Pain Rating Scale (NRS-101), inclinometer testing of passive straight leg raiser test, and algometer assessment of pain threshold in the injured hamstring muscle and ipsilateral sacroiliac joint. Results: Data was analysed using the SPSS version 18.0 (SPSS Inc. Chicago, Ill, USA). Subjective and objectives outcomes were measured quantitatively. The effect of the intervention was measured using repeated measures ANOVA testing. The time versus treatment group interaction effect assessed whether the effect of the different treatment over time is the same, with a p value of <0.05 being v considered significant. Both treatment groups showed improvement of outcomes, and manipulation showed a marginally non-significant trend of greater improvement with regards to sacroiliac joint algometry. Conclusion: This study did not provide conclusive evidence of either a benefit or no benefit of manipulation, but where non-significant trends were shown, it is likely that this was due to lack of statistical power and that with an appropriate a priori analysis being done a greater sample size may have shown the same effect to be statistically significant.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Lateral epicondylalgia (L.E) is a common diagnosis in elbow pathology. The aetiology is poorly understood but it is generally accepted to be as a result of repetitive microtrauma, affecting the proximal end of the extensor carpi radialis brevis tendon. Elbow bracing and exercise modification are often utilised by sufferers in order to reduce symptoms. In addition, there have been multiple treatment regimes used in practice to treat L.E, but none has stood out as being more effective than another. Thus, the aim of this study was to investigate the relative clinical effectiveness of therapeutic exercises alone and in combination with orthotic bracing, in terms of subjective and objective clinical findings. Methods This stratified, quantitative, prospective clinical trial consisted of two equal groups (n=15) diagnosed with L.E. Group One consisted of a strengthening and stretching programme alone, and Group Two consisted of a combination of the same programme and an orthotic brace. The participants performed the programme daily at home for six weeks, and the brace was worn throughout the day for six weeks. Each participant was assessed before, during and after the programme, in terms of subjective and objective clinical data which was then statistically analysed using SPSS version 18. Repeated measures ANOVA testing was also used to compare the outcomes between the groups over the time points. Results Both groups showed significant statistical improvement in terms of all the outcome measures. The groups also showed a clinically significant improvement for all the outcome measures except pressure pain threshold where Group Two showed clinically significant improvement over Group One. v Conclusion The results show that there was negligible benefit when combining an orthotic brace with therapeutic exercises as opposed to performing the therapeutic exercises alone.

Dissertation completed in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background:Myofascial Pain Syndrome is characterized by localized muscle pain, in which affected muscles are in a chronically-shortened state and contain trigger points.It is the single most common source of musculoskeletal pain that is encountered in clinical practice. Modalities such as electrotherapy, cryotherapy, thermal therapy, dry-needling and ultrasound are used in its management. The use of phonophoresis has generated much interest; and literature around this modality continues to accumulate. Numerous studies have demonstrated the efficacy of phonophoresis with an anti-inflammatory in the treatment of musculoskeletal disorders, attributing the efficacy to the penetration of the coupling medium by means of the ultrasonic waves. Traumeel®S, is a homeopathic anti-inflammatory, that has successfully been used in the treatment of musculoskeletal injuries.It has anti-oedematous, anti-exudative, anti-inflammatory and analgesic properties. Its efficacy as a coupling agent in phonophoresis has not been tested for myofascial pain syndrome. Methodology:This study was designed as a prospective, double-blinded, randomized, and controlled experimental investigation. Sixty subjects were randomly allocated to three groups of 20 subjects each. Group Areceived active phonophoresis with Traumeel® S gel;Group B received sham phonophoresis with Traumeel® S gel; Group C received an application of Traumeel® S gel only.Algometer and Numerical Pain Rating Scale 101 (NRS) readings were taken immediately before treatment at visit one and thereafter at visits three and four. Results:Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS and algometer readings. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. It was noted that there was a higher rate of improvement in Group A over time; however, this difference was not statistically significant. Conclusion:The results from this study revealed that all three treatment groups responded favorably to the alleviation of pain. It was concluded that phonophoresis with Traumeel® gel had no significant additional beneficial effects.

Dissertation submitted in compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: Horses are unlike most animals as they take part in equine sports and thus are athletic animals. Comparable to a human athlete, horses are prone to sports related injuries and disease. Equine chiropractic has shown to be one of the most utilized forms of complementary and alternative veterinary medicine (CAVM) worldwide, providing a drug free approach to equine health care and maintenance. However, equine chiropractic lacks research and therefore a wide gap in the literature exists. Studies on CAVM therapies have shown that these therapies are largely driven by the public and the public’s perceptions towards these therapies. However, little is known of the public’s perceptions towards equine chiropractic in KwaZulu-Natal (KZN). Horse riders represent the primary contact with the horse and are in the best position to note the outcome of post equine chiropractic treatment. For this reason they have influence on the utilization of equine chiropractic. It is, therefore, important to attempt to close the gap through ascertaining the horse riders’ knowledge, perception and utilization of equine chiropractic, particularly in KZN, where no such data exists. Aim: The aim of this study is to determine the knowledge, perception and utilization of equine chiropractic amongst horse riders in the KZN region. Method: The research design is a descriptive, quantitative, self administered survey based study. The study population included all horse riders in KZN (N= 500). There is no available list that details the number of horse riders in KZN, therefore, it was estimated that there are 500 horse riders in KZN (This was based on the number of horses stabled in KZN). The study sample included all horse riders at stable yards in KZN that had given written permission for the research to take part at their yard (N= 330). This was estimated by the number of horses stabling at the yards where owners had given written permission. Results: The response rate was 25% (n=83). The respondents were predominantly white (98%) and female (81%), and between the ages of 41- 50 years. Most respondents had previously been treated successfully by a chiropractor and had tertiary education. The majority of respondents were part of a horse society and participated predominantly in show- jumping. Most respondents had ridden horses for 0-10years, and currently rode only one horse. Their main horse (the horse they rode the most), for which most respondents were both the owner and rider, stayed predominantly in a stable and was between the ages of 5- 10 years. Most respondents had not sought alternative veterinary care for this horse, but had sought alternative veterinary care for their other horse(s) that they rode. Out of all the alternative veterinary therapies respondents reported to utilize, equine chiropractic showed to have the highest utilization. Equine chiropractic reported to have an overall high success rate with both the respondents’ main horse (92%) and their other horse(s) (87.5%). Respondents’ overall subjective knowledge of equine chiropractic was ‘that they knew something about it’. Respondents’ objective knowledge score was 75%. Most respondents had gained their knowledge of equine chiropractic through a friend and stated that the information they had gained was favourable towards equine chiropractic. It was interesting to note that 90% of respondents had some knowledge of equine chiropractic. Most respondents knew of one or more equine chiropractor(s), and were referred to them predominantly by a riding instructor. Just under half (49.4%) of the respondents had utilized an equine chiropractor, yet most respondents showed to have accurate knowledge of what equine conditions chiropractors treat. The majority of respondents supported the future utilization of equine chiropractic, but would like more information on equine chiropractic techniques. The research data revealed a trend showing that the utilization of alternative equine therapies or equine chiropractic corresponded with an increased knowledge of equine chiropractic. The data revealed graphically that the more equine chiropractors a respondent knew of, the more they utilized equine chiropractic. Conclusion: Respondents showed predominantly to have a positive perception towards equine chiropractic. Their knowledge of equine chiropractic was overall accurate and they showed to utilize and support the future utilization of equine chiropractic.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background : Many treatment options provide symptomatic improvement of joint function for osteoarthritis (OA) of the knee. Research suggests full kinetic chain (FKC) manual and manipulative therapy (MMT) and rehabilitation yields greater benefits than home rehabilitation alone. However this treatment combination has never been compared against FKC MMT alone. Objectives : Objectives: To determine the effectiveness of three FKC treatment protocols in the management of knee OA. Method : A single-blinded, randomised comparative trial of sixty-six patients with knee OA, equally allocated to three treatment groups: manipulation only, rehabilitation only or manipulation plus rehabilitation (a.k.a. combination group). Manipulation groups received bi-weekly FKC treatment, while a daily at-home stretching and exercise programme was prescribed to the groups receiving rehabilitation. Treatment lasted three weeks, with outcomes measure taken at baseline, pre-visit 4 and 1-week follow up. Primary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and McMaster Overall Therapeutic Effectiveness (OTE) Tool. Results : There was a drop-out rate of 7.6% (n=5), with intent to treat analysis providing the missing data. All three treatment groups showed clinically and statistically significant changes in overall WOMAC scores from baseline to 1-week follow up. The combination group showed the largest improvement (50.5%), followed by manipulation (44.4%) and rehabilitation (33.6%). However, this difference between group improvement was not statistically significant (p= 0.156). Conclusion : All three intervention protocols showed statistically significant improvement in most outcome measures at 1-week follow-up. However, there was no statistically significant difference between groups and therefore it is concluded that the interventions appear to be equally effective in the short-term management of knee OA.

Completed in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Dry needling is known to be effective and efficient in the treatment of myofascial pain syndrome; pragmatically however, patients utilise Flurbiprofen LAT patches as home therapy anticipating similar results. This may not be true and thus, this study aimed to investigate the effectiveness of dry needling versus Flurbiprofen LAT patches in the treatment of myofascial pain syndrome of the upper Trapezius muscle. Methods: This ethics approved, prospective, randomized, single blinded (blinded assessor), comparative clinical trial required sixty participants, randomly (randomisation table) allocated to two groups. After the completion of informed consent participants received treatment over three consultations with a follow up a week later. Baseline and repeated outcome measures included Numerical Pain Rating Scale, Neck Disability Index Questionnaire, Myofascial Diagnostic Scale, Algometer and Cervical Range of Motion device. The data was analysed using ANOVA tests with the p-value set at 0.05. Results: Baseline demographics and outcome measures showed that only age was significantly different between the groups. This difference was controlled for in the statistical analysis. Dry needling resulted in better treatment outcomes than the Flurbiprofen LAT patches in terms of function (cervical range of motion) (right lateral flexion p=0.043) and Myofascial Diagnostic Scale scores (p<0.001), whereas the Algometer measures and remaining cervical ranges of motion improved significantly over time in both groups, but not between the groups. Tthe Flurbiprofen LAT patches fared better in terms of the subjective reporting (Numerical Pain Rating Scale), this was not significant. Conclusion: The interventions were both effective over time, however, the needle group achieved improved functional ability and the Flurbiprofen LAT patches improved the pain outcomes with limited functional ability. Therefore the use of these modalities requires clinical judgement to appropriately administer the treatment option that the patient would best benefit from.