A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Myofascial pain syndrome is the second most common reason patients seek the help of health care workers. It costs billions of dollars each year in lost revenue due to loss of productivity and other costs. The treatment of myofascial pain syndrome has been extensively researched and it appears that dry needling and medicinal injections of trigger points are some of the most effective modalities. However, an unwanted side effect common to both these therapies is post-needling soreness. Despite being mentioned in passing by many authors, very little detail is available regarding post-needling soreness. It is unclear whether post-needling soreness arises from the trigger point itself, or whether the tissue damage caused by the needle insertion is responsible. Therefore, this study was aimed at investigating whether dry needling muscle tissue in asymptomatic subjects (i.e. subjects not suffering from myofascial pain syndrome) resulted in post-needling soreness. Two different dry needling techniques were also compared with a placebo group in order to determine which technique resulted in the least post-needling soreness. This study was designed as a prospective, randomised, placebo controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups. Group one received the single needle insertion technique and the second group received the fanning dry needling technique. The last group formed the control group and the subjects were treated using the Park Sham Device (placebo needles). All the subjects were between the ages of 18 and 50 and were required to be asymptomatic in the low back region. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Low back pain has been shown to be associated with inhibition of the lower limb musculature. This inhibition is called arthrogenic muscle inhibition (AMI). Sacroiliac joint dysfunction has been linked with AMI of the ipsilateral and contralateral quadriceps and hamstring muscles. Sacroiliac manipulation has been shown to significantly reduce ipsilateral AMI, however no studies have been conducted to illustrate the effect of sacroiliac manipulation on contralateral AMI. Neither have their been studies to show the presence or extent of spinal dysfunction between the levels of L2-L5 and its significance on muscle inhibition in the quadriceps and hamstring muscles, nor the effect of manipulation of these levels on AMI of the quadriceps and hamstring muscles. The purpose of this study was therefore to determine whether spinal manipulation has an effect on AMI of the contralateral limb as well as that of the ipsilateral limb. / M

Dissertation submitted in fulfillment of requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Delayed onset muscle soreness (DOMS) is muscular pain which ranges from mild discomfort to severe debilitating pain, caused by eccentric exercise. It generally sets in 12 - 24 hours after the causative activity and subsides within approximately seven days. The aim of this study was to determine whether proprioceptive neuromuscular facilitated (PNF) stretching immediately after eccentric exercise was more beneficial than PNF stretching 24 hours after eccentric exercise on the muscle pain experienced in DOMS. This study was a prospective, randomised clinical trial. Thirty healthy sedentary male participants were randomly selected to participate in the study by advertising in local newspapers and pamphlet distribution in Durban and its surrounding areas. The patients' ages ranged from 20 to 32 years of age. Subjective and objective readings were taken at the beginning and end of each visit, over the three-day study period. This was done with the numerical pain rating scale and the algometer force gauge, respectively. Baseline measurements were taken before any exercise or stretching at the initial visit. All participants then were asked to do squats until fatigue to induce delayed onset muscle soreness. III The participants were divided randomly into two groups, Group A and Group B. The former group underwent PNF stretching immediately after exercise and the latter group underwent PNF stretching twenty four hours after exercise. Both groups were asked to return for two subsequent days following the initial visit and they again underwent PNF stretching at each visit. Comparison was made between the individual patients' pain perception over time, as well as between each group. Descriptive analysis was done using frequency tables (reporting counts and percentages) for categorical variables and summary statistics (reporting mean, standard deviation and range), for quantitative variables. Baseline and demographic characteristics were compared between the two treatment groups using independent t-tests for quantitative variables and Pearson's chisquare tests for categorical variables. The treatment effect was assessed using repeated measures ANOVA testing. Statistical analysis revealed that there was no difference in the improvement of pain experienced between the two groups. However, Group B (PNF stretching 24 hours after exercise) appeared to improve at a greater rate than Group A (PNF stretching immediately after exercise). A larger study needs to be conducted in order to provide statistically relevant results. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / An inversion ankle sprain can be defined as an injury caused by landing forcefully on an inverted, plantarflexed and internally rotated foot. This results in the fibres of the surrounding ligaments to become ruptured without disturbing the continuity of the ligament. Chronic stable ankle sprains was defined as the recurrent giving way of the ankle and there may be residual pain and swelling with no mechanical instability. According to literature, mechanisms involved in the development of chronic ankle sprains are: the lack of appropriate and early immobilization in severe cases, the development of scar tissue, lack of strengthening exercises or the development of hypermobility. Many treatments have been suggested to address these factors and would include: peripheral manipulation of the ankle joint, Muscle Energy Technique, muscle strengthening and stretching, proprioceptive training and deep transverse friction massage. Of the above mentioned treatments, Muscle Energy Technique has not been researched in a clinical setting for the treatment of chronic stable ankle inversion sprains. Therefore the purpose of this study was to investigate the relative effectiveness of Muscle Energy Technique compared to Manipulation in the treatment of chronic stable ankle inversion sprains. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Purpose: Ankle sprains are amongst the most common injury sustained by athletes and the general public. When an ankle is repeatedly sprained it results in chronic ankle instability syndrome (CAIS). This repeated trauma results in disruption of the afferent nerve supply from the injured joint, which affects the motor neuron pool excitability of the peroneal and soleus muscles resulting in arthogenic muscle inhibition (AMI). Traditional treatment for CAIS focuses on rehabilitation of the affected muscles via strength and proprioceptive training. Recent literature has shown that the addition of ankle joint manipulation resulted in improved clinical outcomes in the treatment of CAIS. The mechanism on how joint manipulation affects AMI is under-investigated especially in extremity joints. Thus this study aimed to determine the immediate effect of ankle joint manipulation on peroneal and soleus muscle activity, by assessing surface electromyography (sEMG) H/M ratio to detect a change in the proportion of the total motor neuron pool being recruited, in participants with CAIS. Methods: The study utilised a quantitative, experimental, pre-test post-test study design. Forty two participants with grade I and II CAIS, aged 18-45 years, were randomly allocated into one of three groups. Group one received a single talocrural joint long axis distraction manipulation, group two received a sham manipulation and group three was the control receiving no intervention. sEMG H/M ratio measurements were taken before and immediately after the intervention using a Biopac wireless emg system. Results: The groups were comparable at baseline for age, gender, body mass index and H/M ratio measurements for the soleus and peroneal muscles (p < 0.050). Intra-group analysis of the soleus muscle H/M ratio showed no statistically significant change over time for the manipulation (p = 0.975) and sham (p = 0.056) groups, with the control group showing a statistically significant (p = 0.019) decrease in the H/M ratio. For the peroneal muscle no statistically significant (p > 0.050) differences were observed in any of the three groups. Inter-group analysis of the soleus muscle H/M ratio measurements showed no statistically significant differences between the three groups (p = 0.470; F = 1.010) over time, with Tukey’s HSD post-hoc test revealing a statistically significant (p = 0.028) difference being observed between the sham and control groups in terms of post soleus muscle H/M ratio measurements. Conclusion: This study failed to show that ankle joint manipulation affects the soleus and peroneal muscles in terms of H/M ratio measurements in participants with CAIS. There may have been a trend of an effect of the sham and manipulation interventions counteracting the muscle fatigue experienced in the control group, however further investigation is required. / M

M.Tech. / Purpose: To determine what effects flexion distraction will have on males with chronic lumbar facet syndrome, in reference to intersegmental range of motion and pain. Method: Thirty male participants with chronic lumbar facet syndrome received flexion distraction technique. The trail consisted of seven visits over two to three weeks. Treatment was performed on the first to sixth visit, readings and questionnaires were completed on the first, fourth and seventh visits. Data collection was concluded before treatment on the mentioned visits. Subjective data consisted of the Oswestry Disability Index (ODI) and the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). Objective data included global lumbar range of motion measurements using the Baseline Digital Inclinometer, and segmental lumbar range of motion by means of the Radiographical Midplane Angle method. Results: Objectively, clinical significance of the intersegmental lumbar range of motion increased from the L1/L2 to the L4/L5 level (2.2% - 17.7%), but showed no statistical significance. In relation to the maximal motion possible at these levels, the increase in motion escalated from 0.8% at the L1/L2 segment to 9.2% at the L4/L5 segment. The global lumbar range of motion showed clinical significant increase in all of the ranges except for extension, however statistical significance was found in right lateral flexion only (p = 0.045). The greatest increase in motion was observed in left lateral flexion (15.72%) and a decrease in extension (3.72%) was illustrated. Subjectively, the group showed statistical significant improvement in both the SF-MPQ-2 (p = 0.000) and ODI (p = 0.000). Clinical meaningful change was noted throughout the subjective data, which resultantly showed a 66% and a 67% change in pain respectively. Conclusion: Flexion distraction has shown to have clinical significant effects on segmental and thus global range of motion, and great clinical meaningful change in pain levels and pain perception. Thus specific segmental mobilisation does affect the segmental motion.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2013. / Background: Paediatric visits to complementary and alternative medicine (CAM) practitioners results from a wide range of childhood disorders. As there are significant anatomical differences between children and adults, scientific evidence for the effectiveness of chiropractic care for adults is not applicable to paediatrics, leaving a paucity of information supporting the management of paediatric conditions by chiropractors. Most studies regarding paediatrics have been performed in first world countries, leaving a paucity of information about third world countries, where the health care milieu differs. Therefore, this research aimed to determine the practice characteristics regarding paediatric care in chiropractic practices in KwaZulu-Natal. Objectives: This prospective, quantitative, descriptive, cross-sectional study based on a focus group refined and piloted questionnaire, determined the practice characteristics with regards to paediatric practice amongst chiropractors in KwaZulu-Natal. The total sample population was n=118, with each practitioner receiving a Letter of Information and Informed Consent Form and a Questionnaire. Data was analysed using the data analysis tools of Microsoft Office Excel and a p value of <0.05 was considered as statistically significant. Results: A response rate of 36% was obtained. Most of the respondents were middle-aged, female chiropractors who had been practicing for less than a decade. Very few of the chiropractors held paediatric qualifications (18.6%). In terms of paediatric care, most of the respondents used a variety of conservative approaches as evidenced by the type and number of assessments, treatment and management procedures used in practice. Conclusions: The results showed that few chiropractors in KwaZulu-Natal see paediatric patients in their practices; however the chiropractors that managed paediatric conditions were predominantly conservative. This is positive for the chiropractic profession, as it shows diligent and responsible decision making within a vulnerable population group. Future research must assist with facilitating inter-professional relations with other health care professionals and public relations need to be aimed at creating more awareness generally regarding chiropractic paediatric care. / M

Thesis (M.Tech.: Chiropractic)--Durban University of Technology, 2008 / Core strengthening has become a major trend in the rehabilitation of patients suffering with acute low back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus, lessen mechanical stress to the spine. Literature suggests that vibration/acceleration training may be a more effective and sufficient method of core stability exercises, with regards to core muscle endurance and activation in treatment of acute low back pain. This may have more advantages than using traditional core stability exercises in the treatment of acute low back pain. However, vibration/acceleration training as core stability exercises has yet to be investigated. In order to choose the most appropriate treatment protocol for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the acute period. Therefore, this study was designed to establish the effectiveness of vibration/acceleration training as a core stability exercise in the treatment of acute low back pain and to establish whether this protocol should be utilized routinely in the management of this condition.

Submitted in partial compliance for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / The aim of this study was to investigate patient management protocols of low back pain (LBP) by chiropractors in the greater Durban metropolitan area. In this investigation a more generalized approach was chosen to investigate trends within the field of patient management and education for LBP. The study population of 80 chiropractors in the greater Durban metropolitan area, required a minimum response rate of 70% to obtain statistical significance (Esterhuizen, 2008), which was achieved. This study involved a quantitative descriptive design utilizing a questionnaire developed and validated by the researcher and focus group. The questionnaire was comprised of three sections, including personal information, treatment protocols and patient management with advice and education. Statistical analysis involved the use of SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA), a data analysis tool. Descriptive objectives were analysed with frequency tables and cross-tabulation tables (Esterhuizen, 2008). Demographic variables and practice variables were assessed for association with responses to the questionnaire using Pearson’s Chi square test in the case of categorical demographics and responses (Esterhuizen, 2008). Bar graphs were included to reflect the treatments that were always or frequently used by respondents (Esterhuizen, 2008). There appeared to be a wide range of influences on practice philosophy and methods, independent of demographics and training institute. A chiropractor’s age was regarded as significant with regard to philosophical orientation. However, the majority of these chiropractors obtained their qualifications from international colleges. vi Spinal manipulations directed at quadratus lumborum myofascial trigger points were strongly advocated by respondents. Specific short lever manipulations were the preferred manipulation technique for treatment of LBP. Sacroiliac joint manipulation was also considered important by a significant proportion of respondents. Respondents most commonly recommended the use of mobilizations and cryotherapy when contra-indications to manipulation were evident. There was consensus in the number of days before the first follow-up after an initial treatment for a presentation of acute LBP, where 96.42% of respondents recommended follow-up at day 1 or 2. In chronic LBP first follow-up after initial treatment was recommended by 41.1% of respondents on day 2; 28.6% day 3 and 8.9% on day 1. Management protocols for acute LBP appeared to be more uniform when compared to management of chronic LBP. Despite the variances in philosophy and management protocols amongst respondents, there remains consensus that manual articular manipulation remains the mainstay in chiropractic treatment protocols for both acute and chronic LBP.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Aim The aim of this study was to determine the concurrent validity of an isiZulu Bournemouth Questionnaire in comparison to its English counterpart. Methodology This quantitative correlational study compared the isiZulu version of the Bournemouth Questionnaire to its English counterpart, (consisting of three sections: back, neck and musculoskeletal). The study employed a design where subjects were compared to themselves. A sample of 120 volunteers over the age of 18 years, who were literate in both English and isiZulu took part in the study. Whether the participant was symptomatic or asymptomatic was not of concern. Using a randomised list, the participants were administered one of the two versions of the questionnaire to be completed first, the second and alternate questionnaire was administered after an interval of at least 20 minutes. Results Of 120 paired questionnaires, 107 completed pairs were returned, resulting in a response rate of 89.2%. Results, using Cronbach-α (α= 0.05) with subsequent testing using the Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartlett’s Test of Sphericity, revealed that the questionnaires, in toto, had high levels of correlation. The relationship between the isiZulu and the English questions revealed a positive and high correlation using Kendall’s tau-b which was statistically significant (τb > 0.55, p = 0.000), although there were isolated instances of statistical difference between individual pairs of questions in respect to age, gender, site, primary language and level of education. Conclusions The study found that the isiZulu version of the Bournemouth Questionnaire showed concurrent validity with its English counterpart, and recommendations were made for the clinical application of the isiZulu version as a means of refining the interpretation of disjunct question pairs. / M