Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005. xiii, 115 leaves / One of the most common clinical disorders known is mechanical low back pain (Painting et al. 1998:110). A significant source of low back pain is the sacroiliac joint and therefore, according to Schwarzer et al. (1995:31), it warrants further study. With respect to treatment, Gatterman (1995) states that specific manipulative therapy is the treatment of choice for sacroiliac dysfunction. This is supported by clinical studies (Cassidy et al., 1992), which have shown significant improvement with daily manipulation over a 2-3 week period in 90% of the patients suffering from sacroiliac dysfunction. Different adjusting techniques for the sacroiliac joint include side posture adjustment and prone drop piece adjustments (Bergmann, 1993). With respect to side posture, Bergmann (1993) further states that the side posture adjustment is the most common position used. However, it has been noted that side posture can produce unwanted rotation in the lumbar spine. This may be detrimental to patients who have contra-indications to torsioning such as abdominal aortic aneurisms, nerve root entrapment or disc pathology. Patients, who experience anterior catching of the hip capsule or decreased flexibility with side posture adjustments, experience more discomfort and could therefore benefit from a different technique (Gatterman, 1995). Hence the need for an effective adjustment technique that does not rely on torsioning (e.g. drop piece technique). (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Although drop table thrusting techniques were rated as being effective for the care of patients with neuromuskuloskeletal problems (Haldeman et al., 1993) as cited by Gatterman et al., (2001), it is still unknown which specific drop piece technique is the most appropriate for sacroiliac dysfunction. Therefore this study was aimed at determining the efficacy of a toggle recoil drop piece adjustment technique.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / The low back and the lower limb are generally viewed as two isolated regions, however, there are many authors who believe that these two regions are functionally related. This is due to the two regions being connected to each other through the kinematic chain of the lower extremity. The lumbar spine is the link between the lower extremities and the trunk, and plays a significant role in the transfer of forces through the body via the kinematic chain. The physical link between the low back and the lower limb is supplied by the thoracolumbar fascia, which plays an important role in the transfer of forces between the spine, pelvis and legs. Although a relationship between the lower extremity and low back pain is often assumed, little research has been published to demonstrate the association. Most of the evidence so far has been anecdotal, without scientific research to support it. This study was designed to compare the relative effectiveness of lumbar spine manipulation, compared to combined lumbar spine and subtalar manipulation for the treatment of chronic mechanical low back pain, using subjective and objective measures, for the management of chronic mechanical low back pain. The study design was a quantitative clinical trial, using purposive sampling. It consisted of forty voluntary participants with chronic mechanical low back pain. There were two groups of twenty participants each, each of whom received six treatments within a three week period. Group A received manipulation of the lumbar spine only, whilst Group B received manipulation of both the lumbar spine and subtalar joint. The outcome measures included the response of the participants to the Numerical Pain Rating Scale-101 and the Quebec Low Back Pain and Disability Questionnaire. Objective data was obtained from three digital Algometer measures. Data was collected prior to the initial, third and sixth treatment. iv Statistically both groups showed improvements, subjectively and objectively, with regards to chronic mechanical low back pain. Inter-group testing for NRS over time showed no significant effect for both treatment groups. There was a significant treatment effect for Algometer Average TP1 while the treatment effect for Algometer Average TP2 was not significant. However, inter-group testing for the Quebec LBP over time showed no significant effect for both treatment groups. Inter-group analysis demonstrated no statistical significance between the two groups for subjective and objective measurements, thus suggesting that there is no additional benefit in treating the subtalar joint in the management of mechanical low back pain. Further studies will also benefit greatly from the use of larger sample sizes to improve statistical relevance of data.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The aim of this research was to investigate the relative effectiveness of manipulation versus core rehabilitation in the treatment of acute mechanical low back pain in sedentary patients. Recent research has found that dysfunction of the primary core stabiliser muscles is linked with an increasing number of the general population suffering from low back pain; this is thought to be due to the fact that people in general are living more sedentary lifestyles. The Aims and Objectives of this study were to determine the relative effect of manipulation and core rehabilitation in sedentary patients suffering from acute mechanical low back pain in terms of subjective findings, objective findings and to determine any correlations between these findings Thirty-two participants, with acute low back pain participated in the study. They received treatment over a period of three weeks, two treatments in the first week, two treatments in the second week and a follow up seven days later. Group A received a spinal manipulation while Group B received core rehabilitation exercises. Readings were taken at three time points, namely visit one, three and five before the treatment, they included the following readings: Numerical Pain Rating Scale, Algometer, Roland Morris Low Back Pain and Disability Questionnaire, Biofeedback Stabiliser and the Surface EMG. The results showed that there was no differential (p<0.05) treatment effect between the two Groups, and that both Groups showed a clinical improvement in their low back pain. In conclusion, it appears that even though both these treatment protocols have very different mechanisms of action, both can be effective treatment protocols and that core rehabilitation exercises when properly performed are as effective as manipulation in the treatment of acute low back pain.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Wong and Deyo (2001) believe that 98% of the LBP cases are musculoskeletal (mechanical) in origin and 51,7% of these individuals are chronic sufferers (Andersson, 1999). Weak spinal stability muscles have shown to be an aetiological cause (Chok, Lee and Latimer, 1999). Wolff, Weinik and Maitin (2003) agree a combination of brace aided pelvic stabilization combined with a spinal stability programme may be the best treatment intervention for chronic low back pain (CLBP). Objective: The purpose of this research was to determine the relative effectiveness of three treatment protocols with (Group A-Groovi-SI-Belt®; Group B-standard SI belt) and without (Group C-control) brace aided pelvic stabilization in patients with CLBP. Method: Forty-six patients suffering from CLBP were randomly allocated to one of the three treatment groups. A spinal stability programme was progressively taught and enforced in all three groups. Weekly follow-up consultations were required to assess subjective and objective outcomes of the three treatment interventions. Outcomes were obtained by using the Numerical Pain Rating Scale (NRS); Quebec disability scale; Active straight leg raiser test; Biofeedback device and the static trunk extensor endurance test. Results: Data was analysed using the SPSS version 15.0 (SPSS Inc. Chicago, Ill, USA).Comparing pre and post outcome measurements using a p value <0.05 which was considered to be statistically significant. All three treatments improved most outcomes significantly over time. The Groovi-SI-Belt® showed non significant trends of quicker rates of improvement. . Conclusion: This study revealed that brace aided pelvic stabilization combined with a spinal stability programme was a beneficial treatment intervention with the Group A being superior to Group B.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non - specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the nonspecific effect in the healing encounter by manipulating the practice setting in which the patients were treated. This was achieved using a prospective, randomised, comparative clinical experiment consisting of 60 individuals with Low Back Pain (LBP), selected by convenience sampling. Individuals were then divided into 2 groups of 30. The IV first group's treatment consisted of the standard diversified method of manipulation in a Clinical Research Setting, and the second group received the same treatment except the treatment took place in a Normal Practice Setting. / M

Partial Dissertation in compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Aims and Objectives: The aim of this study was to determine whether spinal manipulation affects the perceived performance of runners with low back pain. More specifically, the objective was to determine whether any relationships existed between spinal manipulation, a runner’s perceived performance and their low back pain. Method: Twenty subjects who ran thirty kilometers a week and had LBP were selected for a pre- post- cohort study according to criteria set out beforehand. The subjects received spinal manipulation applied to their lower back twice a week for a period of two weeks. At each consultation, they were requested to fill out a “Perception of Running Performance” questionnaire prior to each treatment, and one week following the final consultation. / M

M.Tech. (Chiropractic) / Chronic lower back pain is a very common condition affecting 60-80% of the worlds’ population at sometime in their lives. Manual therapy, including chiropractic manipulation, has been proven to be very successful in the treatment of chronic lower back pain and reduction in muscle tension. Although chiropractic treatment alone is effective in the treatment of chronic lower back pain, chiropractors often search for adjunctive modalities to enhance the positive outcomes of their treatment. Kinesio® tape application to the lumbar para-spinal muscles has been proven to be effective in increasing lumbar range of motion and in decreasing lower back pain. The purpose of this study was to determine whether the combination of Chiropractic manipulation and Kinesio® taping of the lumbar para-spinals is a more efficient, and possibly effective, treatment protocol in the treatment of chronic lower back pain. Method: This study was a comparative study and consisted of three groups of ten participants. The participants were between the ages of eighteen and forty years of age, with a male to female ration of 1:1. The potential participants were examined and accepted according to the inclusion and exclusion criteria. Group 1 received chiropractic manipulative therapy to the lumbar spine and sacroiliac joints. Group 2 only received the application of Kinesio® tape to the lumbar para-spinal muscles. Group 3 was the combination group, and received chiropractic manipulative therapy to the lumbar spine and sacroiliac joints together with the application of Kinesio® tape to the lumbar para-spinal muscles. Subjective measurements consisted of the Numerical Pain Rating Scale and the Oswestry Pain and Disability Index and objective measurements was range of motion of the lumbar spine. Procedure: Treatment consisted of seven consultations over a three week period. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations before treatment. Subjective readings were taken from the Numerical Pain Rating scale and the Oswestry Pain and Disability index.Objective Readings were taken from measurements taken from the Digital Inclinometer device measuring lumbar range of motion. At the first to sixth consultation participants each received their groups’ specific treatment protocol, the seventh consultation consisted of data collection only.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / The low back and the lower limb are generally viewed as two isolated regions, however, there are many authors who believe that these two regions are functionally related. This is due to the two regions being connected to each other through the kinematic chain of the lower extremity. The lumbar spine is the link between the lower extremities and the trunk, and plays a significant role in the transfer of forces through the body via the kinematic chain. The physical link between the low back and the lower limb is supplied by the thoracolumbar fascia, which plays an important role in the transfer of forces between the spine, pelvis and legs. Although a relationship between the lower extremity and low back pain is often assumed, little research has been published to demonstrate the association. Most of the evidence so far has been anecdotal, without scientific research to support it. This study was designed to compare the relative effectiveness of lumbar spine manipulation, compared to combined lumbar spine and subtalar manipulation for the treatment of chronic mechanical low back pain, using subjective and objective measures, for the management of chronic mechanical low back pain. The study design was a quantitative clinical trial, using purposive sampling. It consisted of forty voluntary participants with chronic mechanical low back pain. There were two groups of twenty participants each, each of whom received six treatments within a three week period. Group A received manipulation of the lumbar spine only, whilst Group B received manipulation of both the lumbar spine and subtalar joint. The outcome measures included the response of the participants to the Numerical Pain Rating Scale-101 and the Quebec Low Back Pain and Disability Questionnaire. Objective data was obtained from three digital Algometer measures. Data was collected prior to the initial, third and sixth treatment. iv Statistically both groups showed improvements, subjectively and objectively, with regards to chronic mechanical low back pain. Inter-group testing for NRS over time showed no significant effect for both treatment groups. There was a significant treatment effect for Algometer Average TP1 while the treatment effect for Algometer Average TP2 was not significant. However, inter-group testing for the Quebec LBP over time showed no significant effect for both treatment groups. Inter-group analysis demonstrated no statistical significance between the two groups for subjective and objective measurements, thus suggesting that there is no additional benefit in treating the subtalar joint in the management of mechanical low back pain. Further studies will also benefit greatly from the use of larger sample sizes to improve statistical relevance of data.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1997. / There have been few studies performed to determine the combined effects of spinal manipulative therapy with other modalities known to have beneficial physiological effects, especially in terms of mechanical low back pain (Ottenbacher and Difabio 1985). / M

Dissertation submitted in compliance with the requirement for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / The purpose of this study was to compare the effects of McMannis traction and Intermittent traction, both m conjunction with chiropractic manipulation in the treatment of chronic i.e. longer than four weeks, mechanical lower back pain. It was hypothesised by the author that McMannis traction would be the traction treatment of choice, as it enables the joints of the lumbar vertebrae to be moved through their normal anatomical range of motion while being traeticned axially. In addition this type of traction is more specific and allows the therapist to determine the amount of traction that is being applied to the patient because it is being applied manually. Intermittent traction on the other hand is a motorised non-specific traction and affects several joints at one time (Saunders 1979). / M