Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / The lifetime incidence of low back pain is between 48% to 79% in South Africa. Globally, chronic Sacroiliac Joint Syndrome occurs in 13% to 63% of the world’s population. Therefore, chronic Sacroiliac Joint Syndrome is a significant health problem that has the potential to have a major impact on quality of life. Chronic Sacroiliac Joint Syndrome is described as an alteration in normal motion or mechanics. The Sacroiliac Joint fibrous capsule contributes to proprioceptive and nociceptive output, which may be exacerbated when the joint is in a dysfunctional state. Chronic Sacroiliac Joint Syndrome may be effectively treated by spinal manipulative therapy. Spinal manipulative therapy is professed to have four therapeutic effects – mechanical correction, pain reducing effects, circulatory increase and neurobiologic effects. Similarly, Kinesio Tex® Tape therapy is professed to have comparable therapeutic effects – circulatory increase, pain reduction and stimulation of proprioceptive systems. Spinal manipulative therapy and Kinesio Tex® Tape therapy may, therefore, have similar therapeutic effects which, if used in adjunction, may produce enhanced therapeutic effects and accelerated results regarding reduction of symptoms in patients with chronic Sacroiliac Joint Syndrome. This investigation aimed to determine whether Kinesio ® Taping methods would have any relative effect on the Sacroiliac Joint, and whether it would be appropriate to use as an adjunct to spinal manipulative therapy in the treatment of chronic Sacroiliac Joint Syndrome. The study was a prospective stratified clinical trial with three intervention groups, twenty participants in each (n = 60). All participants were 18-50 years of age and suffering from chronic Sacroiliac Joint Syndrome. Subjective measurements included the Numerical Rating Scale and Oswestry Low Back Pain Disability Index. Objective measurements included the Algometer Scores. Numerical Rating Scale and Algometer measurements were taken before and immediately after treatment at the first consultation and at the second consultation. Oswestry Low Back Pain Disability Index measurements were taken at the first and second consultation. Group One underwent spinal manipulative therapy alone, Group Two underwent Kinesio Tex® Tape therapy alone and Group Three underwent both spinal manipulative therapy and Kinesio Tex® Tape therapy in combination. Comparisons were made using the Unpaired and Paired t-tests. The results for the Inter-group analyses suggested that most comparisons were statistically insignificant (p ≥ 0.05) which indicated that all treatment groups appeared to improve to a similar degree. The results for the Intra-group analyses suggested that most comparisons were statistically significant (p < 0.05) which indicated that Kinesio Tex® Tape therapy was effective as an adjunct to spinal manipulative therapy, however not statistically more or less effective that spinal manipulative therapy or Kinesio Tex® Tape therapy alone. In conclusion, it was found that some differences did occur, however these differences were not sufficient enough to conclude that one treatment was more effective than the other. Further research with a larger sample size, more frequent treatments and follow-ups, a more homogenous stratification of age, ethnic group, gender, side of diagnosis and categorizing participant occupation is needed in order for the power of the study to be amplified and, therefore, any results would carry more weight.

A dissertation submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The purpose of this research is to conduct a descriptive study of cases that presented with thoracic complaints to Durban University of Technology chiropractic Day Clinic from the 13 January 1995 to 30 November 2005. This is a retrospective, quantitative, non-experimental, clinical survey. The sample size for this study included 7111 cases obtained from the Durban University of Technology chiropractic day clinic. There were no thoracic cases recorded in the random sample for the year 1995, therefore the random sample allocated for this year was subtracted from the total sample. 249 Thoracic cases were included in this research. The overall prevalence for the time period 1996 - 2005 was 3.5%. Gender: 248 of the 249 patients had recorded gender information. The majority were female 54.8% while 45.2% were male. Age: The ages ranged from 11 to 73 years. The mean age was 33.3 years. Occupation: 241 patients had a recorded occupation. 21.6% of them were classified as active or non-sedentary while the majority had sedentary jobs. The main complaint was mid-back pain which was noted in 41.4% of the population. Thoracic facet syndrome was the primary diagnosis given in 74.7% of the population; myofasciitis was the second most diagnosed condition with 8.8% of the population having this primary diagnosis. The most common treatment was joint manipulation, which was used in 82.6% of the cases, followed by soft tissue therapy (79.4%) and stretches (44.9%). The facets that were most commonly found to be fixated were in the T5 toT8 region. The investigative procedure that was used most often in the sample was x-rays. Fourteen patients were sent for x-rays (5.6%). One patient was sent for a blood test (0.4%). No other investigative procedures were used in these patients. Even though the overall prevalence of thoracic pain sufferers was only 3.5% over the ten year period, it is still an area of pain that must be investigated. The thoracic spine has been overlooked as a major region for research. This study has proved that there is need for continuing research in this area, to assist chiropractors to treat the thoracic spine more effectively. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / To determine the efficacy of the Harpago and celery seed cream in mild to moderate degenerative joint disease of the knee in terms of subjective and objective clinical findings / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Chronic Idiopathic Constipation (CIC) is a common patient complaint (Browning 1999) and as such is defined as : “Constipation” being the infrequent or difficult evacuation of faeces, “idiopathic”, denoting the condition occurs in the absence of any known cause and “chronic”, implying a problem that has persisted for a long time (Anderson 1989). It has been suggested that the bony subluxation or motion segment dysfunction in the spine, could produce these symptoms (e.g. altered visceral function) in the segmentally related visceral structures (Korr 1976, Nansel and Slazak 1995, Budgell 2000). In support of this three case reports in the literature suggest that spinal manipulative therapy to effect removal of these bony subluxations or motion segment dysfunctions, may relieve chronic idiopathic constipation (Hewitt 1993, Marko 1994, Redly 2000). However all three cases involved a single patient case analysis, where patients received spinal manipulation and a vast improvement in bowel function within three weeks of the initiation of the intervention was noted. Only one case report measured global wellbeing outcomes and was able to document a steady increase in the patient’s sense of wellbeing (Redly 2000). As a result of the above evidence in the literature, the researcher was led to the following hypotheses regarding spinal manipulation and chronic idiopathic constipation: • That spinal manipulation would affect a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. • That placebo would affect an increase in the subject’s abdominal pain intensity and level of constipation and a decrease in the subject’s sense of wellbeing and spinal range of motion. • That spinal manipulation would be more effective than placebo in bringing about a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Purpose: Chronic ankle instability (CAl) is characterised by ankle pain, weakness, edema, crepitus, adhesions, restrictions and ligamentous laxity. Various treatment options target a variety of aspects of this condition. However, there is a paucity of literature with regards to combined treatment choices. The purpose of this study was to investigate the relative effectiveness of combining manipulation with rehabilitation, compared to rehabilitation only, in participants with CAl. Methods: The study was a single blinded, randomised and comparative clinical trial at a chiropractic day clinic. Thirty participants with grade I and II CAl were recruited and randomly allocated into one of two treatment groups. Fifteen participants received a combination of manipulation and rehabilitation (coupled peroneal muscle strengthening and proprioception) and fifteen received the rehabilitation only programme. All six treatments in each group were conducted over five weeks. Results: A P value of <0.05 was considered statistically significant. The intra-group outcomes in the Manipulation and Rehabilitation Group indicate that statistically significant improvements were achieved for all six parameters in this study (VAS p<0.001; FAOI p<0.001; Algometer p<0.001; motion palpation p<0.001; WBO p=0.001 and BBS p<0.001). This is in comparison to the three outcomes where statistical significance was achieved (VAS p<0.001; FAOI p<0.001 and BBS p<0.001) in the Rehabilitation only Group. Inter-group analysis revealed statistically significant improvement in favour of the Manipulation and Rehabilitation Group for VAS (p<0.001); algometer readings (p=0.002) and Motion palpation findings (p<0.001). Conclusions: The findings of this study show that manipulation in combination with rehabilitation is relatively more effective than rehabilitation only for most outcome measures. III Key indexing terms: Ankle; Combination Therapy; Joint Instability; Manipulation; Rehabilitation / 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

Dissertation submitted to the Faculty of Health at the Durban University of Technology in partial compliance with the requirements for the Master‟s Degree in Technology: Chiropractic, 2009. / The prevalence of neck pain in musculoskeletal practice is second only to that of low back pain (Vernon et al., 2007). There is a growing interest in neck pain research due to the escalating disability burden and compensation costs associated with neck pain (Côte et al., 2003). Manual therapies are commonly used in the treatment of neck pain (Côte et al., 2003). After an extensive literature review by Haldeman et al. (2008) they found that manual therapy techniques have some benefit but no one technique was clearly superior to the next. Therefore, the purpose of this study is to compare three commonly used manual therapy techniques in the treatment of chronic mechanical neck pain. OBJECTIVES The purpose of this study was to compare three different manual therapy techniques (SMT, MET and PNF) which are commonly used in the treatment of chronic MNP in terms of range of motion, pain and disability. METHOD Forty-five patients with chronic mechanical neck pain were obtained through non-probability convenience sampling and assigned into one of three treatment groups (15 per group) using a computer generated randomized table. The three different treatment groups were: Spinal Manipulative Therapy (SMT), Muscle Energy Technique (MET) and Proprioceptive Neuromuscular Facilitation (PNF). Each group received six treatments over a period of three weeks with a follow-up consultation. Measurements were taken at the first, third and sixth treatment and at the follow-up consultation. SPSS version 15.0 was used to analyse the data. A p value of <0.05 was considered as statistically significant. An intra-group analysis was done using repeated measures ANOVA testing to assess the time effect for each outcome separately. For inter-group analyses the time x group interaction effect was assessed using repeated measures ANOVA testing, and profile plots were used to assess the trend and direction of the effects. RESULTS Intra-group analysis of the results revealed that all three groups improved significantly between the first and the final consultation, for all measures. Inter-group analysis of the data did not show any difference between the three groups by the end of the final consultation. However, extension range of motion appeared to improve slightly faster in the PNF group iv but it was not significant when compared to the other two groups. Therefore, there was no statistical significance between the three groups. CONCLUSION It was concluded that all three treatment groups responded equally to the treatment, thus, suggesting that MET or PNF techniques can be used if SMT is contra-indicated. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007 / The purpose of this study was to determine the relationship between Myofascial Pain Syndrome (MPS) of the pericranial musculature and the clinical presentation of episodic tension-type headache (ETTH). It set out to determine the extent to which MPS is related to the nature of the ETTH. ETTH is a very prevalent disorder, common to individuals in their third decade, and particularly females. Current literature suggests a multi-factorial aetiology, combining psychological and neuromusculoskeletal mechanisms, to name a few. Due to the many facets of this disorder, it has, for a long time, provided a challenge to the practitioner with regard to patient treatment and management. MPS is a condition that may affect any number of muscles, resulting in motor, sensory and autonomic symptoms. MPS of the pericranial muscles, namely the upper Trapezius, Sternocleidomastoid, Temporalis and Suboccipital muscles, produces a referred pain pattern similar to the pain pattern experienced during an ETTH. The literature states that the pain produced by MPS has been somewhat overlooked and it was thus necessary to further investigate the myofascial component of ETTH. This study was a quantitative, pilot, non-intervention, clinical assessment study, which required forty participants residing in the province of Kwa-Zulu Natal suffering from ETTH. The clinical assessment included a case history and physical and cervical examinations. The participants were requested to complete a headache diary over a period of 14 days. Following this, they returned to the Chiropractic Day Clinic for a second consultation. Data was collected at both consultations and the participant was offered one free treatment. The headache diary and Numerical Pain Rating Scale provided the subjective measurements, while the algometer and Myofascial Diagnostic Scale were used to gather the objective measurements. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 2001. / For neck pain, the first-line treatment of allopathic physicians is usually the prescription on non-steroidal ant-inflammatory drugs (NSAIDs), whereas the firstline treatment of chiropractic physicians is usually cervical manipulation. The literature shows that both chiropractic manipulation alone and NSAIDs alone are effective for the treatment of cervical facet syndrome, with chiropractic manipulation being much safer than the use of NSAIDs. Furthermore, patients that receive chiropractic care have been shown to generally be much more satisfied than those that receive conventional medical care. The aim of this study was to determine the short-term effectiveness of cervical spine manipulation as compared to Piroxicam administration in the treatment of chronic cervical facet syndrome. The study design that was chosen was that of a comparative clinical trial. Forty consecutive patients diagnosed with chronic facet syndrome of the cervical spine were randomly assigned to either the manipulation group or the NSAID group (twenty patients in each group). Each patient in group A received manipulative therapy of the cervical spine on three consecutive days. Each patient in group B received 40 mg of Adco Piroxicam on the first two days of treatment, and 20 mg daily for the remainder of the seven day treatment period. The patients were assessed by means of objective and subjective data obtained before each consultation on days 1, 3 and 7. The objective data was gathered from algometric pressure-pain threshold readings over the involved facet joint. The subjective information was obtained from the Short-Form McGill Pain Questionnaire, the Numerical Pain Rating Scale - 101 and the CMCC Neck Disability Index, as well as the patients perceived improvement which was recorded as a percentage on days 3 and 7. / M

M.Tech. (Chiropractic) / Postural kyphosis of the thoracic spine is a common condition which affects a large percentage of the population. With an increase in anteriorly orientated activities, such as working on a computer, driving and studying, postural kyphosis has become more prevalent. Currently, the gold standard for the treatment of postural kyphosis is the stretching of the involved anterior musculature (pectoralis major and minor) and the strengthening of the involved posterior musculature (mid trapezius, rhomboids and levator scapulae). This involves the compliance of patients in the completion of exercises and stretching routines. This often resulted in poor outcomes as routines were performed irregularly or incorrectly. Although, if properly executed, this treatment protocol is effective, chiropractors, and other manual therapists, continue to search adjunctive modalities to improve the positive outcomes of their treatments. With the introduction of Kinesio® taping, the problem of patient compliance could be reduced. The tape is applied by the practitioner and simply left for several days. It has very little effect on the patient’s day to day activities and should continue to have positive impact on the involved musculature with no additional effort required from the participant. The benefits of chiropractic manipulation on the biomechanical relationship between a joint/s and linked musculature has long been recognised. However, very little research has been done to ascertain the direct benefits of chiropractic manipulation to the cervical and upper thoracic regions on postural kyphosis. This study will not only provide valuable information on these two modalities used individually, but also on the effectiveness of the combination of the two treatments. Method: This study was a comparative study consisting of three groups of ten participants. The method of treatment was determined by random group allocation. Group 1 received spinal manipulation to restriction(s) of the cervical and upper thoracic regions only. Group 2 received Kinesio® taping to the rhomboid muscle group only. Group 3 received the combination of spinal manipulation and Kinesio® taping. Subjective measurements consisted of the measurement of the thoracic kyphosis with the use of flexicurve ruler, a series of lateral view plumb line photographs and a set of secondary measurements consisting of three inter scapular measurements, one inter acromioclavicular measurement and two C7 to acromioclavicular measurements on each side.