Background: Epidemiological findings indicate a higher risk of muscular thigh strain injury during the latter stages of both halves of soccer match-play, with muscular fatigue highlighted as a key etiological factor in injury causation. Anthropometric, biomechanical and physiological differences present in the Black African population may elicit unique thigh injury risk profiles, different from those of European and American players. Objectives: The purpose of the current research was to investigate the impact of soccer-specific fatigue on the risk of hamstring and quadricep injury in amateur Black African soccer players, in both the dominant and non-dominant legs. Methods: Participants were required to perform a soccer matchplay simulation (SAFT⁹⁰), consisting of multidirectional and utility movements, as well as frequent acceleration and deceleration. Selected physical, physiological and psychophysical responses were collected at specific time intervals throughout fatigue protocol performance. Results: Heart rate responses were observed to increase significantly (p<0.05) in response to the start of both halves, and remain elevated (but showing no further significant increase) during the performance of the remainder of the fatigue protocol. Significant (p<0.05) changes in both concentric and eccentric isokinetic variables of the knee flexors and extensors highlight the effect of muscular fatigue on performance in soccer match-play. Eccentric hamstring peak torque was observed to decrease significantly over time (60°.s⁻ₑ=17.34%, 180°.s⁻ₑ=18.27%), with significant reductions observed during both halves. The functional H:Q ratio at 180°.s⁻ₑ indicated a significant decrease over time (10.04%), with a significant decrease indicated during the second half of the SAFT⁹⁰ protocol. The passive half time interval did not result in significant changes in isokinetic variables. Isokinetic strength, work and power indicated no significant effects of leg dominance.. ‘Central’ and ‘Local’ ratings of exertion were observed to increase significantly (p<0.05) as a function of exercise duration. Conclusion: The overall reduction in both the eccentric hamstring peak torque and the functional strength ratio was illustrated to be similar to that of other soccer-specific fatigue research. As a result, the risk of thigh strain injuries is suggested to be similar regardless of playing level and race. These time dependent changes may have implications for competitive performance and increased predisposition to hamstring strain injuries during the latter stages of both halves of match-play

Dissertation submitted in compliance with the requirements for the Masters Degree in Chiropractic at the Durban University of Technology, 2009 / Occupational injuries sustained by Emergency Rescue Care workers have been well documented. However, despite their high rates of injury, the literature regarding the risk factors for work-related musculoskeletal injuries (WRMSIs) in the fire service has not been well-established, especially in South Africa. Objectives: To determine the prevalence and risk factors for musculoskeletal injuries in the Durban Metropolitan Fire Department and to evaluate the relationship between selected risk factors and the prevalence of musculoskeletal injuries. Methods: This was a descriptive study from a large urban Fire Department employing 350 active firefighters. Using a cross sectional study design, a retrospective analysis investigated the musculoskeletal injury prevalence from 2006-2008 by means of a questionnaire. Individuals reported on demographics, injury location, injury etiology, injury nature, extent of treatment rendered and time lost from work. Additionally, data was obtained regarding smoking, occupational stress, fitness, protective gear and injury prevention advice given by the Durban Metropolitan Fire Department. A 41% response rate was achieved. Results: The point prevalence of WRMSIs was 33.6% and the period prevalence was 81.1% of the sample. Low back injuries (47.9%) and strain injuries (40.8%) were the most common, followed by knee (22.5%), shoulder (19.7%) and ankle injuries (19%). The most common causes included lifting heavy objects, working in awkward postures and running. Weight, ethnic group, stress, lack of nutritional advice and alcohol consumption were all significantly associated with the prevalence of injuries. Ex-smoking was significant in the prevalence of low back injuries, stress was significant in the prevalence of knee injuries and alcohol consumption was associated with the prevalence of shoulder injuries. Conclusion: WRMSIs are of great concern in the fire service as their prevalence is substantial. Evaluation and implementation of further preventative measures and advice based on the results of this study can be effective in reducing WRMSIs.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Running injuries are increasingly common as participation in this sport increases. Health care providers need to be better able to treat and manage these injuries and prevent their recurrence. Thus, there is a need for profiles of different population groups to enable the development of health promotion and injury prevention strategies. This research study profiled and tracked runners over seven marathons held in the eThekwini and uMgungundlovu Municipalities during the first quarter of 2014. Methods: This Durban University of Technology, Institutional Research and Ethics Committee approved retrospective Chiropractic Treatment Facility record analysis, analysed 741 recorded marathon visits. The records were based on a previously validated data collection tool (CSSA questionnaire) that allowed clinical data to be captured relating to patient demographics, anatomical site of the complaint, clinical impression, diagnosis and treatment. These fields were analysed for each visit, and then captured in SPSS version 22 with records only being excluded because they were unsigned. Descriptive and inferential statistics (McNemar’s tests) were compiled and a p-value of 0.05 was used. Results: The majority of the runners were Black males of approximately 40 years of age. A total of 95.6% of runners presented with overuse injuries, of which 73.6% and 89.3% had no history of previous injury or trauma respectively, and with 94.7% being able to continue participation. The shin and calf (21.7%), thigh (21.6%) and lumbar regions (16.1%) were most commonly affected by injuries which were predominantly muscle strains (23.2%) and SI syndrome (21.4%). These injuries were treated by manipulation (82.8%), massage (57.2%) and PNF stretching (33.6%). With runners that presented at subsequent marathons, a significant difference (McNemar’s p=0.013) in history of previous injury between the first and second marathon was found, with the runner being more likely to report a history of previous injury at their second marathon visit. Specific trends, although not significant, were found for specific subgroups (defined by age, gender, ethnicity, history of previous injury / trauma and chronicity of the diagnoses). Conclusion: The data is not dissimilar to the literature on running injuries, although specific trends in terms of sub categories were noted. These trends require further investigation through prospective, longitudinal studies. / M

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 There has been a remarkable increase in the participation of sport for athletes with disabilities. Consequently, there have been many international studies on injuries in athletes which have shown a high prevalence in wheelchair basketball, largely attributed to the fast-paced, high intensity nature of the sport. This sport has grown worldwide including South Africa, however, very little research has been published on South African wheelchair basketball players and more research is, therefore, needed. Aim To determine the prevalence and profile of musculoskeletal pain in elite wheelchair basketball players of different point classifications in South Africa. Hypothesis 1: Upper extremity (including neck and back) pain is experienced more commonly in lower point classified wheelchair basketball players than in higher point classified players. Hypothesis 2: Lower extremity pain is experienced more commonly in higher point classified players than in lower point classified players Method This study was a quantitative, cross-sectional, questionnaire-based study. The questionnaire comprised of sub-sections on demographics and disability characteristics; activity levels pertaining to wheelchair basketball and other sport/physical activity; the prevalence of pain and the impact thereof on wheelchair basketball and/or activities of daily living. This questionnaire was administered to 48 wheelchair basketball players who were competing in the 2015 Supersport League. A response rate of 70% was decided as the lower limit cut-off for statistical power. Results Fourty-three participants responded yielding an 89.58% response rate. The mean age of participants was 33.3 (SD:9.5) years and the majority of participants (n=35) were male and African (n=29). Out of the 43 participants, 79.1% (n=34) used mobility devices, the majority (n=20) used wheelchairs. Most of the participants (n=41) played wheelchair basketball for more than five years and 32 participants did not participate in other sport. Almost half of the participants (n=25) experienced musculoskeletal pain in the last twelve months or at present, 75% of whom (n=12) visited a Physiotherapist for the pain. More than half of these participants (n=15; 60%) reported that the pain negatively affected their basketball performance. It was established that arm pain occurred frequently in lower point classified players (1.0-2.5 point players) and that hand and wrist pain was also more prevalent in lower point players than in higher point players. The prevalence of lower extremity pain was low and there was no statistically significant difference between higher and lower point classified players. Conclusions and Recommendations The finding that upper extremity pain occurred more frequently in lower point classified players was in keeping with the first hypothesis (the null hypothesis was, therefore, rejected). The second hypothesis was, however, rejected (and the null hypothesis was, therefore, accepted) as lower extremity pain did not occur more frequently in higher point classified players than in lower point classified players. The Eta scores may have been higher and may have shown a much larger than typical relationship between point classification and the prevalence of musculoskeletal pain had there been a larger sample size. Notwithstanding this limitation, it is a challenge to obtain a significantly larger sample size due to the nature and limited number of participants in this sport. More studies are warranted on this group of individuals, as a large number experienced pain which affected more than half of the participants’ performance in wheelchair basketball. These studies are important for the future success of the South African players and the sport in South Africa. / M

Background: The hippocampus and corpus callosum have been shown to be vulnerable in head injury. Various neuroimaging modalities and quantitative measurement techniques have been employed to investigate pathological changes in these structures. Cognitive and behavioural deficiencies have also been well documented in head injury. Aims: The aim of this research project was to investigate structural changes in the hippocampus and corpus callosum. Two different quantitative methods were used to measure physical changes and neuropsychological assessment was performed to determine cognitive and behavioural deficit. It was also intended to investigate the relationship between structural change and neuropsychology at 1 and 6 months post injury. Method: Forty-seven patients with head injury (ranging from mild to severe) had undergone a battery of neuropsychological tests and an MRI scan at 1 and 6 months post injury. T1-weighted MRI scans were obtained and analysis of hippocampus and corpus callosum was performed using region-of-interest techniques and voxel-based morphometry which also included comparison to 18 healthy volunteers. The patients completed neuropsychological assessment at 1 and 6 months post injury and data obtained was analysed with respect to each assessment and with structural data to determine cognitive decline and correlation with neuroanatomy. Results: Voxel-based morphometry illustrated reduced whole scan signal differences between patients and controls and changes in patients between 1 and 6 months post injury. Reduced grey matter concentration was also found using voxel-based morphometry and segmented images between patients and controls. A number of neuropsychological aspects were related to injury severity and correlations with neuroanatomy were present. Voxel-based morphometry provided a greater number of associations than region-of-interest analysis. No longitudinal changes were found in the hippocampus or corpus callosum using region-of-interest methodology or voxel-based morphometry. Conclusions: Decreased grey matter concentration identified with voxel-based morphometry illustrated that structural deficit was present in the head injured patients and does not change between 1 and 6 months. Voxel-based morphometry appears more sensitive for detecting structural changes after head injury than region- of-interest methods. Although the majority of patients had suffered mild head injury, cognitive and neurobehavioural deficits were evidenced by a substantial number of patients reporting increased anxiety and depression levels. Also, the findings of relationships between reduced grey matter concentration and cognitive test scores are indicative of the effects of diffuse brain damage in the patient group.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Classical ballet is an art form that seems graceful on the surface. However, beneath the disguise of beauty and ease lies an extremely physically demanding activity that calls for dedication, strength and perseverance. Ballet requires a specific body type and precise techniques, which predispose the dancer to musculoskeletal injury. Although a few studies have been conducted to investigate biomechanical factors as risk factors for injury in ballet dancers, few have included amateur ballet dancers and a range of biomechanical factors. Objectives: This study aimed to determine characteristics of ballet-related injury in amateur ballet dancers in the greater Durban area; to measure and record lower limb biomechanical measurements of these dancers; and to identify associations between the biomechanical measurements and characteristics of injury in the population. Method: A quantitative, questionnaire-based survey with biomechanical measurements was conducted on 21 amateur ballet dancers in the greater Durban area. Statistical analysis included the description of categorical variables using frequency and percentages in tables and bar charts. Continuous variables were summarised using mean, standard deviation and range, or median and range as appropriate. Independent Sample T-tests were used to compare biomechanical measurements between two independent groups. A p value <0.05 was considered as statistically significant. Pearson’s correlations and ANOVA testing were also used. Results: The period prevalence of ballet-related injury over the last 2 years was found to be 62% and the point prevalence 38%. There were 37 total previous injuries, most of which occurred in the hamstring (24%). Most of the worst previous injuries were reported to have occurred in the low back (31%). Most of the worst previous (70%) and current (93%) injuries occurred over time. The worst previous injuries reported ranged from mild to severe in severity, while the worst current injuries reported ranged from mild to moderate. Significant associations were found between right weight-bearing ankle dorsiflexion and previous injury; right weight-bearing ankle dorsiflexion and current injury; ‘functional turnout’ and onset of injury; right non weight-bearing ankle dorsiflexion and onset of injury; and ‘compensated turnout’ and onset of injury. Conclusion: The results suggest a significant association between musculoskeletal ballet-related injury and reduced weight-bearing ankle dorsiflexion; between injuries that occur over time (overuse injuries) and decreased ‘functional turnout’; and between overuse injuries and decreased non weight-bearing ankle dorsiflexion. These findings may help identify risk factors for injury in ballet dancers and contribute towards preventing ballet-related injury. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Classical ballet is an art form that seems graceful on the surface. However, beneath the disguise of beauty and ease lies an extremely physically demanding activity that calls for dedication, strength and perseverance. Ballet requires a specific body type and precise techniques, which predispose the dancer to musculoskeletal injury. Although a few studies have been conducted to investigate biomechanical factors as risk factors for injury in ballet dancers, few have included amateur ballet dancers and a range of biomechanical factors. Objectives: This study aimed to determine characteristics of ballet-related injury in amateur ballet dancers in the greater Durban area; to measure and record lower limb biomechanical measurements of these dancers; and to identify associations between the biomechanical measurements and characteristics of injury in the population. Method: A quantitative, questionnaire-based survey with biomechanical measurements was conducted on 21 amateur ballet dancers in the greater Durban area. Statistical analysis included the description of categorical variables using frequency and percentages in tables and bar charts. Continuous variables were summarised using mean, standard deviation and range, or median and range as appropriate. Independent Sample T-tests were used to compare biomechanical measurements between two independent groups. A p value <0.05 was considered as statistically significant. Pearson’s correlations and ANOVA testing were also used. Results: The period prevalence of ballet-related injury over the last 2 years was found to be 62% and the point prevalence 38%. There were 37 total previous injuries, most of which occurred in the hamstring (24%). Most of the worst previous injuries were reported to have occurred in the low back (31%). Most of the worst previous (70%) and current (93%) injuries occurred over time. The worst previous injuries reported ranged from mild to severe in severity, while the worst current injuries reported ranged from mild to moderate. Significant associations were found between right weight-bearing ankle dorsiflexion and previous injury; right weight-bearing ankle dorsiflexion and current injury; ‘functional turnout’ and onset of injury; right non weight-bearing ankle dorsiflexion and onset of injury; and ‘compensated turnout’ and onset of injury. Conclusion: The results suggest a significant association between musculoskeletal ballet-related injury and reduced weight-bearing ankle dorsiflexion; between injuries that occur over time (overuse injuries) and decreased ‘functional turnout’; and between overuse injuries and decreased non weight-bearing ankle dorsiflexion. These findings may help identify risk factors for injury in ballet dancers and contribute towards preventing ballet-related injury. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background Dog agility has become one of the most popular canine sport disciplines, growing annually with many owners enrolling their canines without an educated understanding of what the sport of agility entails. Various factors have been identified that can contribute to the injury of the agility dog, these include coming into contact with the agility equipment, the experience of the dog, nutrition, supplementation, handler training in warm up technique and participation in additional sporting activities such as flyball, and risk factors such as breed, sex and age of the dog have been shown to have an impact on the prevalence and type of injury that sporting dogs are at risk for, most commonly, injuries to the shoulder, wrists, hip and an extensive range of soft tissue injuries. There is a significant knowledge gap in the literature that describes injury prevalence, profiles and the potential risks facing the sporting canine participants in a South African context and that, as more and more owners are seeking out CAM therapies such as chiropractic, literature is needed in order to enable these owners and veterinary chiropractors to better understand the risk that the sport of agility entails. Chiropractic treatment can offer both treatment and prevention, from enhancing the performance of the canine athlete, allowing them to compete more effectively and for a longer period at national and international level, to improving the quality of life of the geriatric canine patient. Aim The aim of this study is to determine the prevalence and selected risk factors of musculoskeletal conditions affecting working canines registered in the herding breed category in Kwa-Zulu Natal. Study Design This study was a cross sectional, prospective survey of sporting canine owners registered with the KZNDAA. The study employed a quantitative descriptive design. Participants The study comprised of 70 dogs registered to 38 owners who are affiliated with the KZNDAA. Methodology Potential participants were identified on the KZNDAA membership list. These members were approached by the researcher at registered agility shows and invited to participate in the study. Once it has been established that the owners and the canines met the inclusion and exclusion criteria of the study, participants were required to sign a letter of information and confidentiality and a consent form and were included as participants in the study. The research questionnaire was then given to participants, who then completed the questionnaire on site and returned it by hand to the researcher. Data was captured on excel and transferred to IBM SPSS version 23. A p value of <0.05 was considered statistically significant. Descriptive statistics such as mean, standard deviation and range were used to describe continuous variables which were normally distributed, while median and inter-quartile range were used for skew variables. Categorical variables were summarized using frequency tables. Associations between lifetime prevalence and risk factors were tested using Pearson’s chi square tests for categorical risk factors, or Fischer’s Exact tests for continuous variables. Results The period prevalence of MS conditions was found to be 8.5% and the lifetime prevalence 45.8%. Injuries were found to occur most often during play, followed by injury during agility competition, a very small percentage of the injuries incurred were due to direct contact with agility equipment. Shoulders and hips were the areas most commonly affected, with arthritis and DJD being the most prevalent type of conditions and muscular strains being the most prevalent type of injury. The breed with the highest prevalence of injury was the Border Collie(63%). Neutered males had the highest prevalence of injury (52%), followed by spayed females (30%). The 8-10 year old category had the highest prevalence of injury (30%), followed by the 2-4 year old category (22%). Large breed dogs in the 15-20kg weight category had the highest prevalence of MS injury (40%). Dogs participating in dog jumping showed a decreased risk of MS injury, while dogs participating in flyball showed an increased risk of developing MS injuries. Handlers with training in specific warm up techniques showed a decreased risk of having dogs developing MS injury. Reverse casualty associations were found between the increased risk of MS injury and dogs fed on Hills specific diets, dogs supplemented with glucosamine and chondroitin, and dogs currently receiving anti-inflammatories. Conclusion The prevalence of musculoskeletal (MS) injuries in agility dogs in KZN is low when compared to studies done outside of South Africa. Factors such as breed, age, sex, and weight of the dog influence the prevalence of MS conditions. Risk factors influencing the development of MS conditions include contact with the equipment, nutrition, participation in other sporting activities and whether warm up periods are allowed. A larger population is needed in order to further analyse the risk of injury in sporting dogs in a South African context. / M