M.Tech. / Myofascial pain has become a major cause of disability and chronic pain in our society today. Left untreated, myofascial pain syndrome can become a chronic pain condition. Chronic pain conditions can not only cause disability due to pain, but can also lead to related conditions such as depression, physical deconditioning due to lack of exercise, disturbance of sleep and other psychological and behavioural disturbances (Rachlin, 1994). The aim of this study was to determine whether cryotherapy or moist heat therapy was a superior therapeutic modality when applied to active Infraspinatus muscle trigger points post-dry needling. Participants were recruited into the study by the use of advertisements put up at various places on the university campus as well as in the University of Johannesburg Chiropractic Day Clinic. Fourty participants that conformed to the specific inclusion and exclusion criteria were recruited. The participants were randomly placed into two groups containing twenty participants in each group. Group A received cryotherapy post-dry needling and Group B received moist heat therapy post dry needling. Each participant received four treatments. The subjective and objective measurements were taken on the first, third and fifth visits. The fifth visit was scheduled to take final subjective and objective data only. The subjective data was obtained by measuring the participant‟s perception of their myofascial pain using the Visual Analogue Pain Scale. The objective data was obtained from the readings of the Algometer instrument, measuring the pressure pain threshold of the active myofascial trigger points in the Infraspinatus muscle. The results of this study indicated that both cryotherapy and moist heat therapy significantly benefited the participants in terms of the treatment of the active myofascial trigger points of the Infraspinatus muscle. However, based on the results, final conclusions could not be formulated on whether the dry needling itself would be beneficial without needing the cryotherapy or the moist heat therapy, as neither modality proved superior over the other.

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 department (Murphy, 2000). Anti-inflammatory creams and gels are readily available to individuals suffering from musculoskeletal pain. The purpose of this study was to determine the effectiveness of Traumeel®S ointment together with chiropractic spinal manipulative therapy as a treatment form for posterior mechanical neck pain, with regards to pain, disability and cervical spine 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. Group A received chiropractic spinal manipulative therapy followed by the application of aqueous cream over the upper trapezius muscle area of the posterior neck. This was the placebo group. Group B received chiropractic spinal manipulative therapy followed by the application of Traumeel®S ointment over the upper trapezius muscle area of the posterior neck. This was the experimental group. Objective and subjective findings were based on the above treatment protocols. 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. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index as well as from the Visual Analogue Scale (VAS). Objective readings were taken from measurements taken from the Cervical Range of Motion device (CROM). At the first to the sixth consultations participants received spinal manipulative therapy with either the application of aqueous cream or the application of Traumeel®S ointment depending on whether they were in group A or group B. Results: Clinically and statistically significant improvements in both group A and group B were seen over the course of the study with regards to cervical spine range of motion, pain and disability. Conclusion: The results show that both treatment protocols were effective in decreasing cervical spine pain and disability and increasing cervical spine ROM. Group B receiving Traumeel®S ointment did show a greater increase in cervical spine ROM clinically, but statistically there was no significant difference between the two groups.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves / Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xi, 60 leaves, Annexures 1-9 / The Transversus Abdominis (TrA) muscle is recognised in the literature as playing a vital and protective role in maintaining a healthy core and aiding lumbar biomechanics in the dampening of external forces applied to the lumbar spine. Pilates purports to employ the principles of core training yet there remains a deficit in the literature despite its popularity in rehabilitation and fitness industries. This study aimed to evaluate the efficacy of Pilates method in training the TrA in comparison to a moderately active population that regularly exercises in a gym environment, as well as a sedentary control.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Durban University of Technology, 2013. / Objectives: Myofascial pain dysfunction is a common musculoskeletal disorder, known to affect athletes. This research aimed to create a map of myofascial trigger points (MFTPs), to ascertain sport specific combinations. Design and Setting: This IRB approved study was a cross-sectional, observational study. Participants: Forty swimmers and forty non-swimmers (soccer players). Measurements : All participants underwent one assessment, non-intervention session where primary measures included: shoulder disability index (SDI), myofascial diagnostic scale (MDS), algometer and numerical pain rating scale (NRS). Manual palpation, the MDS and an algometer assessed MFTPs and the SDI overall function. SPSS version 20 (IBM) using Pearson’s chi square tests / Fisher’s exact tests compared MFTP locations between the groups, and non-parametric Mann-Whitney tests compared continuous measures (due to significant non-normal distribution), with a p-value <0.05 level of significance. Results: MFTP presence is very uncommon in swimmers, with associated pain and loss of function being very low on average. No evidence was found that swimmers were affected more than non swimmers by MFTPs related pain or loss of function, but has indicated that algometer measurements for infraspinatus MFTP 1, were significantly higher (p<0.027) (showing decreased tenderness) than the values in non swimmers. Conclusions: These results contradict the literature which suggests that unique activity specific patterns of MFTPs exist. This may be as a result of underlying systemic causes of MFTPs that obscured the pattern in this study. It is therefore suggested that larger trials with more participants per group be done in order to verify the results of this study.

Submitted in fulfillment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Mid-back pain (mbp) is defined as pain occurring within the limits of the third thoracic (T3) and ninth thoracic (T9) vertebrae, caused by the dysfunction of the musculoskeletal structures in the thoracic spine. It can present as pain and/ burning between the shoulder blades with reduced thoracic spine mobility and increased muscle tension. Congenital disorders such as scoliosis and Scheuermann’s disease, or acquired disorders such as thoracic facet and costovertebral joint dysfunction may cause mbp. The thoracic facet and costovertebral joints are similar in anatomy and share a mutually dependent biomechanical relationship. There were a handful of controlled studies that highlighted the effectiveness of thoracic facet manipulation on mbp, but there were none on the effects of costovertebral manipulation on mbp. Objectives The aim of this study was to investigate the immediate effects of the combination of thoracic facet and costovertebral joint manipulation on mbp in terms of pain perception, pressure pain thresholds (PPT) and thoracic spine range of motion (ROM). Design A prospective single-blind randomised comparative clinical trial. Setting This study was conducted in a university setting at the Durban University of Technology Chiropractic Day Clinic Participants Fifty participants were recruited via responses to advertisements placed around the Durban University of Technology (DUT) campuses and individuals presenting at the Chiropractic Day Clinic (CDC). Intervention The participants were divided into two groups of twenty-five. Group A received the thoracic facet joint manipulations and Group B received a combination of the thoracic facet and costovertebral joint manipulations. Outcome measures All subjective and objective measurements were taken before and after the application of the manipulations. Pain perception i.e. subjective measurement) was measured by the Numerical Pain Rating Scale (NPRS), pressure pain thresholds (PPT) (i.e. objective measurement) were measured by the Wagner’s FDK Force Gage Algometer and thoracic spine range of motion (ROM) i.e. objective measurement was measured by the Saunders Digital Inclinometer. Results The data was analyzed using the latest version of SPSS and a p-value = 0.05 was used to determine statistical significance. Descriptive statistics in the form of univariate analysis described the data in terms of measures of central tendency and measures of dispersion. Data that was distributed normally was analyzed using the t-test and ANOVA. Data that was distributed abnormally was analyzed using the non-parametric Wilcoxon ranked and Mann Whitney tests. Nominal and ordinal data was analyzed using the Chi squared test. The results of the intra-group analysis indicated a statistically significant decrease in pain perception (p ≤ 0.000), increase in PPT (p ≤ 0.05) and decrease in thoracic spine ROM (p ≤ 0.000). However, the results for the inter-group analysis indicate there was no statistically significant difference in pain perception (p = 0.386), PPT (p > 0.05) and thoracic spine ROM (p >0.05) between Group A and Group B. Conclusions These results showed that the combination of thoracic facet and costovertebral joint manipulation was as effective as thoracic facet joint manipulation alone, in the treatment of mbp. These findings suggested that manipulation of the costovertebral joints may not be necessary for the effective treatment of mbp. / M

M.Tech. / OBJECTIVE: To determine the most effective treatment protocol in the treatment of Lower-Crossed Syndrome by comparing objective results gained from a Rehabilitation program (group one), Spinal Manipulative Therapy (group two) and a combination of these therapies (group three) directed at the sacroiliac joints and lumbar spine. DESIGN: The study was a clinical trial in which three experimental groups of sixteen participants each were compared to each other. These participants were recruited from the local general population and were selected on the basis of inclusion and exclusion criteria, presenting with Lower-Crossed Syndrome and demonstrating unremarkable clinical and radiological findings. INTERVENTION AND DURATION: After randomisation, group one received a Rehabilitation program which consisted of a stretching and strengthening program only, group two received Spinal Manipulative Therapy only whereas group three received a combination of Spinal Manipulative Therapy and a Rehabilitation program. The frequency of the follow up consultations for this study was two consultations over the first two weeks of the trial and once a week for the following four weeks of the trial. MEASUREMENTS: Objective measurements included lumbar spine flexion and extension ranges of motion, hip flexor flexibility (hip extension), active and passive hamstring flexibility, gluteus maximus and abdominal strength tests and Sorenson’s Test (static back extensor strength test). Subjective measurements were the Oswestry Low Back Pain and Disability Index and McGill’s Questionnaire. Measurements were taken before (pre-) and after (post-) the first (initial), third, fifth and eighth (last) consultations. CONCLUSIONS: The aim of the study was to determine the most effective treatment protocol in the management of Lower Back Pain in athletes presenting with Lower-Crossed Syndrome. Although the combined group (group three) showed the greatest improvement these findings were statistically no greater than the statistical findings in group one and group two. All groups showed a statistically significant improvement over the trial period. This illustrates that both Spinal Manipulative Therapy and a Rehabilitation program (including stretching and strengthening) was effective in the management of Lower-Crossed Syndrome. From this study it can therefore be concluded that one treatment protocol did not prove to be more effective than that of the others.

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Motion palpation is used to assess the functional status of a joint and is defined as “The manual palpation of bony structures and soft tissues, through pressure applied in various directions of joint motion to ascertain areas of joint hypomobility and hypermobility.” Motion palpation is a collection of manual examination procedures, used to identify the site and characteristics of altered joint motion and which has been an important part of chiropractic since its inception. One of the most important goals for any clinical instrument is for it to have good reliability and reproducibility, this is because the clinical value of a test must be demonstrated before the results are considered valid. The extent to which a repeated test will produce the same result when evaluating an unchanged characteristic is its reliability. Reliability is evaluated by multiple blinded measurements performed on a sample of subjects. Inter-examiner reliability evaluates the consistency of different examiners and is determined through repeated assessment by two or more raters. Objective The aim of this study was to determine the inter-examiner reliability of motion palpation of knee joints with patellofemoral pain syndrome and asymptomatic knee joints, and to compare the inter-examiner reliability of motion palpation between the two groups. Method This quantitative, inter-examiner, clinical reliability study, included 30 patients each with one knee with patellofemoral pain syndrome and one asymptomatic knee. Each patient had both of their knees motion palpated by three independent examiners blinded to which was the symptomatic knee. The examiners were senior student interns at the DUT Chiropractic Clinic. The motion palpation findings were recorded and statistically analyzed through the SPSS statistical package. Fleiss Kappa statistic was used to give a Kappa score for each direction of motion palpation and these scores evaluated the inter-examiner reliability of motion palpation in the symptomatic and the asymptomatic knee. A comparison of the inter-examiner reliability of motion palpation between the two groups was performed using a paired Wilcoxin signed ranks test. Results The Kappa scores for motion palpation ranged from -0.2081 to 0.1802 for the symptomatic knee joint and -0.2836 to 0.0339 for the asymptomatic knee. This shows poor agreement in both cases. There was no significant difference in Kappa values (p= 0.609) for the two groups for the Wilcoxin signed ranks test and the number of positive and negative ranks were similar. This indicates that the reliability of motion palpation in both groups was similar. Conclusion It was concluded that inter-examiner reliability of motion palpation of the knee joint was poor in knees with patellofemoral pain syndrome and in knees that were asymptomatic. Motion palpation was found to be equally reliable in both groups, indicating that motion palpation of a symptomatic joint does not improve its reliability. This research suggests that motion palpation should be used together with other diagnostic tests to identify patellofemoral pain syndrome as it is not a reliable tool when used in isolation.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: The most common shoulder complaint seen by physicians is shoulder impingement syndrome. There has been limited success with the current conservative treatment that has been provided for this condition. Thoracic spine and rib manipulation is purported to aid in the treatment of this condition; however there is a paucity of controlled investigations. The purpose of this study was to determine the short term efficacy of thoracic and prone rib manipulation on shoulder impingement syndrome. Methods: A randomised, placebo controlled pre-test post-test experimental design was used. Informed consent was obtained and 30 participants were recruited according to inclusion criteria and allocated to either a placebo or intervention group. Intervention consisted of thoracic spinal and rib manipulation. Data was collected, pre and post the first treatment and at a 48 hours follow up. SPSS was used to analyse the data with a p value of 0.05. Results: No statistically significant differences were seen between the groups for pain rating, range of motion of the glenohumeral joint, lateral scapula slide test or scapula isometric pinch test. The shoulder pain and disability index (SPADI) showed significant (p = 0.04) differences between the groups in terms of disability scores, with the intervention group having a great improvement in disability. No clinically significant differences were observed between the groups. Conclusion: Thoracic spine and rib manipulation appears to improve the disability associated with shoulder impingement syndrome, however further research is required with a larger sample size.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of technology, Durban, South Africa, 2016. / INTRODUCTION: The utilization of complementary and alternative medicine (CAM) in the treatment of paediatric patients is increasing, especially the utilization of chiropractic treatment for children. However controversy exists regarding the reasons why parents may or may not choose to utilize chiropractic treatment for children. Parents are the gatekeepers to care as they consent to all treatment that is given to their children. Parents that have a lack of knowledge and understanding regarding chiropractic, as well as a negative perception regarding chiropractic treatment for children may be reluctant to choose chiropractic treatment as a treatment option. Both positive and negative opinions regarding chiropractic treatment have been identified in other populations in South Africa which emphasizes the need to explore the way parents feel about chiropractic treatment for children. A lack of knowledge and understanding of CAM has been identified as a reason for underutilization. Insight into the status of knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients in the Durban Metropolitan Area equips the profession to better understand how parents view chiropractic treatment for children. AIMS AND OBJECTIVES: The main aim of this research was to explore and describe the knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients. The outcomes of such a study can provide useful information which can serve as a baseline from which education and chiropractic treatment awareness can be built, as well as dispelling any misconceptions and myths regarding chiropractic treatment for children. RESEARCH DESIGN: An explorative, descriptive, qualitative research design was followed in this research. This research design was chosen in order to evaluate the knowledge, understanding and perception of parents regarding the utilization of chiropractic treatment for paediatric patients, within the Durban Metropolitan area. RESEARCH METHODOLOGY: Semi-structured interviews were conducted with participants of the Durban Metropolitan Area in order to determine the current knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients within this area. Interviews were conducted with the participants until saturation was met, after which an additional five interviews were conducted. A total of 13 interviews were analyzed. The data was transcribed and coded by the researcher as well as a co-coder. NVivo software was utilized for the coding process. RESULTS: It was found that the participants had a lack of knowledge and understanding regarding chiropractic treatment for children. The participants felt that this lack of knowledge and understanding of chiropractic treatment for children left them unsure, resulting in the non-use of this form of treatment for their children. The participants were however not opposed to the utilization of chiropractic treatment for children; they felt fear and concern regarding chiropractic treatment as they felt they were uneducated regarding the outcome of the treatment, what the treatment would involve and the reasons why chiropractic treatment should be utilized for children. The participants mentioned that if they had increased knowledge and understanding they would feel more comfortable in utilizing chiropractic treatment for their children. The participants felt that they did not have the resources to learn more about chiropractic treatment and they showed interest in learning more about chiropractic treatment for children. Recommendations were made for further research and for the chiropractic profession regarding increasing the knowledge and understanding of parents regarding chiropractic treatment. / M