M.Tech. (Chiropractic) / Aim: The aim of this study was to determine the effectiveness of chiropractic spinal manipulative therapy to the thoracic spine or stretch and strengthening exercises (stretching the pectoralis major muscle and strengthening the rhomboid, middle and inferior trapezius muscles), versus the combined treatment of chiropractic spinal manipulative therapy to the thoracic spine in conjunction with the stretch and strengthening exercises. This would then establish which treatment approach was the most effective in improving postural kyphosis with regards to a change in thoracic curvature over time. Method: A total of thirty female participants volunteered to take part in this study. All the participants were between the ages of twenty and thirty nine. The participants were randomly placed into one of three groups, each group consisted of ten participants. Group 1 received chiropractic spinal manipulative therapy to the thoracic spine. Group 2 received chiropractic spinal manipulative therapy to the thoracic spine as well as stretch and strengthening exercises i.e. stretching the pectoralis major muscles and strengthening the rhomboid, middle and inferior trapezius muscles. Group 3 received stretch and strengthening exercises. The stretch and strengthening exercises were performed in the consultation rooms to ensure that the participants were complying with the treatment and doing the exercises properly. Procedure: In this study group 1 participants received treatment once a week for 6 weeks. Groups 2 and 3 participants received 3 treatments a week for 6 weeks. Postural advice was given to all 3 groups. One final follow-up visit was done in the 7th week where no treatment was administered but only data collection was done. Objective data was recorded at the beginning of the first, fourth and seventh consultations for Group 1 and the first, tenth and nineteenth consultations for groups 2 and 3. Objective data included the Flexicurve® Ruler measurements for the angle of kyphosis. Visual analysis was done by taking lateral (sagittal) view photographs at the beginning of the initial and final consultations. Results: Statistical analysis performed included the non-parametric tests to determine if significant results were found over time. The Friedman and Wilcoxon Signed Rank tests were performed for the intragroup analysis and the Kruskall-Wallis test for the intergroup analysis. Statistical analysis revealed significant statistical changes for the intragroup results for all 3 groups. No significant statistical difference was found between the groups for the intergroup analysis. Conclusion: The study showed that all three treatment protocols for groups 1, 2, and 3 were effective. However, group 1 had not shown a great improvement in their postural kyphosis. Group 3 had shown a VII relatively good improvement in their posture. Group 2 had shown the best results with regards to improvement of the participants’ posture. Therefore in conclusion group 2 and 3 treatment protocols can be used effectively to treat postural kyphosis but group 2’s treatment protocol consisting of chiropractic spinal manipulative therapy to the thoracic spine in combination with stretch and strengthening exercises will yield the best results.

M.Tech. (Chiropractic) / Purpose: The aim of this study was to compare the effects of chiropractic adjustment versus mobilization to the cervical spine in participants with chronic cervical facet syndrome with regards to neck pain, cervical spine range of motion and position sense. Method: Thirty participants, male or female between the ages of 18 and 45 years, diagnosed with cervical facet syndrome were used in the study. The thirty participants were divided into two groups consisting of fifteen individuals each, ensuring equal male to female and age ratios. Group 1 received chiropractic adjustments over the restricted joints to the cervical spine. Group 2 received mobilization over the restricted joints to the cervical spine. The trial consisted of seven visits over a treatment period of three weeks, of which the first six visits the participants received treatment and the seventh visit served the purpose of obtaining the final data. The data was gathered on the first, fourth and seventh visits. Subjective data was obtained by using the Vernon-Mior Neck Pain and Disability Index and the Visual Analogue Scale for pain intensity. Objective data consisted of measuring cervical spine range of motion with a CROM instrument and Laser Pointer Device to measure head repositioning accuracy (position sense). Results: Subjective results indicated that group 1 (chiropractic adjustment) proved to be the most effective treatment protocol in decreasing neck pain intensity by 92%, and neck pain disability index by 65.7%. Group 2 (mobilization), also showed good results with a decrease in neck pain intensity by 53.9%,and neck pain disability index by 23.8%. Subjective results produced statistically significant results with VAS score (p= 0.000) for both groups and NDI score (p=0.000) for group 1 and (p=0.002) for group 2. Objective results also proved that chiropractic treatment was most effective in increasing cervical spine range of motion by 21.9% (right rotation) and 21.07% (left rotation). In group 2 by 9.93% (right rotation) and 12.72% (left rotation). Results were statistically significant for both groups with CROM score (p=0.002) for group 1 (right rotation) and (p= 0.000) (left rotation). Group 2 CROM score (p=0.040) (right rotation) and (p= 0.007) (left rotation). Objective results also proved that chiropractic adjustment was most effective in improving position sense by 76.54% (right rotation) and 72.06% (left rotation). In group 2 by 38.01% (right rotation) and 13.03% (left rotation). Results were statistically significant for group 1 with Kinesthetic Sensibility Test score (p=0.000) (right rotation) and (p=0.002) (left rotation). In group 2, the result for right rotation was statistically significant with (p=0.019) and not statistically significant for left rotation with (p=0.167). Both subjective and objective results showed that although group 2 produced statistically significant results, group 1 showed the best clinical results overall. Thus it was noted that in order to obtain a vii lasting increase in range of motion of the cervical spine, a decrease in neck pain and disability and an improvement in position sense, the treatment protocol used for group 1 should be the treatment of choice. Conclusion: Based on the results of the study, it was concluded that chiropractic adjustment was more effective than mobilization in the treatment of cervical facet syndrome. This conclusion is based on the results that chiropractic adjustment was more effective in all the objective and all the subjective measurements. However, this does not rule out mobilization as a treatment for neck pain, because mobilization treatment did show improvement in cervical spine ROM, a decrease in pain and slight improvement in position sense although not as efficiently as chiropractic treatment.

M.Tech. (Chiropractic) / PURPOSE: The aim of the study was to compare the effectiveness of treating inter-scapular pain with either chiropractic adjustments delivered to the costovertebral joints, with ischaemic compression of the myofascial trigger points of the rhomboid muscles, or using a combination treatment protocol in order to determine which of the three treatment protocols was superior. DESIGN: This study was a comparative study consisting of three groups of ten participants each. Participants were between the ages of eighteen and forty-five and there was an equal male to female ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. A McGill Pain Questionnaire, numerical pain rating scale, a clinical case history, full physical examination, a cervical regional examination were completed. The method of treatment for each participant was determined by random group allocation. Group 1 received chiropractic adjustments to the costovertebral joints, Group 2 received ischaemic compression to the myofascial trigger points of the rhomboid muscles. Group 3 received a combination treatment involving both chiropractic adjustments to the costovertebral joints together with ischaemic compression of the rhomboid trigger points. Subjective and objective readings were based on the above treatment protocols. All participants received a total of six treatments over a three week period. MEASUREMENTS: Subjective measurements were obtained by the Numerical Pain Rating Scale and the McGill Pain Questionnaire. Objective measurements were obtained using the hand-held pressure algometer. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the McGill Pain Questionnaire for the intragroup analysis indicated that the ischaemic compression group showed the greatest improvement over time (84.06%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the adjustment group showed the greatest improvement over time (78.70%). The intergroup analysis indicated that there were no statistically significant differences. With regards to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the ischaemic compression group showed the greatest improvement over time (35.44%). Once again, there were no statistically significant differences with the intergroup analysis. CONCLUSION: Based on the results of this study, it showed that all three treatment groups were effective in decreasing inter-scapular pain and disability. Although all three treatment protocols have shown to be effective, and have shown similar improvement, intergroup analysis indicates that statistically there is no treatment protocol that is seen to be more superior or more effective in treating inter-scapular pain.

M.Tech. / The most common cause of chronic cervicogenic headache is believed to be mechanical pain from the muscles, ligaments and joints of the upper cervical spine (Hubka and Hall, 1994). Much controversy and debate surrounds all aspects of cervicogenic headache, including the aetiology and treatment of these headaches. The purpose of the study was to determine the effectiveness of chiropractic spinal manipulation of the upper cervical spine alone as a treatment form for cervicogenic headache, with regards to pain, disability and cervical spine range of motion. Method: This study consisted of a single group of thirty participants between the ages of eighteen and thirty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The only method of treatment administered to each participant was chiropractic manipulation, delivered to restrictions of the upper cervical spine, from which the objective and subjective findings were based. Procedure: Treatment consisted of seven consultations, with two consultations being performed per week. Objective data and subjective data was taken at the beginning of the first, fourth and seventh consultations. Objective data consisted of cervical range of motion readings taken using a Cervical Range of Motion measuring instrument (CROM). The subjective data collected was in the form of a Vernon-Mior Neck Pain and Disability Index and a Numerical Pain Rating Scale. Spinal manipulative therapy based on restrictions identified during motion palpation was applied at the first six consultations with the seventh consultation consisting of data gathering only. Results: Clinically and statistically, significant improvements in the entire group were noted over the course of the treatment with regards to cervical range of motion, pain and disability. Conclusion: The results show that upper cervical spine manipulation is effective, both clinically and statistically, in decreasing pain and disability and increasing cervical spine vi range of motion in those with cervicogenic headache. As the study consisted of a small group of participants treated as a single group, further study is needed in the form of randomised, controlled clinical trials.

M.Tech. / Purpose: To determine the effect of Chiropractic spinal manipulative therapy (SMT) compared to that of fascial treatment on Superficial back line (SBL) fascial line restrictions. It has been suggested that a fascial line restriction can cause a decrease in performance and lead to over – use injuries. Methods: A randomised study design with thirty asymptomatic male participants, which were moderate to highly active as indicated by the International Physical Activity Questionnaire (IPAQ). Participants were divided into two equal groups, group A (n=15) received Chiropractic SMT of the lumbar spine and Sacroiliac joints, group B (n=15) were treated with Direct Release Myofascial Technique to the restricted SBL. The study design consisted of seven consultations, with intervention being applied at each consultation. Objective data was obtained by the Bunkie test and Range of Motion testing which determined the participant‟s level of endurance and fascial line restriction. Objective data was obtained before and after the first intervention, after intervention on the fourth consultation and on the seventh consultation, which did not include intervention. The short term effect was represented by comparing the before values of consultation one (baseline) to consultation seven. The immediate effect of intervention was represented by the before versus the after measurements of consultations. Results: The objective results showed that there was a short term and immediate improvement in Lumbar range of motion for both groups and a short term and immediate improvement in Bunkie test times of both groups, except for the immediate effect of group B, which decreased the Bunkie test time. With the Bunkie test group A showed an immediate mean improvement of 2.4 seconds (11.3%) on the right and 2.3 seconds (4.9%) on the left. With the Bunkie test group A showed a short term mean improvement of 9 seconds (41.8%) on the right and 10.1 seconds (44.1%) on the left. Group B showed no immediate mean improvement for the Bunkie test and a short term mean improvement of 3.3 seconds (19%) on the right and 2 seconds (10.9%) on the left.

M.Tech. / The aim of this study was to determine whether Chiropractic cervical spine and/or upper thoracic adjustments had an effect on eye-hand co-ordination in asymptomatic participants presenting with cervical and/or upper thoracic spine dysfunction. Forty eight asymptomatic participants took part in this study. The participants were divided into three groups of sixteen participants each, each group consisting of eight male and eight female participants. Group 1 participants received Chiropractic adjustive therapy to dysfunctional segments in the C0-C3 spinal segments and C5-T1 spinal segments. In Group 2 the participants received Chiropractic spinal adjustive therapy to dysfunctional spinal segments in the C0-C3 region. Group 3 acted as the control group and participants received detuned ultrasound applied to the posterior cervical spine region. Two computer tests were involved in this study, namely the 2HAND test and the B19 test which had to be completed successively. The subjects were allowed to have a trial run each time they were tested to get a “hand’s-on feel” for the equipment. After the trial run the participants were tested, their respective treatment was carried out and the participants were then re-tested. Overall the study was able to show that Chiropractic adjustive therapy had no effect on eye-hand co-ordination in asymptomatic participants. Group 1 did not show any greater improvement in eye-hand co-ordination when compared to Group 2 where Group 1 received upper cervical spine and upper thoracic adjustments and Group 2 received only upper cervical adjustments. Gender was seen to play a significant role in the study, mainly during the B19 test. Overall it can be said that Chiropractic adjustive therapy had no effect on speed (OMD) or accuracy (OPED) during the test. Future research is needed on the possible effects of Chiropractic adjustive therapy on speed and accuracy as the study design showed some potential positive influences but may have been merely due to coincidence because of the small sample sizes. When testing eye-hand co-ordination it was noted that after the participants received Chiropractic adjustive therapy the length of mistakes in percent (LMP) decreased, meaning that the participants were able to correct any mistakes made at a faster rate after receiving Chiropractic adjustive therapy, but only when delivered to the spinal levels C0-C3 and/or C5-T1 (i.e. Group 1) for male participants only. Statistically significant results were noted when testing the number of mistakes made (NM) but only for male participants receiving Chiropractic adjustments to the C0-C3 levels only (i.e. Group 2). Future research needs to be done on the gender discrepancies noted for the different manner that Chiropractic adjustive therapy affected the different genders.

M.Tech. / This study compared the effectiveness of two different Chiropractic treatment protocols in the treatment of patellofemoral pain syndrome. This was done in order to establish whether or not core stabilisation exercises play a role in the treatment of patellofemoral pain syndrome. Thirty participants were used for this study. They were randomly placed into two groups namely; group 1 and group 2. Group 1 received strengthening exercises of the quadriceps muscle group and stretching exercises of the hamstring muscles. Group 2 received strengthening of the quadriceps muscle group, stretching of the hamstring muscles and core stabilisation exercises. Six treatments were administered over a period of three weeks with each participant receiving two treatments per week. Prior to the commencement of treatments one, three and six; each participant was objectively measured for quadriceps strength using the isometric dynamometer. The subjective measurements used in this study were the Numerical Pain Rating Scale and the Patellofemoral Joint Evaluation Scale, these were also completed prior to the first, third and sixth treatments. All the collected data was statistically analysed using the one-way Anova test, the Independent-t test and the Paired-t test. The statistical analysis revealed statistical differences on intra-group analysis for both groups involved especially between treatment 3 and treatment 6 for both the objective and subjective measurements. On Inter-group analysis group 2’s subjective and objective measurements improved by a larger amount than group 1’s. It was thus concluded that a combined treatment of quadriceps strengthening, hamstring stretching and core stabilisation exercises was the most effective treatment protocol in individuals suffering from patellofemoral pain syndrome.

M. Tech. / Objective: This study was conducted in order to compare the effectiveness of Chiropractic spinal manipulative therapy (SMT) combined with guided imagery versus only guided imagery in the treatment of chronic neck pain and stiffness. Chiropractic SMT is aimed at treating neck pain as well as increasing the range of motion (ROM) of the neck. Guided imagery is aimed at reducing stress levels within the patient with a secondary effect of reducing tension in the neck muscles. This study therefore also has a secondary purpose to assess the effects of stress on chronic neck pain. It was hypothesised that Chiropractic SMT combined with guided imagery would be more effective in the reduction of chronic neck pain than guided imagery or alone. This is based on the fact that Chiropractic SMT has been exhaustively proven to be effective in treating chronic neck pain as well as increasing cervical range of motion. Guided imagery has also been proven to be effective in reducing stress even though there has not been enough research on its effect on chronic neck pain and cervical range of motion. Methods: Patients were recruited by means of placing advertisements in and around the University of Johannesburg. Patients that presented to the Chiropractic day clinic with chronic neck pain between the ages of 18 and 30 were included in this study. The participants were then randomly placed in one of two groups. Group A received four sessions of Chiropractic SMT combined with two sessions of guided imagery while Group B received two sessions of guided imagery relaxation techniques and four sessions of detuned ultrasound (U/S). The researcher performed all the sessions of Chiropractic SMT and detuned U/S while Dr A. Fourie (a registered Counselling Psychologist) performed the Guided Imagery sessions. In the initial visit patients in both groups had to undergo a history taking, physical examination and cervical spine regional examination. They were required to sign subject information and consent form and complete a Neck Disability Index (NDI) Questionnaire, Numerical Pain Rating Scale and the Stress Questionnaire. The researcher measured their cervical range of motion on the first and last treatments. The objective and subjective data was collected on the first visit and again on the final visit.

M.Tech. (Chiropractic) / The aim of this study is to compare Chiropractic Manipulative Therapy of the lumbar spine combined with Therapeutic Ultrasound Therapy over the adjacent lumbar paraspinal muscles to ascertain the most effective protocol in the treatment of Chronic Mechanical Lower Back Pain. Thirty participants with Chronic Mechanical Lower Back Pain between the ages of 18 and 35 years were recruited. Successful participants were randomly placed in two groups, of fifteen participants each, which would receive different treatment protocols according to their group allocation. Group One received Chiropractic Manipulative Therapy to lumbar spine restrictions. Group Two received Chiropractic Manipulative Therapy to the lumbar spine restrictions as well as Therapeutic Ultrasound Therapy to the adjacent paraspinal muscles. The participants completed a total of seven visits, including 6 treatments over 3 weeks. Subjective and Objective readings were taken on the first, fourth and seventh visits. Subjective readings from each participant were recorded using the Oswestry Disability Iindex and Numerical Pain Rating Scale. Objective readings were taken and recorded three times consecutively using a Pressure Algometer over the adjacent lumbar paraspinal muscles and a Digital Inclinometer to measure lumbar spine range of motions. The statistical data was analysed using the Friedman test, Mann-Whitney test and the Bonferroni test. The results demonstrated overall that both groups responded favourably to their specific treatment protocols, however no significant differences between groups was noted, highlighting the positive effects of the manipulation alone.

M.Tech. (Chiropractic) / The aim of this study was to compare the effectiveness of two different treatment methods for myofascial pain and dysfunction syndrome of the Gluteus Medius muscle. This was done in order to determine whether or not a combined treatment of the integrated neuromuscular inhibition technique (INIT) and sacroiliacjoint (SU) adjustive therapy was more effective than the INIT applied in isolation, in the treatment of the Gluteus Medius myofascial pain and dysfunction syndrome (OMMPDS). Participants were recruited using advertisement posters placed throughout the University of Johannesburg Doomfontcin Campus and were treated at the University of Johannesburg Chiropractic Day Clinic. Thirty participants, between the ages of eighteen and fifty years, who were suffering from lower back pain and presented with Gluteus Medius rnyofascial trigger points (Trl's) and an SIJ dysfunction were selected for the study. They wcre randomly assigned into one of two groups, consisting of fifteen subjects each. as they entered into thestudy. Group one received the INIT to the affected Gluteus Medius muscle. Group two received a combination of the INIT to the affected Gluteus Medius muscle and an SIJ adjustment. Patients attended four sessions over a period ofeight days and were treated on all of these sessions. Subjective and objective data were recorded on all sessions. Subjective data was recorded using the McGill Pain Questionnaire and the Numerical Pain Rating Scale. Objective data was recorded using the Universal Goniometer, to measure hip ranges of motion of the affected Gluteus Medius muscle, and the Wagner Pressure Algometer to measure pain-pressure threshold of the affected Gluteus Medius muscle Trl's, All of the data were statistically analyzed using Repeated Measures and Independent t-Tcsts, P-values were calculated to determine the statistical significance of the datu. The results of the study indicate that both treatment methods nrc effective in treating GMMPDS. However a combined treatment approach of INIT and SIJ adjustive therapy was more effective in achieving a greater therapeutic response compared to INIT alone.