M.Tech. / Purpose: In soccer the re-injury rate of Hamstring muscle strains is between 12 and 14 percent. A previous or recent Hamstring injury is the most recognised risk factor for future injury. On recurrence of the injury, it tends to be more severe and disabling than the initial injury. Given the high recurrence rates, Hamstring injuries provide a significant challenge to the treating clinician. Knowledge surrounding optimal treatment and preventative measures is therefore critical (Hoskins and Pollard 2005). The aim of this study is to assess the effectiveness of lower lumbar spine segment adjustment, namely the L4/5 spinal level, in the contractile strength of the Hamstring muscle group in professional soccer players that have a history of a Hamstring strain. Design: Forty professional soccer players between the ages of 15 and 34 years with a history of a grade one or grade two Hamstring strain were considered for this study. Participants in this research were obtained from the University of Johannesburg inter-residence players and from the University of Johannesburg first soccer team. Two groups of twenty players were randomly assigned to one of two groups. Group A received spinal adjustive therapy (SAT) to the L4/5 spinal segment with an ultrasound treatment to their Hamstring muscle group and Group B will receive only the ultrasound treatment to the hamstring muscle group. Each participant was treated five times over a period of three weeks. Measurements: Before any intervention was given to either of the groups, Hamstring muscle contractile strength was first recorded using a Cybex system 2000. Hamstring contractile muscle strength measurements were taken again after the fifth treatment for both groups and compared to ascertain if there had been any change in the contractile strength of the Hamstring muscles. Results and Conclusion: Even though the two groups did not start at the same contractile strength for the Hamstring muscle in knee flexion, as measured a CCybex system 2000 possibly due to the selection criteria used in the study in terms of age and body weight of the participants, results showed that spinal adjustive therapy was more effective in improving the muscle contractile strength of the Hamstring muscle in knee flexion since there was a favourable difference in both Group A and Group B following intervention, but more so in Group A (in the once injured leg) which received spinal adjustive therapy due to a greater increase in the overall muscle contraction in the Hamstring muscle group. For the Chiropractic profession this opens huge potential with regards to the Chiropractic benefits and improving the functioning of professional soccer players.

M.Tech.

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

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The purpose of this study is to determine the relative effectiveness of (Contract-Relax- Agonist-Contract) CRAC stretching, a component of Proprioceptive Neuromuscular facilitated (PNF) stretching, as opposed to static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. This was a randomised clinical trial consisting of two groups. Group A received static stretching as their treatment protocol and Group B received PNF (CRAC) as their treatment protocol. Each group consisted of fifteen people between the ages of 18 and 55 who were randomly allocated to their respective groups. It is hypothesised that PNF (CRAC) stretching would be relatively more effective than Static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. Subjects diagnosed with active myofascial trigger points in the Trapezius, Infraspinatus and Rhomboid muscles were included in the study. The treatment regime consisted of a course of five treatments spread over a period of two weeks and then a one - month follow up consultation. Subjective and objective measurements were taken at the first, fifth and follow up consultations. Subjective data consisted of the Short Form McGill Pain Questionnaire, the CMCC Neck Disability Index and the Numerical Pain Rating Scale -101. The objective data was collected by means of algometer and goniometer measurements. This data was used to perform statistical analysis using the non-parametric Wilcoxin signed-rank test and the Mann Whitney unpaired test to compare intra-group and intergroup data respectively, at a 95% confidence level. This study suggests that both static and PNF (CRAC) stretching are effective in the treatment of active myofascial trigger points. However there is no clinical statistical difference between these two treatments. Further studies with a larger sample size are needed to clearly evaluate the use of stretching in the treatment of active myofascial trigger points. / M

Thesis (M.Tech.: Chiropractic)--Durban University of Technology, 2008. 149 p. / Objectives: To investigate the knowledge and perceptions of Paediatricians in South Africa with respect to Chiropractic, and to determine if any correlation exists between the two. Methods: A posted quantitative questionnaire was used to collect data from Paediatricians in South Africa. Follow up telephonic calls were made to encourage response from participants. After a 12-week period, returned questionnaires were collected and data analysed. Results: The results obtained (25% response rate), indicated that there are relatively low levels of knowledge and poor perceptions amongst Paediatricians, which was supported by the low referral rate from Paediatricians for Chiropractic treatment. With regard to perception, Paediatricians seem to have a better perception of Chiropractic for the general compared to the paediatric population. Paediatricians felt that they do not have enough knowledge to discuss Chiropractic with their patients and would like to be further informed. This was reflected in the statistically significant correlation between knowledge and perception, and it would seem that better knowledge allowed for more positive perceptions. The study also found that Paediatricians agreed that they would like to receive treatment feedback after referring a patient for Chiropractic treatment and they were more likely to refer to a Chiropractor if they had a post-registration paediatric specialisation. Conclusions: A correlation exists between knowledge and perceptions of Paediatricians in South Africa with respect to Chiropractic, with both being relatively, although better perceptions of Chiropractic for the general than for the paediatric population exist.

Dissertation submitted to the faculty of health in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, at the Durban University of Technology, 2008 / Introduction: Myofascial Pain Syndrome (MPS) is a painful and prevalent muscular condition. It is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active and which can refer pain through specific patterns to other areas of the body distal from the trigger point. There exist many types of treatments for MPS of which dry needling is one of the most effective forms. However, a very common side-effect experienced is postneedling soreness, which when compared to trigger point injections are more painful, with respect to both intensity and duration. Studies have shown that the exact cause of post-needling soreness has not been clearly documented. Action Potential Simulation (APS) Therapy operates using a direct electric current (DC) on muscles. It stimulates action potentials that are stronger than the natural nerve impulses. It operates on a similar principle to the gate control theory of Melzack and Wall (1988) which results in the inhibition of nociceptive signals. Stimulation by the APS unit creates a normal action potential that restores the inherent biochemical processes in the region. This low to medium frequency current (below 150 Hz) has been reported to alleviate pain, decrease inflammation, enhance blood circulation and aid in wound and bone fracture healing. Methodology: This study was designed as a prospective, randomised, controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups of 20 subjects each. Group One received the fanning dry needling technique; Group Two received a combination of fanning dry needling plus APS Therapy. Group Three was the control group in which the subjects were treated with fanning dry needling with „Sham‟ APS Therapy. Algometer and Numerical Pain Rating Scale 101 (NRS 101) readings were taken immediately before and after the dry needling procedure and again at the follow-up visit 24 hours later. Subjects used a 24-hour pain diary and the NRS 101 scale which was filled out at 3 hour intervals, to record any post-needling soreness. Results: An intra-group analysis revealed that, objectively and subjectively, all groups experienced some degree of post-needling soreness, which deceased significantly over time. This decrease of pain was not significantly related to the treatment group, and there is no evidence of the differential time effect with the treatment. An inter-group analysis yielded no statistically significant results regarding the effectiveness of the treatments received by the patients. This could be because of the small sample size or because „„Sham‟‟ APS is not a useful intervention. Conclusion: The results from this study revealed that all three treatment groups responded equally in the alleviation of pain. However, the dry-needling treatment group alone (Group One) revealed a much more significant decrease in pain compared to the other two. It can thus be concluded that APS Therapy had no significant beneficial effects on post-needling soreness.

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

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 148 leaves / 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.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Introduction: Motion palpation is a commonly utilised clinical assessment tool of joint fixations. Most research surrounding motion palpation discusses inter and/or intra-examiner reliability as a pre-treatment tool. However, only two studies have assessed the reliability of motion palpation as a post-treatment diagnostic tool, and both these studies demonstrated that motion palpation has the ability to identify end-feel improvement in a restricted segment which had been manipulated. Therefore the use of motion palpation as a post-manipulation tool within the spine showed a relatively high level of responsiveness/efficacy of motion palpation. However little research has yet to be conducted on the use of motion palpation as a post-manipulation tool on the extremities and therefore this study aims to provide a clearer insight into the use of motion palpation as a post-treatment assessment tool in an extremity in terms of clinical responsiveness/validity of motion palpation. Furthermore the relationship between motion palpation and other clinical measures/short term outcomes, such as pain, functionality, range of motion and proprioception has yet to be seen i.e. when motion palpation indicates a reduction in a fixation due to manipulation does this correlate to a decrease in pain and increase in functionality, range of motion and proprioception. Therefore the primary aim of this study was to determine the clinical responsiveness of motion palpation as a post-manipulation diagnostic tool within the joints of the ankle in symptomatic participants with Chronic Ankle Instability (CAI). Method: Forty participants with CAI (Grade I and II) were recruited. One Group received manipulation (n=21), the other Group received no treatment (n=19). Motion palpation was performed, and subjective/objective measures were taken in both Groups pre- and posttreatment. Statistical analysis was performed using SPSS 15.0. Results: The findings of this study demonstrated that when using motion palpation as a posttreatment assessment tool a high level of responsiveness was observed (a highly significant association between being manipulated and End-Feel Improvement (EFI) occurred (p<0.001)); it was highly sensitive (0.90); and was highly specific (0.95). Overall no statistically significant association was observed in either group between, motion palpation results (with respect to EFI or no EFI noted) and any of the short term outcomes (the five subjective/objective clinical measures). Within the manipulation group; Visual Analogue Scale (VAS) (p=0.944), Functional Ankle Disability Index (FADI) (p=0.490), Pressure Algometer v (p=0.634), Berg Balance Scale (BBS) (p=0.512) and Weight Bearing Dorsiflexion (WBD) (p=0.966). In comparison, the control group; Visual Analogue Scale (VAS) (p=0.063), Functional Ankle Disability Index (FADI) (p=0.491), Pressure Algometer (p=0.828), Berg Balance Scale (BBS) (p=0.695) and Weight Bearing Dorsiflexion (WBD) (p=0.747). The most common fixations noted in this study, were mortise Long Axis Distraction (LAD), subtalar LAD and subtalar eversion. Conclusion: Therefore, motion palpation appears to be valid when used as a post-treatment tool in the foot and ankle; and overall, common fixations found in symptomatic participants with CAI in this study are similar to those found in previous studies.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Cervicogenic headaches are usually chronic, debilitating and tend to be unresponsive to common headache medications. Manual therapy has been shown to be an effective form of management for cervicogenic headache. The Electromechanical Adjusting Instrument is a hand-held device offered as an alternative to manual therapy for musculoskeletal treatment. Aim: The aim of this study was to determine the effectiveness of the Electromechanical Adjusting Instrument compared to cervical spine manipulation in terms of subjective and objective measures in the treatment of cervicogenic headache. Methodology: This study was a randomised single-blinded clinical trial. There were 41 participants between the ages of 18 and 59 years who were randomly divided into two groups of 21 and 20 respectively by means of a randomisation table drawn up by the statistician. Participants in Group A received cervical spine manipulation while those in Group B received the Electromechanical Adjusting Instrument. Subjective headache intensity was determined using a Numerical Pain Rating Scale. The effect of neck pain on the participants’ activities of daily living before and after treatment was assessed using the Neck Disability Index. The effect of the headache on the participants’ activities of daily living before and after treatment was assessed using the Headache Disability Index. Objective cervical range of motion in all six planes of motion was assessed using a CROM goniometer. Participants in both groups received six interventions over a three-week period with a minimum interval of 48 hours between each intervention. The subjective and objectives assessments were taken at baseline, post-third and post-sixth interventions. The data was analysed using the IBM SPSS version 24.0. Repeated measures ANOVA was used to examine the effect on each outcome measure separately of time and treatment group interaction. Profile plots were generated to show the rates of changes in outcomes over time by the intervention group. A p value <0.05 was considered statistically significant. Results: For most of the outcomes, there was no clinical or statistical interaction present, i.e. the intervention effect was similar in both groups irrespective of the intervention. Conclusion: The trends in each of the outcomes suggest that the Electromechanical Adjusting Instrument is as effective as cervical spine manipulation for the treatment of cervicogenic headache / M