M.Tech. (Chiropractic) / Purpose: The trapezius muscle is thought to be the muscle most commonly associated with the presence of active myofascial trigger points (MFTP’s). Studies of the trapezius muscle clearly show that muscular activity significantly increases in response to psychological stress. Cervical spine manipulation has been proven to be highly effective in the treatment of active MFTP’s and muscular tension. Progressive muscle relaxation (PMR) therapy is frequently utilized as a relaxation technique in subjects complaining of increased levels of muscular tension, possibly due to an increased perception of psychological stress. Although cervical spine manipulation alone is effective in the treatment of active MFTP’s and muscular tension, chiropractors often search for adjunctive therapies to improve current treatment protocols. The purpose of this study was to determine whether the combination of cervical spine manipulation and PMR therapy is a more efficient, and possibly effective, treatment protocol for active MFTP’s of the trapezius muscle. Method: This study was a comparative study and consisted of two groups of fifteen participants each. All participants were between the ages of eighteen and thirty-five years of age, with a male to female ratio of 1:1. Potential participants were examined and accepted according to the inclusion and exclusion criteria. Group A received chiropractic spinal manipulative therapy of the cervical spine. Group B was the combination group and therefore received chiropractic spinal manipulative therapy of the cervical spine together with the application of PMR therapy. Subjective measurements consisted of a Perceived Stress Scale (PSS) Questionnaire, Visual Analog Pain Scale (VAS) and the Vernon-Mior Neck Pain and Disability Index Questionnaire. Objective measurements consisted of pressure pain threshold algometry readings taken from active trigger points one (TP1) and/or trigger point two (TP2) on the right and/or left side of the upper trapezius muscle.

M.Tech. / This study was conducted to determine the effect of Sacroiliac joint adjustment to the restricted Sacroiliac joint in combination with myofascial dry needling to the active/latent Rectus Femoris muscle trigger point and Rectus Femoris myofascial dry needling on its own on Quadriceps Femoris muscle strength. Thirty participants between the ages of 18 and 40 years were recruited through the use of advertisements placed in and around the University of Johannesburg’s Chiropractic Day Clinic. Participants were assessed for exclusion criteria by performing a Full Case History, Pertinent Physical Examination, Lumbar Spine and Pelvis Regional Examination and S.O.A.P note. The participants who conformed to the specific inclusion criteria were accepted for this study. These participants were randomly placed into two groups of sixteen participants each. Group One receive Sacroiliac joint adjustment to the restricted Sacroiliac joint and ipsilateral myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger points. Group two received myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger point on the same side as the Sacroiliac joint restriction. Each participant received five treatments over a three week period, i.e. two treatments for the first two weeks and one follow-up treatment in the third week. The subjective data of the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the Isometric Dynamometer measuring the Quadriceps Femoris muscle strength before and after each treatment. In addition the Algometer was used for measuring the pressure pain threshold of the Rectus Femoris trigger points. An analysis was performed using Repeated Measures Analysis, t-Test, Frequencis, Descriptives and Friedman’s Tests. The results of this study demonstrate that Sacroiliac joint adjustment to a restricted Sacroiliac joint with ipsilateral myofascial dry needling of the Rectus Femoris muscle showed a statistically significant, but temporary increase in Quadriceps Femoris muscle strength. Myofascial dry needling of the Rectus Femoris muscle on its own was found to be statistically insignificant for the increase in Quadriceps Femoris muscle strength.

M.Tech. (Chiropractic) / Myofascial trigger points (MTrP’s) cause acute discomfort to intense pain and often lead to the use of pain medication as well as loss of man hours (Simons, Travell and Simons, 1999a; Tough, White, Cummings, Richards and Campbell, 2009). Dry needling is very effective and is widely used for the treatment of MTrP’s (Vulfsons, Ratmansky and Kalichman, 2012), but comes with various significant drawbacks, such as the experience of pain during or after treatment (post-needling soreness) or individuals with needle phobias (Unruh, Strong and Wright, 2002). More serious risks also exist, including damage to the viscera (Dommerholt and Fernández-de-las-Peñas, 2013). Low level laser therapy (LLLT) is a non-invasive technique and very little discomfort or pain is experienced by the patient during and after treatment. LLLT is effective in the short- and long-term relief of trigger points and myofascial pain syndrome. Therefore it can easily serve as an alternative to myofacial dry needling (Chow and Barnsley, 2005). This study aimed to determine whether LLLT or myofascial dry needling is more effective in the treatment of active MTrP’s, specifically those of the gluteus medius muscle. It also aimed to determine if LLLT could serve as an alternative treatment to dry needling in cases where dry needling is contraindicated or not desired. Thirty participants who complied with the inclusion criteria were divided into one of two groups. Group 1 (n=15) received dosages of LLLT directly to the active MTrP’s in the gluteus medius muscle and Group 2 (n=15) received myofascial dry needling to active MTrP’s in the gluteus medius muscle. Each participant attended 6 treatment sessions over a course of 2 weeks as well as a 7th measurements-only session.

M.Tech. (Chiropractic) / Myofascial Pain Syndrome, is a common source of frustration for both healthcare practitioners and patients. It is the second most common reason for patients visiting their health care practitioner and constitutes up to 85% of the reasons for visits to pain clinics (Han and Harrison, 1997). As muscle pain is the most common work-related injury (Hubbard, 1998), it costs billions of dollars in lost revenue every year due to lost productivity (Fricton, 1990). Hong (1994), states that dry needling has been extensively studied and has been shown to decrease or even abolish myofascial pain. However post dry needling soreness is a common side effect of dry needling. Stuart (2010), states that applying kinesio tape® to a musculoskeletal injury during rehabilitation could result in a quicker recovery by allowing the body to biomechanically heal itself. Garcia-Mura et al (2009), results suggest that kinesio tape® is a method highly appropriate in the treatment of myofascial trigger points by normalising muscular function, increasing lymphatic and vascular flow, diminishing pain and aid in the correction of possible articular malalignment. The aim of this study was to determine the effects that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and an increased recovery time of the myofascial trigger points, with regards to changes in pressure pain threshold, pain and cervical range of motion. Participants for this study were recruited either by an advertisement which was placed on the information board of the Chiropractic Day Clinic at the University of Johannesburg as well as advertisements placed in and around the University of Johannesburg at the Doornfontein Campus. Also, many participants were made aware of this study via word of mouth from candidates already involved in the study. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received dry needling of the trapezius trigger point one followed by the application of kinesio tape® whereas group B received dry needing of trapezius trigger point one only. Participants were treated 5 times with objective and subjective measurements taken at the 1st, 3rd and 5th visits. Objective measurements consisted of readings taken with an algometer and cervical range of motion (CROM) device. The subjective measurements consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon Mior Neck Disability Index. The results of the study showed clinically and statistical significant improvements for both groups in regards to alleviating pain subjectively (Numerical Pain Rating Scale and Vernon-Mior Neck Pain and Disability Index), increasing pressure pain threshold objectively (Algometer) and increasing range of motion objectively (Cervical Range of Motion device). However group A (dry needing and kinesio tape®) showed a greater improvement in both subjective and objective measurements. Based on the results of the study, it could be concluded that both dry needling on its own as well as applying kinesio tape® post dry needling can be effective in the treatment of myofascial trigger points in the upper trapezius muscle, however applying kinesio tape® post dry needling seemed to be more effective.

M.Tech.

M.Tech. (Chiropractic) / Purpose: This study aims to determine the effect of Bruegger’s exercise on chronic low back pain in association with lower crossed syndrome and compare it to spinal manipulation alone or a combination of Bruegger’s exercise and spinal manipulation with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of three different groups of ten participants each. Group one was only instructed on how to perform Bruegger’s exercise. Group two only received a spinal manipulation/s over the restricted joint/s in the lumbar spine. Group three received a spinal manipulation/s over the restricted joint/s in the lumbar spine in conjunction to being instructed on how to perform Bruegger’s exercise. All participants were assessed over a four week period. All groups attended six treatment sessions over three weeks of which Bruegger’s exercise and/or spinal manipulation were performed. The participants who needed to perform Bruegger’s exercise were also advised to continue doing the exercise out of the treatment session where applicable. In the fourth week only measurements were taken and no treatment was administered. Procedure: Subjective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a universal goniometer for assessing passive hip flexion and extension, a digital inclinometer for assessing active lumbar range of motion and a flexible ruler for measuring the degree of lumbar lordosis. Analysis of collected data was performed by a statician. Results: Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Statistically significant changes were noted in group 1 and group 2 with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis, and in group 3 with regards to hip and lumbar range of motion as well as degree of lumbar lordosis. Conclusion: The results show that Bruegger’s exercise, spinal manipulation and the combination of Bruegger’s exercise and spinal manipulation are effective treatment protocols both clinically and significantly in decreasing pain and disability (not statistically for the combination of Bruegger’s exercise and spinal manipulation), increasing hip and lumbar range of motion as well as decreasing the degree of lumbar lordosis. However, there was no treatment protocol that proved to be preferential over the other. Because spinal manipulation alone showed the greatest overall clinical improvements, it may be suggested that spinal manipulation alone is the most effective in the treatment of chronic low back pain associated with lower crossed syndrome with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Also, the addition of Bruegger’s exercise may help in some instances to further assist in treatment once the full effects of the spinal manipulation has occurred and allowed for the muscles to be in their optimum state for exercise.

M. Tech. / Purpose: Trigger points in the paraspinal muscles are commonly associated with lameness or stiffness in horses, and unless they are “released”, muscle power and flexibility are impaired and athletic performance is reduced (Rogers, Fischer, Pontinen, and Janssens, 1996). The aim of this study was to determine the immediate and the prolonged effects of Sacroiliac mobilization on spot tenderness within the Erector spinae muscles of performance horses. Method: Horses from a selected stable yard underwent a screening process under the supervision of a qualified Chiropractor and Veterinarian to identify horses suitable for the study. Thirty horses were selected for the study based on the inclusion and exclusion criteria. The sample was divided into two groups of fifteen horses. The experiment group received mobilization therapy for SI joint restrictions, while the control group did not receive any treatment intervention. Procedure: Horses received an initial treatment and two follow ups, totaling three treatments. The first follow up treatment was two days after the initial and the second was four days post initial treatment. During these treatment sessions, trigger points in the Erector spinae muscles were located in each horse and algometer measurements were taken. Sacroiliac restrictions were then identified using motion palpation and passive range of motion as indicators. The researcher performed a mobilization technique on the Sacroiliac joints of horses in the experiment group only, and thereafter both groups were reassessed two minutes later, via an algometer, for spot tenderness within the same trigger points. The Sacroiliac restrictions and trigger points were re-assessed without treatment two weeks later. Conclusion: The results indicated that low-velocity Sacroiliac mobilization was effective in increasing the pain-pressure tolerance within the Erector spinae muscles of performance horses immediately and over the treatment period of two weeks.

M.Tech. (Chiropractic) / Objective: The purpose of this study was to compare dry needling with cervical spine manipulation combined with dry needling, in the treatment of infraspinatus muscle myofascial trigger points. Study Design: This was a randomized experimental study Setting: The participants were treated at the University of Johannesburg chiropractic day clinic Subjects: 30 participants volunteered for the study. The participants were divided into groups by randomly drawing thirty numbers from a hat, and placing them into two groups: either dry needling combined with spinal manipulation (group 1) or dry needling only (group 2). Participants had to be between eighteen and fifty years old and they could have been male or female. Participants had to present with active infraspinatus muscle myofascial trigger points and also had to present with shoulder or lateral arm pain reproduced by infraspinatus trigger point palpation. Method: Participants were either treated using dry needling only or dry needling combined with spinal manipulation. There were seven consultations. The first six consultations were treatment consultations. Measurements were taken at consultations one, four and seven. Results: The results indicate statistically that participants who had dry needling on its own had a faster increased pressure pain tolerance and a faster decrease in resting electrical activity of the muscle over the treatment period than those that recieved dry needling in combination with spinal manipulation. We must emphasize however that this did not show in the numerical pain rating scale. Participants felt a relatively even relief of their pain in both groups. These overall results might have been skewed by outliers in groups and a small demographic study size. The rest of the results were statistically insignificant, however there was a clinically desired therapeutic effect noted in both groups throughout the study. Conclusion: Dry needling only and dry needling combined with spinal manipulation, individually have desired therapeutic effects in the treatment of infraspinatus myofascial trigger points. There is however no conclusive statistical results in this study that shows one treatment protocol to have a greater therapeutic effect when compared to the other. However this study size was small and therefore the results may have been coincidental.

M.Tech. (Chiropractic) / Purpose: Low back pain affects the general population worldwide. Low back pain is a multi-factorial problem with debate as to the exact aetiology of low back pain. Thus, this study examines the relationship between lumbar spine lordosis, body fat percentage, physical activity level, lumbar spine range of motion and the incidence of low back pain. Method: There was a total of one hundred female participants between and including eighteen and thirty-five years of age. These females were symptomatic or asymptomatic of mechanical low back pain. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Participants were evaluated once. No treatment was administered. Procedure: Subjective responses were acquired through the Visual Analog Scale, the International Physical Activity Questionnaire and an Oswestry Low Back Pain and Disability Questionnaire. The objective evaluation included a physical examination and a lumbar spine regional examination. The participant’s height was measured using a stadiometer. The Bioelectrical Impedance Analysis (BIA) measured the participant’s weight, water content, lean tissue mass and body fat percentage. BMI was calculated from the weight and height recordings. Range of motion of the lumbar spine was measured with a Digital Inclinometer. A flexi curve ruler molded the lumbar spine lordosis of each participant, which was then traced onto a piece of paper to measure the magnitude of lumbar spine lordosis. Results: A clinical relationship did not exist between a hyperlordotic lumbar spine posture, the incidence of low back pain, body fat percentage and lumbar spine range of motion. A clinical relationship was evident between a hyperlordotic lumbar spine posture and the level of physical activity. Conclusion: Given that a clinical relationship exists between a hyperlordotic lumbar spine posture and the level of physical activity, physical activity specifically exercise to strengthen the abdominal muscles should be included in a treatment protocol to reduce the degree of lumbar spine lordosis if the degree is excessive.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Sacroiliac joint syndrome is diagnosed in patients who complain of various painful symptoms associated to their lower back, for example: hip and groin pain, sciatica pain, and / or a need to frequently urinate. They further report that their pain is further intensified when standing from sitting, stair walking, bending forward or from sitting or standing too long. Sacroiliac joint syndrome has been widely accepted by health professions as a contributor to low back pain. Spinal manipulation has shown to be an effective method for pain relief of this condition. Studies have been done using physical therapy in conjunction with manipulation in treating sacroiliac joint syndrome. However, little research has been done on the effects of static stretching and manipulation combined. The posterior oblique sling group of muscles is created by the biceps femoris, gluteus maximus, erector spinae and latissimus dorsi muscles. The sacroiliac joint can be affected by the functional relationship of the posterior oblique sling muscles. These muscles are involved in forces across the sacroiliac joint. Tightness of muscles can affect the sacroiliac joint. Flexibility is an essential element of normal biomechanical functioning. Flexibility of muscles, tendons and ligaments can influence a joints range of motion. There is evidence that suggests that stretching could increase a joint’s range of motion which was evident one or more days after the stretching protocol in people without clinically significant contractures. Upon review of the related literature, it appears that there is insufficient literature assessing the clinical effectiveness of static stretching of the posterior oblique muscle sling group with respect to sacroiliac joint syndrome. Therefore this study is aimed at providing insight into the role of the posterior oblique muscle sling group in participants with and chronic sacroiliac joint syndrome. It is hypothesized that effective treatment of these muscles will allow for a more effective outcome of symptoms. The study design chosen was a randomised, clinical trial consisting of thirty voluntary participants’ between the ages 18 to 45 years suffering from chronic sacroiliac joint syndrome. There were two groups of fifteen participants, who received four treatment consultations within a two week period. Participants placed into Group One received sacroiliac joint manipulation only, while participants in Group Two received static stretching of the posterior oblique muscle sling and sacroiliac joint manipulation. Subjective and objective readings were taken at the first, third and fourth (final) consultations. The Numerical Pain Rating Scale (NRS) and the Oswestry Low Back Pain Disability Index (OSW) questionnaires were used to assess the subjective findings whilst the objective measurements were collected from results of algometer and inclinometer readings. The intra-group analysis revealed there was a statistically significant improvement within both groups for NRS, OSW, and inclinometer results. It appeared that Group Two fared better in terms of the algometer (pressure) results. The inter-group analysis revealed that all comparisons apart from the algometer readings had no statistically significant improvement between the two groups. From the intra-group comparisons of the objective data, participants in both groups experienced a statistically significant improvement. However, Group Two fared better in terms of the algometric pressure readings (p = 0.001). This study confirms that both treatment protocols were effective in reducing the signs and symptoms associated with sacroiliac joint syndrome. Although the readings were not statistically significant, there is evidence that Group Two responded better than Group One in terms of the algometer readings (Figure 4.13). There is insufficient literature on studies related to the posterior oblique sling muscles, and therefore, comparisons are needed with respect to the posterior oblique muscle sling group and its effects on the sacroiliac joint. This study concludes that overall there was no statistically significant difference between the two groups and recommends that further studies be undertaken with a greater number of participants to gauge if a more significant result can be achieved. / M