A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand Gauteng, 2017 / Background Soccer is a sport that is gaining in popularity in the elite and non-elite populations worldwide. As a result, the number of injuries in soccer is increasing. Hamstring injuries in particular, with a reported incidence rate as high as 63%, are of significant concern. Most hamstring injuries tend to occur during the swing phase of sprinting when hamstring activity is at its highest. As the speed of sprinting increases, greater mobility in the lumbo-pelvic area is required to maximise sprinting efficiency. Any abnormal or dysfunctional lumbo-pelvic movement during this phase could induce pain and hamstring injury. Lumbo-pelvic movement control dysfunction may therefore indirectly link abnormal lumbar spine movement to lumbo-pelvic pain and hamstring injury. The first aim of this study was to compare the performance of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles in soccer players, with and without recent hamstring injuries, while performing isometric contractions, a functional squat and sprinting. The study’s second aim was to compare lumbo-pelvic movement control in soccer players with and without recent hamstring injuries. Method Thirty soccer players were selected to participate in this study. Fifteen were assigned to the injured group and 15 to an uninjured group. The injured group comprised players who had sustained a hamstring injury six months prior to the research and who had partially returned to training, and the uninjured group comprised players with no recent hamstring injuries and who were actively involved in full training. Players were matched in respect of age, height, weight and playing position. All players gave informed written consent, completed the physical activity, training and injury questionnaire, and the Oslo hamstring injury questionnaire. Physical tests, which included isometric contraction of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles, a functional squat and a thirty-metre sprint were done. Muscle activity during these tests was recorded via electromyography (EMG). To determine the lumbo-pelvic movement control of the players, the dorsal pelvic tilt, waiter’s bow, one leg stand and prone knee bend tests were used. Cohen's d (parametric) and Spearman’s correlation coefficient (nonparametric) were used to calculate the effect size, and the Chi-square test and Fisher’s exact to analyse the lumbopelvic movement control data. To establish a statistical significance, the p-value of the study was set at p<0.05. Results EMG muscle activity during isometric contractions was lower in the erector spinae muscles (p=0.04) and biceps femoris muscle (p=0.02) of the injured group. Both these findings were statistically significant. There was no statistically significant difference in muscle activity during the functional squat between the study and uninjured groups. The results of the EMG activity in the thirty-metre sprint were determined to be significant as they demonstrated that the hamstring muscle (p=0.01) activation in the injured group was decreased in comparison with the uninjured group. During the performance of the lumbo-pelvic test, no association was found between the two groups in the dorsal pelvic tilt and one leg stand. The performance of the waiter’s bow (p=0.01) and prone knee bend (p=0.004) revealed statistically significant differences between the study and uninjured groups. The majority of the players in the injured group performed both of these functional tests incorrectly (WB n=10; PKB n=14). Conclusion The study found that the hamstring muscle is at great risk of injury during eccentric contraction of the hamstring muscles. This can be associated with poor lumbo-pelvic movement control, as the load on the hamstring muscle is increased to provide intersegmental stability around the neutral zone, the area of high spinal flexibility. / MT2017

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Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 144 leaves / Objective: The aim of this study was to investigate the relative effectiveness of TENS, versus, needling, versus Electro-needling in the treatment of MTSS. First objective The first objective was to evaluate the effectiveness of TENS therapy on MTSS with respect to the patients subjective and objective responses to the treatment. Second Objective The second objective was to evaluate the effectiveness of needling therapy on MTSS, with respect to the patient’s subjective and objective responses to the treatment. Third Objective The third objective was to evaluate the effects of electro-needling on MTSS, with respect to the patients’ subjective and objective responses to the treatment. Fourth Objective The fourth objective was to integrate the subjective and objective data collected in order to determine the viability of each of the therapies in comparison to one another as treatment options of MTSS.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Faculty: Health Sciences, Durban University of Technology, 2009 / Aim To determine the profile of traumatic cervical spine fractures with respect to the epidemiology, clinical presentation, types of fractures, conservative and surgical intervention, short-term post-intervention (i.e. post-conservative and post-surgical) complications and short-term post-surgical rehabilitation of patients presenting at the Spinal Unit of King George V Hospital over a 12-week period. Methods Patients who presented to the King George V Hospital Spinal Unit from surrounding hospitals with traumatic cervical spine fractures were evaluated by the medical staff. Data concerning the epidemiology, clinical presentation, types of fractures, conservative and surgical intervention, short-term post-intervention (i.e. post-conservative and postsurgical) complications and short-term post-surgical rehabilitation data were recorded by the researcher. A p-value of <0.05 was considered as statistically significant. Appropriate statistical tests were applied to the hypothesis-testing objectives. These involved the Pearson’s Chi Square Tests for categorical variables or Fisher’s Exact Tests as appropriate where sample sizes were small. Paired t-tests were done to compare preand- post-surgical Frankel grading and Norton Pressure Sore Assessment scores. Results The number of patients who presented to the Spinal Unit over a 12-week period was 20, of this number 17 were males, three were females and all were black. Eleven patients were treated surgically while nine patients were treated conservatively. The most frequent aetiology of cervical spine fractures was motor vehicle accidents (n = 10) followed by falls (n = 9). The most common co-existing medical conditions were smoking (n = 7), HIV (n = 5), alcohol abuse (n = 3) and obesity (n = 3). The most frequent locations of cervical spine fractures were C2 (n = 6), C1 (n = 4) and the posterior column of C6 (n = 3), while dislocations occurred primarily at the C5-C6 levels (n = 5) of the lower cervical spine. Odontoid fractures (n = 6), Jefferson’s fractures (n = 4) and unilateral facet dislocations (n = 6) were the most common fractures and dislocations v observed. Head injuries (n = 4) and lower limb fractures (n = 3) were the most common extra-spinal fractures. All subjects who sustained head injuries also had associated C1 or C2 fractures. Neurological complications most frequently involved the upper limb where loss of motor function (n = 8) and weakness (n = 4) were observed. The majority of the patients (n = 8) reported a Frankel Grading of E. There were no significant associations between types of fracture and gender with the exception of fracture/dislocation observed in two females. There was a statistically significant difference in the NPSA score (p = 0.004). Conservative care utilized included soft collar (n = 6), cones calipers (n = 6), physiotherapy (n = 4), Minerva jacket (n = 4) and SOMI (sterno-occipital mandibular immobilization) brace (n = 1) while surgical intervention included anterior decompression (n = 8), anterior fusion (n = 8), allograft strut (n = 8), discectomy (n = 8), anterior cervical plating (n = 8), anterior screw fixation (n = 2), a transoral approach (n = 1) and a corpectomy (n = 1). The short-term post-conservative care complications observed in this study were an occipital pressure sore (n = 1), severe discomfort (n = 1) as well as severe neck pain (n = 1), while the short-term post-surgical complications were severe neck pain (n = 2), oral thrush (n = 1), pneumonia (n = 1), odynophagia (n = 1) and hoarseness (n = 1). Of the 11 patients who underwent cervical spine surgery, ten were sent for physiotherapy and one for occupational therapy. No significant associations were seen between the type of cervical spine fracture and the age of the subject. There was a significant association between fracture/dislocation and the female gender (p = 0.016). There was significant negative association between odontoid fracture and: anterior decompression, anterior fusion, allograft strut, discectomy and anterior cervical plating (p = 0.006). Conclusion The results of this study reflect the presentation and management of cervical spine fractures at a referral spinal unit of a public hospital in KwaZulu Natal. The impact of HIV and other co-existing medical conditions were not determined due to the small sample size in this study. Further epidemiological studies are required to be conducted in the Spinal Units of all South African public hospitals in order to confirm or refute the observation of this study. / National Research Foundation (NRF)

Dissertation submitted in partial fulfilment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Motion palpation is an examination technique commonly used by chiropractors to identify a manipulable subluxation prior to manipulation. In order for its continued use, it must be validated. Many studies conducted on motion palpation’s inter-examiner reliability in the spine have shown it to be below average, however only a few studies have addressed its use in the extremity joints. No inter-examiner reliability studies on motion palpation were found for the elbow, let alone the symptomatic elbow with regards to chronic lateral epicondylalgia, a common disorder of the elbow effectively treated by the use of manipulation. Objectives The objectives of this study were to determine the inter-examiner reliability of motion palpation of the elbow for the asymptomatic elbow and the symptomatic elbow with regards to chronic lateral epicondylalgia. It also aimed to compare these results to determine any difference in reliability, the number of manipulable subluxations and the presence of manipulable subluxations in particular directions, between the two groups. Method Twenty participants (n=40 elbows) between the ages of 18 to 65, with one asymptomatic and one symptomatic elbow (chronic lateral epicondylalgia) were examined by three final year masters chiropractic students for the presence of manipulable subluxations in end play, using only motion palpation. The examiners were pre-trained, randomised and blinded. Each examiner individually motion palpated both elbows on each participant, in nine directions of motion palpation, incorporating the humeroulnar and proximal radioulnar joints. They were also required to identify which elbow was symptomatic. Fleiss’ kappa and percentage agreement (perfect percentage agreement and mean percentage agreement) were used to measure reliability. Paired non parametric Wilcoxon signed ranks compared the difference between both groups and McNemar’s chi square tests assessed the percentage of correctly identified symptomatic elbows for each examiner. A p value <0.05 was considered statistically significant. iv Results The asymptomatic elbows showed a poor range of kappa results, from 0.0683 to -0.1321, with a mean kappa of -0.0664. Perfect percentage agreement was 50% to 85% and mean percentage agreement was 83.30% to 94.99%. The symptomatic elbows’ kappa values ranged between -0.2691 to 0.4034 with a mean kappa of -0.0028. The humeroulnar medial to lateral direction of motion palpation had a moderate kappa value of 0.4034. Perfect percentage agreement ranged from 10% to 85% and mean percentage agreement from 69.94% to 94.99%. There was an insignificant difference in kappa values between the two groups (p=0.260), although there was a trend towards the asymptomatic kappa values being lower than the symptomatic values. The difference between symptomatic and asymptomatic elbows was significant in proximal radioulnar posterior to anterior glide in pronation (p=0.013), as well as proximal radioulnar rotation of the radial head on the ulna (p=0.008). Overall, more manipulable subluxations were found in the symptomatic elbows than in the asymptomatic elbows. The examiners correctly identified the symptomatic elbow in 65% to 90% of participants (p=1.000). Conclusions and Recommendations In conclusion, the inter-examiner reliability of motion palpation in the asymptomatic elbow was poor, and in the symptomatic elbow (chronic lateral epicondylalgia), poor to moderate. There was an insignificant difference in reliability between the two groups, although more manipulable subluxations were found in the symptomatic elbows overall. These were mainly in proximal radioulnar posterior to anterior glide in pronation, as well as proximal radioulnar rotation of the radial head on the ulna, two directions of motion that form part of Mills’ manipulation. This study also found that examiners were able to identify the symptomatic elbows with the use of motion palpation. It is recommended that future research continue from this study in assessing the identification and presence of manipulable subluxations in all the extremity joints. However the methodological problems with the statistical analysis need to be addressed.

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Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners. / AFRIKAANSE OPSOMMING: Inleiding: Iliotibiale-band-sindroom (ITBS), ’n besering vanweë oormatige gebruik, is die tweede algemeenste hardloopbesering en die hoofoorsaak van laterale kniepyn by hardlopers. Namate die getal hardlopers wêreldwyd toeneem, neem die voorkoms van hierdie toestand ook toe. Hardlopers met ITBS ervaar tipies simptome ná die hakslag met die knie ongeveer 20-30° gebuig (die wrywingsone of “impingement zone”) gedurende die staanfase van hardloop. Verskeie intrinsieke en ekstrinsieke risikofaktore kan ’n rol speel in waarom sommige hardlopers meer geneig is as ander om gedurende die wrywingsone simptome te ervaar. Abnormaliteite in hardloopbiomeganika is ’n intrinsieke risikofaktor wat reeds omvattend in die literatuur beskryf is. Tog is weinig bekend oor presies hoe dit met ITBS verband hou. Oogmerke: Die doel van hierdie stelselmatige ondersoek was om ’n sintese te bied van die jongste bewyse van die biomeganiese risikofaktore van ITBS. Hierdie risikofaktore kan dalk oorweeg word om ITBS by hardlopers te voorkom of te bestuur. ’n Kliniese algoritme word ook aangebied. Metodes: ’n Stelselmatige ondersoek is met behulp van meta-ontleding onderneem. PubMed, PEDro, SPORTSDisc en Scopus is elektronies deurgesoek vir literatuur wat tot en met Mei 2014 verskyn het. Deursnee en kohortstudies is ingesluit indien dit gehandel het oor die biomeganika in die onderste ledemate van hardlopers wat ITBS het of later ontwikkel het. Alle studies wat deel was van die ondersoek is metodologies geëvalueer. Bewyse is aan die hand van bewysvlak, bewyskonsekwentheid en kliniese impak beoordeel. Data is narratief beskryf met behulp van tabelle of narratiewe opsommings waar dit toepaslik was. ’n Meta-ontleding is onderneem waar biomeganiese risikofaktore in minstens twee studies aangemeld is, mits daar homogeniteit in die uitkomste sowel as die steekproewe was. Resultate: Altesaam 11 studies is ingesluit (een prospektief en tien deursnee). Die metodologiese telling van die studies was oorwegend gemiddeld. Verhoogde spitsheupadduksie en interne knierotasie gedurende die staanfase kan op die ontwikkeling van ITBS by vrouehardlopers dui. Hierdie biomeganiese risikofaktore kan dalk nagegaan word vir ITBS-voorkoming, al was die bewysbasis beperk tot ’n enkele studie. Daar is tans geen afdoende bewys dat enige van die biomeganiese parameters oorweeg behoort te word in die bestuur van langafstandatlete met ITBS nie. Gevolgtrekking: Daar bestaan dalk biomeganiese verskille tussen hardlopers wat ITBS het of kan ontwikkel en gesonde hardlopers. Hoewel ’n groot verskeidenheid biomeganiese risikofaktore beoordeel is, is die bewysbasis vir die toets of bestuur daarvan by atlete met ITBS beperk. Dít is vanweë die klein hoeveelheid bewyse, die klein kliniese impak, en heterogeniteit tussen studie-uitkomste en bevindinge. Verdere prospektiewe en deursneenavorsing word vereis om te bepaal of abnormaliteite in hardloopbiomeganika ’n rol kan speel in waarom langafstandhardlopers ITBS ontwikkel, of om vas te stel watter risikofaktore ter sprake kan wees in die bestuur van hierdie hardlopers.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction ACL injuries are among the most serious injuries that professional and amateur sports men and women sustain. More than 120 000 ACL injuries occur annually in the USA alone. The highest incidence of ACL injuries are seen in multi-directional and multi-factorial sports such as soccer, basketball, lacrosse, American football, rugby and Australian rules football. It is hoped that the proposed review will clarify issues relating to the effect of fatigue on knee control, as it will focus on multiple movements found in different sporting codes. By including both studies on healthy adults as well as subjects who have sustained ACL injuries, a clearer picture can be formed on the global effect of fatigue on knee control. Objective The objective of this review was to identify, collate and analyse the current evidence on the effect of fatigue protocols on knee control during functional tasks, such as side-stepping, bilateral jumping/landing and crossover-cutting. Methodology A comprehensive search of electronic databases was conducted between April 2013 and August 2013 (updated in April 2014) for eligible articles for inclusion in the review. Methodological quality was assessed using a modified Downs and Black checklist. Results Ten studies met the eligibility criteria and were included in the review. The included studies reported a wide variety of fatigue protocols. Several different test movements were utilised in the studies. The test movements included cutting movements, drop jumps, stop jumps, vertical jumps, bilateral drop landing and rotational movements. The overall results indicated that fatigue had a negative impact on knee control. There were however studies which reported conflicting results. Gender differences were also highlighted in the results of included studies where it became evident that females tend to be more susceptible to knee injuries due to altered kinematics as a result of fatigue. Conclusion Fatigue generally seems to affect knee control negatively across various fatigue protocols. Future research should investigate using a standardised fatigue protocol to achieve more accurate and consistent results during the different functional activities. / AFRIKAANSE OPSOMMING: Nie beskikbaar