M.Tech. / Purpose: Posterior mechanical neck pain is considered a debilitating musculoskeletal problem and is one of the most common reasons for visiting an emergency sector (Murphy, 2000). This study aims to compare the effects of Chiropractic manipulative therapy directed at the thoracic spine to that directed at the cervical spine for the treatment of chronic neck pain with regards to pain, disability and cervical range of motion. Method: This study was a comparative study and consisted of two groups of fifteen. The participants were between the ages of eighteen and forty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each participant was determined by group allocation. Group 1 received chiropractic spinal manipulative therapy to restriction(s) of the upper thoracic region only. Group 2 received chiropractic spinal manipulative therapy to restriction(s) of the cervical spine only. Objective and subjective findings were based on the above treatment protocols. Procedure: Treatment consisted of six treatment consultations with an additional follow up consultation over a three week period, with two consultations being performed per week interval. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index as well as from the Numerical Pain Rating Scale (NPRS). Objective readings were taken from measurements taken from the Cervical Range of Motion device (CROM). Analysis of collected data was performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data gathering only. Results: Clinically significant improvements in both Group 1 and Group 2 were seen over the course of the study with regards to cervical spine range of motion, pain and disability. However group 1 showed greater statistically significant improvements in their mean cervical range of motion whereas group 2 showed a greater statistically significant improvement in their subjective readings of pain and disability.

M.Tech. (Chiropractic) / Introduction: Neck pain is a common condition which affects up to 70 percent of people at some point in their lives, and at any given time about 10 to 20 percent of the population reports neck problems. Although spinal manipulation on its own is effective in the treatment of chronic neck pain, chiropractors continue to search adjunctive modalities to improve the positive outcomes of their treatment. Therefore, it is important to look for the best possible treatment protocol as well as research alternatives, should contraindications for present protocols, such as spinal manipulation, arise. One such alternative could be Kinesio® taping. The purpose of this study was to determine the efficacy of utilising Kinesio® taping, spinal manipulation or the two therapies combined, for the treatment of chronic neck pain. It will also provide further evidence on the efficacy of spinal manipulation and Kinesio® taping in isolation. 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 spine only. Group 2 received Kinesio® taping to the longissimus cervicis muscles only. Group 3 received a combination of spinal manipulation and Kinesio® taping as previously described. Subjective measurements consisted of the Vernon-Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (NPRS) and objective measurements was assessed in degrees by making use of the Cervical-range-of-motion (CROM) instrument. Procedure: There were seven consultations in total. There were six treatment consultations over three weeks. The seventh consultation consisted of data collection only. Subjective and objective measurements were taken prior to treatment on the first and fourth consultation, and on the seventh consultation where no treatment took place. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index and the NPRS. Objective readings were assessed in degrees by making use of the Cervical-range-of-motion (CROM) instrument. Results: It was evident from the data that all three groups responded well to their respective treatment protocols. With regards to the subjective measurements Group 1, 2 and 3 demonstrated statistically significant improvement in both neck pain severity and functional disability. As Group 1 had the highest clinical improvement with regards to the NPRS, it indicates that the Group 1 treatment protocol was more effective in decreasing the pain intensity throughout the treatment period. All three groups responded similarly with regards to the Vernon-Mior Neck Pain and Disability Index, although Group 1 responded the best clinically. With regards to the objective measurements Group 1, 2 and 3 demonstrated statistically significant improvement in all ranges of motion of the cervical spine. However, it was found that Group 3 clinically responded best to treatments in all the ranges of motion except for right lateral flexion in which Group 2 responded best to treatment. Conclusion: The study showed that the treatment protocols for Group 1, 2 and 3 were effective in treating chronic neck pain. The evidence suggests that the Group 1 treatment protocol, which received spinal manipulation, is more effective than Kinesio® taping alone and the two therapies combined in decreasing pain intensity and functional disability in the treatment of chronic neck pain. The evidence further suggests that the Group 3 treatment protocol, which received spinal manipulation in combination with Kinesio® taping, is more effective than spinal manipulation and Kinesio® taping alone in increasing all cervical spine ranges of motion in the treatment of chronic neck pain.

M.Tech. / Purpose: Heachaches are a very common complaint among society today, and as a result there are a vast number of individuals seeking medical treatment specifically for headaches (Alix and Bates, 1999). The impact that headaches have on a patients quality of life far exceeds that of other conditions such as osteoarthritis and hypertension. Primary headaches such as Cervicogenic, Cluster and Tension-type headaches have no specific underlying cause. However, it has been shown that spinal manipulative therapy (SMT) can be used as an effective tool in the treatment of these primary headaches (Brontford, Assendelft, Evans, Haas, and Bouter, 2001; Khoury, 2000 and Vernon, 1995). A Cervicogenic Headache is defined by the North American Cervicogenic Society (NACHS) as referred pain perceived in any region of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by cervical nerves. The aim of this study was to determine the efficacy of upper cervical spine manipulation in conjunction with Interferential current and Ultrasound therapy, compared to upper cervical spine manipulations alone as a treatment protocol for Cervicogenic headaches. Method: This study consisted of two groups; both Group 1 and Group 2 consisted of 15 participants with Cervicogenic headaches. The participants were between the ages of 18 and 55 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Group 2 received a combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Objective and subjective findings were based on the treatments. Procedure: The participants received six treatments in total over a three week period that is two treatments a week for three weeks followed by a seventh consultation visit where only subjective and objective measurements was taken. The participants completed a Numerical Pain Rating Scale and Headache Disability Index Questionnaire. Algometer readings were taken over the most sensitive trigger point in the Posterior Cervical muscles. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine and Group 2 received a ten minute combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine. The same treatment procedures were administered over the study; subjective and objective readings were only taken at visits 1, 4 and 7. Results: In terms of objective measurements based on the pressure Algometer readings, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in muscle sensitivity between the two groups over time was revealed. However, Group 1 showed a larger overall clinically significant difference in Posterior Cervical muscle sensitivity. In terms of subjective measurements based on the Headache Disability Index Questionnaire scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in terms of intensity, duration and frequency of the headaches between the groups over time was revealed. However, Group 1 had a greater clinical reduction in intensity, duration and frequency of headaches when compared to Group 2. In terms of subjective measurements based on the Numerical Pain Rating Scale scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. A statistically significant difference in terms of intensity of the headaches between the groups over time was revealed. The overall clinical improvement was similar for both groups however Group 1 had a slightly greater clinical reduction in headache intensity when compared to Group 1. Conclusion: Both groups showed an overall improvement in the headache symptoms as well as Posterior Cervical muscle sensitivity; however Group 1 showed a greater clinical improvement when compared to Group 2.

M.Tech.

M.Tech. / This study was conducted to determine whether Chiropractic Spinal Adjustment Therapy (SAT) of the upper cervical spine has an effect on the normal physiological reactions that take place in the Autonomic Nervous System and Cardiovascular System whilst using the Electrocardiogram as a monitoring device. This area within Chiropractic research calls for further studies to be conducted. One hundred and twenty normotensive participants between the ages of 18 and 30 years were recruited to partake in the study via an advertisement placed in and around the University of Johannesburg Doornfontein Campus (Appendix A). Participants were assessed for exclusion criteria by completing a Full Case History (Appendix B), Pertinent Physical Examination (Appendix C), Cervical Spine Regional Examination (Appendix D) and a S.O.A.P. note (Appendix E). Participants were excluded from the study if it was revealed that they have contra-indications to Chiropractic SAT (Appendix F). The participants demonstrating upper cervical spine dysfunction were treated with a Chiropractic upper cervical SAT (Appendix J) while they were monitored for 3 minutes before, during treatment and 3 minutes after treatment by means of the Electrocardiogram to monitor the cardiovascular response. Participants were asked to read and sign the Subject Information and Consent form (Appendix G). Participants were required to complete the Patient Biographical Information Sheet (Appendix H) and the Patient Questionnaire regarding treatment experience (Appendix I)

M.Tech. / Purpose: To determine the effect of Chiropractic spinal adjustive therapy (SAT) of the lumbar spine and Sacroiliac joints on performance utilising indicators such as vertical jump height and T-test time of moderate to highly active sport participants. It has been suggested that a dysfunctional vertebral subluxation complex can cause a decrease in performance. The decreased performance may be due to dysfunctional biomechanics and altered neurological functioning of the lumbar spine and Sacroiliac joints. Methods: A randomised study design with thirty asymptomatic male subjects, which were moderate to highly active as indicated by the International Physical Activity Questionnaire (IPAQ), participated in this study. Participants were divided into two equal groups, group A (n=15) received Chiropractic SAT of the lumbar spine and Sacroiliac joints, group B (n=15) were rested for five minutes. The study design consisted of six consultations, with intervention being applied at each consultation between objective measurements. Objective data was obtained by the vertical jump test and T-test which determined participant’s explosive power and agility respectively. Objective data was obtained before and after intervention on each of the six consultations. The immediate effect of intervention was represented by the before versus the after measurements of consultations. The short term effect was represented by comparing the before values of consultation one (baseline) to consultation six. Results: The objective results showed that there was a short term and immediate improvement in vertical jump height and T-test time of both groups. With vertical jump height group A showed an immediate mean improvement of 3.845 cm (7%) and a short term mean improvement of 0.74 cm (1%); group B showed an immediate mean improvement of 1.6 cm (3%) and a short term mean improvement of 1.47 cm (3%). With the T-test time group A showed an immediate mean improvement of 0.433 s (4%) and a short term mean improvement v of 0.673 (6%); group B showed a immediate mean improvement of 0.1745 s (2%) and a short term mean improvement of 0.6 s (5%). Conclusion: Although results obtained were not statistically significant (p>0.05), it demonstrated from a clinical perspective that interventions caused an improvement in jump height and T-test time in both groups. Group A showed a greater improvement in every aspect, except in the short term effect of Chiropractic SAT on vertical jump height. It is therefore postulated that improvements noted were as a result of the adjustment providing an enhanced biomechanical and neurological advantage, and therefore in performance indicators such as the vertical jump test and T-test in the participants.

M.Tech. / The aim of this study was to compare the effectiveness of cervical adjustment therapy, dry needling of the levator scapulae muscle and a combination of the two in the treatment of chronic mechanical neck pain. Forty-five patients were recruited via posters and advertisements from in and around the University of Johannesburg. The participants had to present with bilateral neck pain, decreased range of motion and an active levator scapulae muscles trigger point, which was diagnosed using range of motion and trigger point examination. The participants were randomly allocated into three groups of fifteen participants each. Prior to treatment a full case history, physical examination and cervical regional examination were performed to ensure that the patients were eligible to partake in the clinical trial. Group 1 was the adjusting group; group 2 was the combination group while group 3 was the needling group. Participants were treated five times over a period of three weeks. The objective measurements used in this clinical trial involved a cervical range of motion instrument (C.R.O.M., Performance Attainment Associates) and an algometer (Wagner Instruments). Subjective measurements were achieved using the Neck Pain and Disability Index (Appendix G) and the Numerical Pain Rating Scale (Appendix H). Each measurement was taken prior to treatment on the first and third visits and after treatment on the fifth visit with three measurements per participant overall. The statistical analysis was conducted using the Kruskal-Wallis, Friedman and Wilcoxon tests to compare data. The results indicated that the three groups responded favourably to their respective treatments. Overall, this study has indicated that dry needling of the Levator scapulae muscle provides no statistically significant contribution to the conservative treatment of mechanical neck pain caused by levator scapulae trigger points.

M.Tech. (Chiropractic) / Purpose: The purpose of this randomised comparative study was to establish the effects which these modalities had on pain perception and range of motion in patients with acute cervical facet syndrome. This was done by comparing manual cervical spine traction alone; to cervical spine adjustments alone to manual cervical spine traction applied post cervical spine adjustments. Method: A total of 30 participants were recruited for this study by placing advertisements in and around the University of Johannesburg, Doornfontein Campus. Participants had to meet the requirements of the inclusion criteria and were excluded if they were found to be unfit for this particular study. The 30 participants were asked to draw a number out of a bag which therefor randomly divided them into three groups of 10 participants each. Procedure: Participants in group A received manual cervical traction alone as their treatment. Participants in group B received cervical spine adjustments alone as their treatment. Finally, participants in group C were treated by performing manual cervical spine traction after the cervical spine adjustment. Each participant was treated a total of six times over a two week period. Measurements were taken on the first, fourth and a seventh consultation. Results: Regarding the Subjective readings, there was an improvement with regards to the Numerical Pain Rating Scale values for all three groups, but the combination group of manual cervical spine traction performed post cervical spine adjustment, showed the greatest improvement over the trial period on intra-group analysis. No statistical significant changes were found on inter group analysis. There was an improvement in Neck Pain Disability Index values for all three groups, but the cervical spine adjustment group showed the greatest improvement over the trial period on intra-group analysis. No statistical significant changes were found on inter group analysis. Regarding the Objective readings, there was an improvement in pressure algometer readings for all three groups, but the cervical spine adjustment group showed the greatest improvement over the trial period on intra-group analysis. No statistical significant changes were found on inter group analysis. There was an improvement in Cervical Range of Motion readings for all three groups, but the combination group of manual cervical spine traction performed post cervical spine adjustment showed the greatest improvement for flexion, extension and bilateral rotation on intra-group analysis. However, for bilateral lateral flexion, the cervical spine adjustment group showed the greatest improvement on intra group analysis. No statistical significant changes were found on inter group analysis. Conclusion: There were clinically significant improvements within each of the three groups on intra group analysis but no clinically significant differences were found on inter group analysis. Therefore, none of the groups could be singled out as being the best treatment approach for acute cervical facet syndrome. With regards to the Chiropractic profession the outcome of this study therefore suggests, that the chiropractic adjustment alone is sufficient in treatment of acute cervical facet syndrome as none of the groups proved to be superior.

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

M.Tech. (Chiropractic) / Myofascial pain and dysfunction syndrome (MPDS) is presently considered to be the leading diagnosis amongst pain management physicians and the leading diagnosis amongst pain sufferers reporting to general practitioners (Harden, Bruehl, Gass, Niemiec & Barbick, 2000). The goal of dry needling and the other above mentioned soft tissue treatments is to alleviate the MTrP’s in the muscle, thereby restoring the muscle to its normal tissue mobility and returning it to proper functional capacity (Travell & Simons, 1999). A post-needling protocol may be used to reduce post-needling soreness at the needling site, to facilitate tissue repair after needling and to normalise muscle function and ROM after needling (Travell & Simons, 1999). The aim of this study is to compare the efficacy of dry needling on its own and in combination with a widely prescribed post-needling protocol of heat, active range of motion (ROM) exercises and passive stretches, with regards to changes in pressure pain threshold, pain and cervical spine ranges of motion, to determine which the superior treatment is. Participants who went to the University of Johannesburg Chiropractic Day Clinic were eligible to participate in the study once they met the inclusion and exclusion criteria. Participants were recruited by means of word of mouth as well as with the use of advertisements that were placed around the respective campuses of the University of Johannesburg. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received only dry needling to the upper trapezius muscle TP1 or TP2 whereas group B received dry needling to the upper trapezius muscle TP1 or TP2, moist heat, active ROM exercises and passive stretching of the upper trapezius muscles. Participants were treated for a total of 6 visits. Subjective and objective measurements were done at visits 1, 4 and a final visit 7 during which only measurements were taken.