M. Tech. / Background: No substantiated theory exists by which chiropractic adjustments are known to correct myofascial trigger points (MTrPs). Myofascial trigger points are theorized to be either a primary muscle dysfunction or a secondary manifestation to central/ peripheral neurological mechanisms. Chiropractic adjustments are theorized to exert their therapeutic influence either primarily through biomechanical effects and/ or via neurophysiological mechanisms. Objective: The objective of this study was to investigate the effects of chiropractic adjustments on chronic, active rhomboid MTrPs, by comparing the clinical effects attained with rhomboid attachment-segment (C7-T5) relative to rhomboid innervation-segment (C4 and/ or C5) chiropractic adjustments. Setting: University of Johannesburg Chiropractic Day Clinic in Johannesburg, Gauteng. Participants: Thirty female subjects selected from the general population (from 18 to 40 years) were randomly divided into two different treatment groups of 15 each. Methods: The subjective information required the completion of the Subjective Pain and Discomfort Questionnaire, including the Numerical Pain Rating Scale (NPRS). The objective measures collected were pressure-pain threshold (PPT) and range of motion measurements using the algometer and digital inclinometer, respectively. Additionally, the change in the number of active MTrPs over the treatment period was recorded. All measurements were recorded at the first, third and fifth consultations, over a 3 to 4 week period. The data gathered were then statistically analyzed with the use of a 95% confidence interval. The nonparametric Friedman and Wilcoxon Signed Rank tests were used for the intragroup comparisons, and the Mann Whitney- U test was used for the intergroup comparisons. Interventions: Treatment group 1 received upper-thoracic/ attachment- segment chiropractic adjustments, and treatment group 2 received mid-cervical/ innervation-segment chiropractic adjustments. The research project was carried out so that both groups received 5 treatment sessions over 3 to 4 weeks. Results: There were no statistically significant results obtained for intergroup comparisons. Attachment-segment chiropractic adjustments revealed statistically significant changes in NPRS values (p=0.000), PPT values (p=0.000), cervical spine right lateral flexion range (p=0.004), thoracic spine extension (p=0.005) and left rotation range (p=0.003) over time. Innervationsegment chiropractic adjustments revealed statistically significant changes in NPRS values v ii (p=0.001), cervical spine right rotation (p=0.003), thoracic spine flexion (p=0.001) right lateral flexion (p=0.001) and left rotation (p=0.005) over time. Conclusions: This study does not suggest that attachment-segment or innervation-segment chiropractic adjustments possess greater clinical efficacy relative to one another in terms of improving the clinical picture associated with chronic, active rhomboid MTrP activity. In a further study, a larger sample size will be necessary to identify subtle changes in measurement parameters.

M. Tech. / Abstract Purpose: The purpose of this study was to assess the effects of Diversified Chiropractic adjustments versus Flexion-Distraction Technique in the management and treatment of chronic Lumbar Facet Syndrome. Method: This study consisted of two groups, Group A and Group B, each consisting of 15 participants with chronic Lumbar Facet Syndrome. The participants were between the ages of 20 and 45 years. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Group A received Diversified Chiropractic Adjustments and Group B received Flexion-Distraction Technique to the lumbar facets. Procedure: Each participant was treated eight times over a period of four weeks. Before the commencement of treatment one, four and eight, the participants completed the Oswestry Low Back Pain and Disability Index questionnaire and the Visual Analogue Scale. A Digital Inclinometer was used to measure lumbar spine ranges of motion. Diversified Chiropractic adjustments were then administered to Group A based on the restrictions obtained during motion palpation. Flexion-Distraction Technique was administered to Group B based also on the restrictions that were obtained during motion palpation. Results: Objective statistically significant differences were noted on flexion and left lateral flexion ranges of motion before treatment, and clinically significant differences we noted on flexion and right lateral flexion after treatment, in favour of Group A. Subjective readings also showed statistically significant differences with regards to Oswestry Low Back Pain and Disability Index and Visual Analogue Scale in favour of both Group A and Group B. Conclusion: The results of the study indicate that both Diversified Chiropractic adjustments and Flexion-Distraction Technique have a positive effect on patients suffering from chronic Lumbar Facet Syndrome. However, Diversified Chiropractic adjustments proved to have a greater overall benefit compared to Flexion-Distraction Technique in the management and treatment of Lumbar Facet Syndrome.

M.Tech. / Purpose: This study aims to compare the effects of spinal manipulative therapy to the lumbar spine and/or pelvis, and spinal manipulative therapy to the lumbar spine and/or pelvis in conjunction with the application of transcutaneous flurbiprofen patches in the treatment of sub-acute/chronic mechanical low back pain with regards to pain, disability and lumbar spine and pelvic range of motion. These effects were based on a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Questionnaire, and on lumbar spine range of motion (ROM) readings taken using a digital inclinometer. The questionnaire was completed and the ROM readings taken prior to treatment on the first, fourth and seventh consultations.

Thesis (M.Tech.: Chiropractic)--Dept. of Chiropractic, Durban Institute of Technology, 2006. / Brunarski (1984) says that philosophically and historically, chiropractic has been uniquely orientated toward an emphasis on preventative care and health maintenance with a mechanistic and hands-on model for treatment. Instead of reductionism, chiropractors focus on holism, non-invasiveness and the sharing of the responsibilities for healing between doctor and patient. As stated in a Canadian report by Manga et al. (1993), lower back pain is a ubiquitous problem and there are many epidemiological and statistical studies documenting the high incidence and prevalence of lower back pain (Manga et al., 1993). Evans and Oldreive (2000) revealed in a study of the transversus abdominis that low back pain patients had reduced endurance of the transverses abdominis and that its protective ability was decreased. In addition, it was noted that wasting and inhibition of the other core stabiliser and co-contractor, multifidus, was present (Hides et al.,1994), both of which have been linked to the presence of low back pain (Evans and Oldreive, 2000 and Hides et al., 1994). Thus, it stands to reason that manipulation, as an effective treatment for low back pain (Di Fabio, 1992), could be effective in restoring the strength and endurance of the core stability muscles. This is theoretically supported by the fact that a restriction in motion and pain due to mechanical derangement in the low back can be effectively treated by manipulation (Sandoz, 1976; Korr (Leach, 1994); Herzog et al., 1999; Homewood, 1979; Vernon and Mrozek, 2005 and Wyke (Leach, 1994)). Homewood (1979) described that a subluxation may interfere with the nerve supply and result in a decrease in muscular activity. He hypothesized that removal of the subluxation could restore: normal physiological processes, increase muscle activity and; improve functional ability and normalize the torque ratios (Herzog et al., 1999; Korr (Leach, 1994); Nansel et al., 1993 and Rebechini-Zasadny et al., 1981). In terms of an intervention, Rebechini-Zasadny et al. (1981) and Naidoo (2002) demonstrated and inferred that manipulation to the cervical spine could affect the muscular activity supplied by those levels. They, however, suggested further studies of manipulation-induced peripheral changes in the muscles are needed, due to unaccounted for variables and small sample sizes in their respective studies This research aims to address the questions posed by the above literature, hence by investigating a high velocity low amplitude manipulation as a possible added intervention for improving local core stabilizer muscle strength, a management protocol for the chronic mechanical lower back pain could be developed. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / 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. / M

M.Tech. (Chiropractic) / PURPOSE: Shoulder pain has been identified to be one of the most common musculoskeletal problems found in a variety of different countries, showing characteristics of chronicity and recurrence. It is considered to be a main contributor towards nontraumatic upper limb pain. One of the identifiable causes of chronic or reoccuring shoulder pain may be attributed to myofascial pain syndrome which is caused by MTrP’s and produces symptoms that are similar to that of other shoulder pain syndromes. The infraspinatus muscle as an integral component of the rotator cuff complex is subject to high tension biomechanical strain as well as neuromuscular tension. While therapeutic interventions have been devised to treat varying degrees of biomechanical and neuomuscular tension, little evidence exists establishing which of these treatment regimes is most effective in treating myofascial trigger points. The purpose of this study was to compare different regional chiropractic adjustments relative to the attachment site and the innervation segment of the infraspinatus muscle and to identify the most effective treatment protocol with regard to chronic, active infraspinatus myofascial trigger point dysfunction. DESIGN: A selection of thirty participants were recruited for this study. The participants were divided into two groups of fifteen participants each. Group A received a chiropractic adjustment to the glenohumeral joint, the attachment site for infraspinatus muscle. Group B received a chiropractic adjustment to the cervical spine segments associated with the innervation to the infraspinatus muscle. Cervical spine restrictions specific to levels C4/C5 and/or C5/C6, and glenohumeral joint restrictions were determined using motion palpation techniques. All participants received a total of six treatments over a three-four week period. MEASUREMENTS: Subjective measurements were obtained by the Functional Rating Index Questionnaire and the Numerical Pain Rating Scale. Objective measurements were obtained using the hand-held pressure algometer and counting the number of active infrapsinatus myofascial trigger points. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the Functional Rating Index Questionnaire for the intragroup analysis indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (15.5%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (68.8%). The intergroup analysis indicated that there were no statistically significant differences. vii With regard to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (21.7%). There were no statistically significant differences with the intergroup analysis. The intragroup and intergroup analysis of the number of active infraspinatus myofascial trigger point dysfunction showed no statistically significant differences between the groups or within each of the groups over time. CONCLUSION: The results showed that both treatment groups protocols were effective in reducing chronic, active infraspinatus myofascial trigger point dysfunction. Small differences were noted between the two treatment groups with regards to the subjective and objective findings. The glenohumeral joint adjustment group showed the greatest clinical and statistical improvements over the three-four week trial period.

M.Tech. / This research study was conducted as an unblinded controlled pilot study. The aim of this research was to investigate the effects of Chiropractic adjustive therapy on lower back pain in South African Police Service (SAPS) operational mounted policemen in Gauteng. The participants for this research where obtained from the Johannesburg, East Rand, Vaal Rand and Pretoria SAPS Mounted units. Only male participants were recruited and placed into one group where they received Chiropractic adjustive therapy to the restricted Lumbar and Sacroiliac joints. Thirty participants were treated 6 times over a 3-week period, which translated to 2 treatments per week. A two day follow-up visit (visit 7) was conducted to obtain only subjective and objective data, no treatment was administered. An important part of this study was that the duties of the participants continued as usual and were not stopped during this trial. Subjective data was collected using the Oswestry Pain and Disability Questionnaire. Objective data was collected using lumbar range of motion (with a Digital Inclinometer) in flexion, extension, lateral flexion and rotation. All data was collected during the 1st, 4th and 7th visits. Additional data was collected by enquiring about the saddle type and stirrup length that the participants used. The data collected was analysed using Maunchly and Greenhouse Tests for parametric tests and the Friedman and Wilcoxon Signed Rank Tests for the non-parametric tests. The results of this study concluded that Chiropractic adjustive therapy was effective in relieving or completely eliminating the lower back pain of the participants as well as increasing there lumbar spine range of motion.

M. Tech. / It is well known internationally that the high prevalence of back pain costs the economies of the world many billions of dollars annually. This has prompted a great deal of research abroad into means of reducing the deleterious economic effects of back pain. One of the results of this research is the realisation that Chiropractic treatment of back pain offers an efficacious and cost effective alternative to the conventional medical treatments currently employed in most countries. To this end there has been a move, by health management organisations in the USA and Canada, toward the integration of Chiropractic into their health care systems in a gatekeeper role with notable success in terms of cost reduction. Similar research has not been conducted in the Republic of South Africa and, notwithstanding the evidence emerging from abroad, Chiropractic, although integrated into many health care systems, remains inaccessible to most back pain sufferers, particularly those employed in the lower ranks of industry. This is in large part due to the unavailability of Chiropractic services in the more remote areas of the country where many mines are situated, but also partly due to the lack of incentive for mining companies to make use of Chiropractic services. The data used in this study was obtained from the in-house medical aid of a reputable South African mining company. The data was used to summarise the cost of treatment of selected categories of back pain by the various service providers within the medical fraternity. The medical costs were then compared to the similarly summarised Chiropractic cost of treatment for the same categories of back pain. The results indicate that Chiropractic costs compare favourably with those of the General Practitioner (GP) and Physiotherapists on a stand alone basis. The data indicates however that the medical approach invariable leads to specialist referral that in turn often results in surgery with the associated imaging, theatre and hospitalisation costs. When these costs are considered it becomes obvious that Chiropractic involvement at an early stage has the potential to considerably reduce the cost of treatment of back pain.

M.Tech. (Chiropractic) / The purpose of this study is to evaluate whether action potential simulation (APS) therapy is more effective than placebo therapy in terms of pain relief and improvement in lumbar spine range of motion when treating chronic lumbar spine pain. The comparison of the two therapies was accomplished by objective and subjective assessments. The study was conducted by means of a double blind clinical trial with two experimental groups. Thirty subjects eighteen years of age and older who suffered from chronic lumbar spine pain were chosen from the general population who responded to the advertisements and from Tarentaal Home for the Aged. The researcher examined each of these subjects in order to be accepted into the study. Each subject was treated ten times over a two-week period and underwent a one-month follow-up consultation to be re-examined. Subjects in both groups received therapy for eight minutes at an amplitude of 1-2mA. Only the APS group received the electric current and the placebo group did not receive the electric current. The objective assessment was by means of measurement of the lumbar spine ranges of motion using an inclinometer. The subjective assessment was measured by means of two questionnaires, which are widely accepted in the research community namely: a) Oswestry Low Back Pain and Disability Questionnaire b) McGill Pain Questionnaire. The results, which were obtained, were statistically analyzed using the Mann-Whitney Rank Sum test (inter-group comparison) and the Wilcoxon Signed Rank test (intra-group comparison). Graphs were created using the actual values of each patient in each group and using the medians obtained. The study concluded that both the APS and the placebo group improved in terms of lumbar spine range of motion and pain relief even though not all the results were statistically significant. The graphs representing the mean values at the first, final and one-month follow-up consultations of each group showed the apparent improvement in terms of range of motion in the lumbar spine and pain relief. The APS group's mean values, at the above mentioned consultations, showed a greater improvement in range of motion and pain relief when being compared to the placebo group's mean values that are represented on the respective graphs.

M.Tech. (Chiropractic) / This study aims to determine whether muscle energy technique of the psoas muscle can be used as an effective treatment for low back pain with lower crossed syndrome or whether it is better to be used alone or in conjunction with spinal adjustments with regards to pain and disability, lumbar range of motion and degree of lumbar lordosis. Thirty participants who met the inclusion criteria were randomly allocated to one of three different groups of ten participants each. Group 1 had muscle energy technique performed on the psoas muscle of each participant. Group 2 received spinal adjustment/s over the restricted joint/s in the lumbar spine. Group 3 received spinal adjustment/s over the restricted joint/s in the lumbar spine in conjunction with muscle energy technique on the psoas muscle. All participants were assessed over a four week period. All groups attended six treatment sessions over three weeks of which muscle energy technique and/or spinal manipulation was performed. In the fourth week only measurements were taken and no treatment was administered.Subjective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a digital inclinometer for assessing active lumbar range of motion and a flexible ruler for measuring the degree of lumbar lordosis. Analysis of collected data was performed by a statistician.Statistically significant improvements were seen in Groups 1, 2 and 3 over the duration of the study with regards to pain, disability and lumbar range of motion as well as degree of lumbar lordosis. The data gathered in this study showed statistically significant changes in Groups 1, 2, 3 with regards to lumbar range of motion, lumbar lordosis, pain and disability, with Group 3 showing the most statistically significant changes with regard to pain and disability...