M.Dip.Tech. / Functional leg length discrepancies, as distinct from anatomical discrepancies, are often associated with sacroiliac joint dysfunction. This may result in back pain and discomfort. Chiropractors usually treat this condition using a side posture sacroiliac adjustment, but in some cases, an adjustment may not be indicated. This study aims to determine whether a Modified General Hip technique would be an acceptable alternative treatment. For this study, 30 patients who suffered from both the sacroiliac joint dysfunction and leg length discrepancy were chosen. They were treated using two differing chiropractic techniques on the sacroiliac joint: the side posture technique conventionally used to adjust _the sacroiliac joints, and a mobilisation and muscle stretch technique modified from the General Hip technique. Each patient was evaluated by a case history, lumbar and pelvic regional examination, and a pertinent physical examination...

This unblinded, controlled clinical trial was undertaken in order to demonstrate the advantage of education concerning low back pain in the labour intensive workplace and to show that education alone as well as in conjunction with chiropractic manipulative therapy, is a valuable time and cost-effective mechanism for reducing low back pain. This will be achieved by comparing comprehensive industrial back school (CIBS) in combination with chiropractic manipulative therapy (CMT) and CIBS in isolation. In the execution of the study it was hypothesised that both the treatment protocols would be effective in the treatment of low back pain, but that the combined therapy would be more effective due to the fact that the treatment protocol involving the combined treatment would be assessing and correcting lumbar spine pathomechanics. The patient base for the study was drawn from the technical services division (labour force) of the Technikon Witwatersrand in Johannesburg, South Africa. Patients were recruited by consulting the managers of the technical services departments at the Technikon Witwatersrand, and a presentation concerning low back pain was given to the labour forces involved in the technical services division, detailing the treatment protocols and the risks and benefits involved. After the presentation anyone suffering from low back pain was invited to participate in the study. Only males were included in the study, rendering the data more valuable relative to the small sample group. Thirty patients whom conformed to the diagnostic criteria and did not have any conditions that contraindicated CIBS or CMT were included in the study. The patients were divided into two groups according to where they worked (Doornfontein or Auckland Park campus). Fifteen (15) people were selected from each campus (both campuses are under the same labour demands). This situation was decided upon as to not allow cross contamination of the groups; it was also logistically more practical. The Doornfontein group (DFC) received CMT in combination with the CIBS. All fifteen patients attended one CIBS per week for four weeks; and received six CMT treatments over four weeks. The Auckland Park group (AKP) received the CIBS in isolation; also running once a week for four weeks. All patients (both groups) were assessed and data captured at the first week, fourth week and at a follow up visit one month after the final session (eighth week), where all the data was captured again. The subjective data was collected using the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Index. Objective data was obtained using the cervical and lumbar range of motion instruments (Goniometers) and a universal inclinometer. Anecdotal data was collected using a questionnaire. The data was analysed using “Jandell Scientific Sigma Stat and Sigma Plot 2.02”. The subjective results indicate that both treatment protocols were equally effective in reducing low back pain in men involved in labour intensive work. A statistically significant difference presented in both groups. The results indicated that in order to reduce the period of intense pain more rapidly, a combination of CMT and CIBS would be the treatment of choice. However the long-term benefit of both protocols was equally beneficial. This is believed to be as a result of education changing the way in which people live and work and therefore taking effect over a longer period but having a more lasting effect. The objective results indicate that the protocols were equally as effective in improving the patient’s range of motion. However it was noted that range of motion was seen to reduce over a shorter period of time in the DFC group (combined treatment protocols). Based on the results of this study, the protocols were equally effective in the long term. This is due to the fact that as patients are educated about caring for their backs in the work place, and during activities of daily living, the amount of times they place their backs in positions resulting in excessive loading is reduced, therefore resulting in a reduction in pain, disability and further pathology. / Dr. M.A. Khoury Mr. S. Nalla

The purpose of this study was three fold: 1. To determine the life time incidence, 6 month prevalence and point prevalence of Low Back Pain (LBP) in the work environment of ABSA Bank and compare it to the rest of the world. 2. To determine whether individual factors such as age, gender, body mass index and work environment factors like main daily position and activity could be causal factors contributing to LBP. 3. To determine whether treatment is sought, the type of care sought for LBP and the cost of sick leave due to LBP to the company. A Review of the data indicates that LBP is a condition that 60-80% of people will suffer from at some stage in their lives. Epidemiological studies have shown that simple backache has a point prevalence and 1-month prevalence of 15-30% and 30-40% respectively. (1, 2, 3) LBP could be caused by many disorders of the spine, but for many sufferers no causative diagnosis will be made. There are a large number of occupational causes that could lead to the development of LBP. The major causes are the following: forceful lifting of heavy objects, twisting coupled with bending of the trunk, whole body vibration and heavy manual work. (60) There are a number of causal factors of LBP that are non work related such as personal risk factors including age, gender, fitness level, trauma to the back, cigarette use and recreational activities (60). LBP is seen to be one of the most common ailments affecting people, but most do not seek medical attention. Those patients who do seek medical attention seem to seek the help of the following specialities: physicians, chiropractors, nurses, orthopaedic surgeons, neurosurgeons, physical therapists or alternative medical practitioners. (20) Researchers in the USA, in 1992 found that 73.1% of LBP sufferers sought medical care, while many saw a multiple variety of health care providers. Of those people who sought medical care, 64% consulted a general practitioner, 55% consulted an orthopaedic surgeon, 29% consulted a physical therapist and 25% consulted a chiropractor. (8) A cross sectional, systematic random sample to study the incidence and prevalence of low back pain (LBP) was conducted on 355 employees of ABSA Bank and Unibank. The data was collected by the researcher by means of a personal interview. A permission letter from ABSA Bank Health Clinic (Appendix A) was used to gain access to those who needed to be interviewed in the sample group. The data was recorded on a questionnaire (Appendix B) and a low back diagram (Appendix C) was used to define LBP so that it would be easier to understand. The results of this study showed that the lifetime incidence of LBP was 63% (225/355), the 6 month prevalence of LBP was 41% (147/355) and the point prevalence of LBP was 9.6% (34/225). The major daily activity that was associated with the 6 month prevalence of LBP was computer type work at 93.88% (138/147); this was followed by telephonic work at 65.31% (96/147). Physical and administrative work was only reported to have caused LBP in 4.76% (7/147) and 22.45% (33/147) of the sample population. The major daily position that was associated with the 6 month prevalence of LBP was sitting - 97.28% (143/147). This was followed by walking - 61.64% (90/147), standing - 17.69% (26/147) and lifting-t 6.57% (9/147). Treatment was sought by 46.94% (69/147) of the sample population that suffered from LBP in the last 6 months. Treatment was sought from the pharmacy in 21.99% (31/141) of the cases. Chiropractors were consulted in 8.51% (12/141) of the cases; medical doctors were consulted in 14.89% (21/141) of the cases, physiotherapists in 17.02% (24/141) of the cases, while acupuncture and private hospitals were used by only 0.71% (1/141) of those who suffered from LBP. Biokinetics, homeopathy and osteopathy were three other disciplines that were on the questionnaire, but none of these disciplines were made use of by the study population. This study showed that the lifetime incidence, six month prevalence and point prevalence of LBP in the South African workplace is similar to other countries in the world and that this condition is costing the South African economy millions of rand each year due to lost working days as a result of absenteeism. The only individual factor that seemed to be statistically significantly associated with LBP was trauma to the lumbar spine. Other factors like age, gender and race did not seem to have statistically significant effects on the prevalence of LBP. The results regarding the individual factors that could lead to LBP seem to vary between the different studies evaluated. Just under half of those who suffer from LBP seek treatment for the condition. When evaluating what kind of treatment is used by the study population, it was seen that the majority used drugs from the pharmacy to treat the condition. / Dr. B. Losco Dr. M. Moodley

The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only). / Dr. B. Losco Dr. C. Lyons

This study was conducted in order to determine the effectiveness of ischaemic compression and myofascial dry needling in the treatment of lower back pain due to an active trigger point in the quadratus lumborum muscle. It was also conducted in order to compare the effects of ischaemic compression to the effects of myofascial dry needling of an active trigger point to determine which of the two treatment protocols was superior. It was hypothesised that ischaemic compression and myofascial dry needling would have a positive outcome on the subjective and objective findings in patients with lower back pain. Participants were recruited into the study by the use of advertisements placed in local newspapers and at the University of Johannesburg’s Chiropractic Day Clinic. Thirty patients who conformed to the specified limitations and diagnostic criteria were accepted. These patients were randomly placed into two groups of fifteen patients each. Group one received ischaemic compression and group two received myofascial dry needling. Each patient received six treatments over a three week period, therefore two treatments per week. The subjective data, which was the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the readings on the algometer, measuring the pressure threshold of trigger points. All the algometer readings were statistically analysed using repeated measures tests. These tests were conducted on a 95% confidence level (P<0.05). The results of this study indicate that both treatment protocols were very effective for the treatment of quadratus lumborum myofascial trigger points and lower back pain. Based on the results of this study, ischaemic compression and myofascial dry needling are suggested treatments for myofascial trigger points associated with lower back pain, however ischaemic compression proved to be significantly the most effective. / Dr. S. Wilcox Dr. M. Moodley

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 2002. / Tension-type headache is generally accepted as the most common form of headache and has been shown to have a great impact on work and social activities (Shwartz et al. 1998). Tension-type headache occurs in 39% of people who suffer from headache symptoms with a higher incidence among females, and a peak in the 25-44 year old age group (Wong et al. 1995). The purpose of this study was to investigate the relative effectiveness of 1000mg acetaminophen (paracetamol) combined with 130mg caffeine as opposed to cervical manipulation as a treatment for tension-type headache. / M

Cervicogenic headache is a disorder that is gaining more recognition in the medical field annually. Although a lot of controversy surrounds cervicogenic headache due to its wide array of symptoms and overlap with pre-existing primary headaches, there are many etiologies and treatment procedures that currently exist. The aim of this study was to determine the most effective treatment protocol for cervicogenic headache by comparing three different research trials from the University of Johannesburg Chiropractic day clinic (former Technikon Witwatersrand Chiropractic day clinic) within a two-year period. The treatment protocols that were compared were cervical spinal manipulative therapy, a combination of cervical spinal manipulative therapy and cervical strengthening exercises, temporomandibular joint manipulative therapy and postural correction of the lumbar spine to decrease anterior head carriage. Seventy-eight participants from a possible 96 candidates were contacted telephonically and asked verbal consent to participate in the research trial. The participants were required to complete a telephonic questionnaire that was drawn up by the researcher involved with the aid of a statistical consultant. The questionnaire took 5 minutes to complete. The aim of the questionnaire was to assess the percentage of participants who were currently suffering from headache and the severity, duration and frequency of their headaches. Participants also needed to compare their current and previous headaches. The data was statistically analysed using cross tabulations and CHI squared tests. Statistical significance was calculated using Fischer’s exact test and Phi test for the two-by-two tables, while the Pearson test and Cramer’s V test was performed on tables larger than two-by-two. Statistical analysis revealed that the manipulation groups provided relief for up to three months, after which, symptoms recurred. The group that received the Easy Back Postural Correction Device showed the greatest improvement of symptoms in terms of headache free duration and decrease in current headache severity, duration and frequency. It can thus be concluded that postural correction of the lumbar spine, which in turn corrects anterior head translation, is the treatment of choice for cervicogenic headache. / Dr. M. Moodley Dr. R. van Zyl

M.Tech. / The purpose of this study was to determine the role of treating the gastrocnemius-soleus complex (GSC) through dry needling and passive stretching, in the management of chronic low back pain. This research aims to compare the effects of treating the GSC alone, lumbar spine manipulation alone or the combination of the two modalities in people suffering from chronic low back pain. Thirty candidates suffering from chronic low back pain between the ages of eighteen to forty years participated in this study. These candidates were recruited from the local surrounding area, through information pamphlets distributed throughout the Technikon Witwatersrand Doornfontein and advertisements placed in the local newspapers. Only those candidates that conformed to the selection criteria were allowed to participate in the study. Each candidate was randomly assigned to one of three groups as they enrolled for participation. Each group consisted of ten candidates. Group 1 candidates received treatment to the GSC by means of dry needling and passive stretching only. Group 2 candidates received lumbar spine manipulation only. Group 3 candidates received a combination of lumbar spine manipulation and dry needling and passive stretching of the GSC. Each candidate received treatment three times a week, every second day over three weeks thus receiving a total of nine treatments each. Subjective data was collected using the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain and Disability Questionnaire. Objective data was collected using the electronic inclinometer to measure the lumbar spine range of motion in flexion, extension, right and left lateral flexion and right and left anterior rotation. Pressure algometry of the most active trigger point in the GSC was also recorded. Both the subjective and objective data were recorded on the first, third, fifth and ninth treatment consultations before any treatment was administered.

M.Tech. / PURPOSE: To compare the effectiveness of Traumeel®S in combination with specific knee joint mobilisation with Traumeel®S tablets and ointment, or specific knee joint mobilisation alone, in the chiropractic treatment of knee osteoarthritis. By comparing the objective and subjective results obtained from this comparison, the most effective treatment protocol for knee osteoarthritis may be determined. STUDY DESIGN: A random sample of thirty patients, radiographically diagnosed with Grade 2 or Grade 3 knee osteoarthritis, were selected to participate in this study. These patients were randomly assigned to three equal groups of ten patients each. Monitoring examinations were conducted on the initial, third, sixth and final (ninth) consultations.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background : It has become practically impossible for practitioners to remain current with clinical developments. Additionally the demand from patients and third party payors for quality evidence is increasing. A systematic review is one manner in which information can be graded, summarised and presented in a succinct format for use by practitioners, patients and third party payors. Objectives : To identify the current knowledge available on the conservative management of iliotibial band syndrome (ITBS) and to evaluate the scientific and methodological rigor of that knowledge. The systematic review of these studies identified the level and type of evidence that currently exists in the support of conservative management of ITBS and the specific interventions and combinations of interventions currently employed. Method : A systematic review of ITBS studies was conducted. ITBS studies were identified using key indexing terms (iliotibial band syndrome, treatment, conservative and intervention) on several databases (EBSCOhost, Google Scholar, Metalib, Pubmed, Science Direct and Springerlink), all studies were included up until the date of ethics approval (21st May 2012) . The gathered studies were screened for compliance with the inclusion criteria, and then reviewed by blinded independent reviewers (reviewer criteria included qualification, clinical experience, academic experience, research experience and discipline). Data collection and analysis : The reviewers rated the methodological rigour of the ITBS studies utilising an appropriate scale (e.g. PEDro Scale). Feedback was collated and analysed for discordance. Studies were then analysed, ranked and followed by a discussion in the context of their clinical outcomes, thus formulating a structured summary of the known clinical data with regards to the clinical management of ITBS. Results: The identified citations (4130) were screened and sorted by study type. This resulted in 167 citations that were reviewed by abstract for compliance with the inclusion criteria. A final total of 23 studies meet eligibility criteria. Eight articles reported on a combination of interventions, four discussed biomechanical and causative factors, and the remaining eleven articles investigated individual interventions in the treatment of ITBS. After review and analysis, combination interventions were supported by the strongest level of evidence, thus advocating the use of a combination of interventions in the management of ITBS in providing better clinical outcomes. Moderate evidence favoured the use of customised orthoses, injectable corticosteroids, phonophoresis and addressing biomechanical and causative factors. However, there was moderate evidence against the use of deep tissue frictions, as no improvement was found. This outcome suggests a need for further evidence to advocate the appropriateness of these interventions in clinical care of ITBS. Hip abductor strengthening and stretch therapy were found to have limited evidence. However, no evidence was found to support the application of active release technique, corrective neuromuscular approach, custom dry floatation cushions and talar joint manipulation in the management of ITBS. This latter outcome indicated a need for studies to investigate their appropriateness or inappropriateness in clinical care. Conclusion : The systematic review of ITBS studies revealed that use of a combination of conservative therapies was found to have the strongest level of evidence, which may indicate its appropriateness in the management of patients suffering from ITBS. Specific combinations of conservative therapies and the use of individual therapies require future research in order to better delineate their contribution to the management of ITBS. Randomised controlled trials are the gold standard for research, as they have the greatest level of methodological quality, and should be used where possible when investigating the efficiency of interventions in the treatment of ITBS. Studies, which were not randomised controlled trials, but adopted the principles of a randomised controlled trial structure, contributed positively towards the methodological rigor of these studies.