Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, at echnikon Natal, 1999. / In order to investigate low back pain in an Indian and a Coloured community in South Africa, a population-based epidemiological survey was carried out in which 1 000 subjects were interviewed (500 Indians and 500 Coloureds). Subjects were selected using the Systematic Random Sampling method. A pre-tested questionnaire, designed by the researcher, was used to elicit information about the subjects' demography, general characteristics and details regarding low back pain (incidence, prevalence, severity, disability, treatment). Only subjects 18 years or older who were permanent residents of the 2 suburbs were included in the study. The author carried out the interviews personally / M

M.Tech. (Chiropractic) / Headache is the most common type of pain and is one of the most frequent reasons for medical consultation (Rasmussen, 1995). Tension-type headaches cause substantial levels of disability for the patient as well as the global society because of its high prevalence in the general population (Stovner, Hagen, Jensen, 2007). Tension-Type headache is a primary headache commonly found in three forms: infrequent episodic, frequent episodic and chronic with or without pericranial tenderness (International Headache Society, 2009). The aim of this study was to determine the effectiveness of chiropractic manipulation of the temporomandibular joint in conjunction with ischemic compression of the lateral pterygoid muscle as a treatment protocol for tension-type headache. Method: This study consisted of three groups of sixteen participants each with tension-type headaches. The participants were between the ages of 18 and 25 years of age. Potential participants were examined and selected based on the inclusion and exclusion criteria. Group one received chiropractic manipulation of the temporomandibular joint. Group two received ischemic compression of the lateral pterygoid muscle. Group three received a combination treatment of chiropractic manipulation of the temporomandibular joint and ischemic compression of the lateral pterygoid muscle. Objective and subjective finding were based on the treatment sessions. Procedure: All participants received a total of six treatments over two weeks followed by a seventh visit which consisted of data gathering only. The subjective data collected was in the form of a TMJ symptom questionnaire completed at visit one and seven and a Headache Disability Index (HDI) completed at visits one, three and seven. TMJ motion was measured by means of a vernier caliper.

M.Tech. / OBJECTIVE: The aim of this study was to determine the extent of the benefit of combining psychological intervention, in the form of guided imagery, with spinal manipulative therapy, in the treatment of mechanical chronic lower back pain. The guided imagery functioned to address the psychosocial factors playing a role in the experience, maintenance and exacerbation of chronic pain (Turk, Swanson & Tunks, 2008), while the chiropractic spinal manipulative therapy functioned to address the dysfunctional biomechanics which cause the biological and neurological aspects of the chronic pain. DESIGN AND METHODOLOGY: 30 subjects between the ages of 18 and 40, presenting to the University of Johannesburg Chiropractic day clinic with chronic lower back pain, participated in the trail. They were randomly divided into 2 groups, which both underwent 6 treatments. During the initial consultation, both groups had their lumbar range of motion measured with the digital inclinometer, and were asked to complete the Oswestry Pain and Disability Index (Appendix G), Numerical Pain Rating Scale (Appendix H), and Perceived Stress Scale (Appendix I). This was followed for group A by spinal manipulative therapy to the restricted segments. Group B was treated with spinal manipulative therapy and a guided imagery session, performed by a registered psychologist. The participants were instructed on how to perform the guided imagery on their own, and were asked to perform it at home 3 times per week for the duration of the treatment. During the 2nd consultation, both groups received spinal manipulative therapy, and their progress was noted throughout on a SOAP note. During the 3rd consultation, both groups again had their lumbar range of motion measured, and were asked to complete the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. Treatment followed as per the initial consultation for both groups. During the 4th and 5th consultations, both groups received spinal manipulative therapy. During the final consultation, both groups were again treated with spinal manipulative therapy, followed by lumbar range of motion measurements, and final completion of the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. RESULTS: There was a statistically significant improvement in overall lumbar range of motion for both groups throughout all degrees of freedom respectively. It is interesting to note that both in extension as well as rotation the inter-group measurements were statistically significantly different at treatment outset, but due to greater improvement in group B over group A, became statistically comparable on completion of the trials. There was also a significant overall improvement and decrease in subjective symptoms of perceived pain, disability and stress for both groups, and the Numerical Pain Rating Scale also demonstrated a statistically significant improvement in results, due to greater improvement of group B over group A. CONCLUSION: The subjective and objective results between participants of the same group, demonstrated that both spinal manipulative therapy alone, as well as spinal manipulative therapy in conjunction with guided imagery was effective in treating chronic mechanical lower back pain. When comparing results between the two groups, the combined protocol group showed statistically significant improvement above the purely chiropractic group in 3 out of 6 objective measures, and 1 out of 3 subjective measures. There is thus limited evidence as to the advantage of combining guided imagery with the chiropractic treatment protocol of chronic mechanical lower back pain, however unfortunately not sufficient evidence to draw a definitive conclusion.

M.Tech. (Chiropractic) / Purpose: The aim of this comparative study was to compare the effects of Muscle Energy Technique (MET) versus myofascial dry needling of quadratus lumborum in the treatment of myofascial trigger points (TrPs), with regards to pain, disability and lumbar spine range of motion. Method: Thirty participants, male and female between the ages of eighteen and forty-five years, with an active quadratus lumborum TrP were used in this study. The thirty participants were randomly divided into two groups consisting of fifteen individuals each, ensuring equal male to female and age ratios. Group 1 received treatment in the form of MET. Group 2 received treatment in the form of myofascial dry needling. The trial consisted of five visits over a treatment period of two weeks, of which the first four visits the participants received treatment and the fifth visit served the purpose of obtaining the final data. The data was gathered on the first, third and fifth visits. The data was gathered before the treatment was performed. Objective data consisted of measuring lumbar spine range of motion with a digital inclinometer and pain pressure threshold using an algometer. Subjective data was obtained by using the Numerical Pain Rating Scale (NPRS) and Oswestry Disablity Index for Lower Back Pain (ODI). Results: The results were interpreted by STATKON at the University of Johannesburg. Both groups improved significantly in both the objective and subjective measurements over the two week trial period. This indicted that both treatment interventions were effective in the treatment of active quadratus lumborum TrPs. The results also indicated that group 2 (myofascial dry needling) was statistically superior to group 1 (MET) with regards to the subjective and lumbar spine range of motion measurements obtained during the study. There was no statistical superiority between the two treatment interventions with regards to the pain pressure threshold values obtained. These results indicate that dry needling is more effective than MET in decreasing pain and disability, while increasing lumbar spine range motion due to active quadratus lumborum TrPs. Conclusion: It was concluded, based on the results, that myofascial dry needling was more effective than MET with regards to the subjective pain, disability and lumbar spine range of motion. However with regards to pain pressure threshold values, there was no superiority of either treatment. This study suggests that myofascial dry needling is a preferential treatment option than MET in the case of active quadratus lumborum TrPs as it is possible that dry needling alone is more effective in reducing pain, disability and increasing lumbar spine range of motion. However this does not rule out MET as treatment for active TrPs as objectively MET reduces objective pain as effectively as dry needling.

M.Tech. / Purpose: This study aims to determine whether adjusting the area of nerve root supply, or adjusting the attachment site of the latissimus dorsi muscle, will have an effect on the latissimus dorsi muscle and to which extend, with regards to strength and electromyographic (sEMG) activity. These effects were evaluated by measuring the latissimus dorsi .muscle strength using a Jamar dynamometer as well as sEMG readings of the latissimus dorsi muscle using a Neuro Trac ETS unit. Readings were taken prior to treatment on the first, third, and fifth consultations. Method: Forty five participants who met the inclusion criteria were stratified in number and gender between three groups of equal size (15 participants each). Group 1 received lower cervical adjustments (C5 - C7), group 2 received lower thoracic and lumbar adjustments (T6 - L5) and group 3 received detuned ultrasound therapy on the latissimus dorsi muscle. Group three served as the control group. Participants were treated four times out of a total of five sessions, over a maximum three week period Procedure: Objective data was collected at the beginning of the first and third session, as well as on the fifth consultation by means of a Jamar dynamometer and a Neuro Trac ETS unit in order to assess the functionality of the latissimus dorsi muscle. Analysis of collected data was performed by a statistician. Results: Statistically significant improvement in the dynamometry readings of both the experimental groups were noted when compared to that of the control group. The results of the sEMG activity were variable. Conclusion: The results show that adjusting the area of nerve root supply as well as adjusting the attachment site of the latissimus dorsi muscle are effective treatment protocols (as demonstrated statistically) in increasing strength of the latissimus dorsi muscle. The results suggest that adjusting the attachment site of the latissimus dorsi muscle is most effective in increasing the strength of the latissimus dorsi muscle. The results of the sEMG activity were variable and there were no evidence supporting the effectiveness of adjusting the area of nerve root supply versus adjusting the attachment site ofthe latissimus dorsi muscle on sEMG activity.

M.Tech. / Purpose: This study aims to compare the effects of lumbar spine and/or pelvic manipulation, and lumbar spine and/or pelvic manipulation in conjunction with the application of subcutaneous parenteral Traumeel® in the treatment of chronic mechanical low back pain with regards to pain, disability and lumbar spine range of motion. These effects were evaluated using a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Questionnaire, and by measuring lumbar spine range of motion using a digital inclinometer. The questionnaire was completed and the range of motion readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were stratified in number and gender between two groups of equal size (15 participants each). Group one received spinal manipulation to restricted lumbar spine and/or sacroiliac joints followed by the administration of subcutaneous parenteral Traumeel®. The second group received spinal manipulation to restricted lumbar spine and/or sacroiliac joints. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a Numerical Pain Rating Scale (NPRS) and an Oswestry Low Back Pain Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a digital inclinometer in order to assess lumbar spine range of motion. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and lumbar spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 with reference to lumbar spine range of motion. vi Conclusion: The results show that both spinal manipulation, as well as spinal manipulation in conjunction with subcutaneous parenteral Traumeel® are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing lumbar spine range of motion in patients with mechanical low back pain. However, neither treatment protocol proved to be preferential. The results carry a possible suggestion that chiropractic manipulation (common to both groups) is effective in ameliorating participant-rated pain and disability, and increasing lumbar spine range of motion in the case of chronic mechanical low back pain.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology in Chiropractic at Technikon Natal, 2002. / The purpose of this study, was to investigate and determine what role the treatment of nocturnal bruxism, in conjunction with spinal manipulative therapy, would play in the management of tension-type headaches. / M

A thesis presented in partial compliance wnh the requirements for the Master's Degree in Chiropractic, Technikon Natal, 1999. / Sacroiliac syndrome is a common condition causing low back pain (Mierau et al. 1984, Guo and Zhao 1994). It is a painful, debilitating condition that may cause considerable discomfort (Haldeman 1992:220). According to Frymoyer et al. (1991:2114), sacroiliac syndrome is a frequently overlooked source of low back pain as it may mimic other well known causes of low back pain / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2017. / Radiographs are the most commonly used modalities for the purpose of diagnosing skeletal disorders. Radiographs are important for chiropractors to exclude any contra-indications prior to spinal manipulative therapy. If contra-indications are found treatment is modified to what best suits each patient. There is a gap in the literature regarding chiropractors reading the same set of radiographs and agreeing on findings. Objectives The study investigated inter- and intra-examiner reliability of lumbar spine radiograph analysis by chiropractors and its impact on clinical management. Methods Inter- and intra-examiner examination of radiographs occurred in two rounds separated by two weeks. Six chiropractors read the same 30 radiographs and clinical history was only available in the second round. Results Inter-observer agreement for categorisation for Round One was 96.78% and Round Two 89.49%. Inter-observer agreement in management was 96.45% in round one and 96.00% in Round two. Agreement between chiropractors had no statistically significant difference. Identification average improved from 0.09 to 0.89 kappa. Overall specificity was relatively high and sensitivity was relatively low. Conclusion Reliability/Agreement between chiropractors was strong in both rounds. Categorising of the diagnosis improved from poor to substantial from Round One to Round Two. Case history improved the accuracy of interpreting the radiographs although this change was not statistically significant. / M

M.Tech. (Chiropractic) / A myofascial trigger point is a hyperirritable point within a tight band of voluntary skeletal muscle. The condition causes levels of mild discomfort to intense pain to patients that usually results in loss of man hours and compulsory pain medication. Dry needling is the treatment of choice and other techniques are seldom considered. Dry needling therapy (DNT) is an effective tool in the chiropractic profession but comes with significant drawbacks, such as patients whom have needling phobias and patients who often experience post needling soreness are challenging to treat with DNT. Further and more serious risks include pneumothorax when needling the muscles over the lung fields, which also limits the treatment scope of DNT. Low level laser therapy (LLLT) is non-invasive and non-threatening to patients and could serve as an alternative to DNT. This study therefore aimed, to determine if LLLT could be an alternative treatment to DNT by comparing DNT to LLLT on a target group that all have active trapezius trigger point two myofascial trigger points. The group consisted of 40 participants with posterior trapezius myofascial neck pain caused by active myofascial trapezius trigger points. Participants were then randomly divided into two groups. Group A (20 participants) would receive DNT to the active myofascialtrapezius trigger point two (TP2) and group B (20 participants) would receive LLLT also to the active myofascial trapezius TP2. Participants would then be treated according to a set protocol, over a two week period with a total of four treatments. Subjective and objective readings were taken and noted on the first, third and fifth visits. Subjective data was collected from the visual analogue scale and the Vernon-Minor neck pain and disability index questionnaires. Whereas the cervical range of motion (CROM) and algometer readings provided the objective data.