Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Thoracic spine pain (TSP) is a very common condition and can be just as disabling as cervical and lumbar pain. The causes of thoracic spine pain are numerous, ranging from less serious non-specific mechanical causes to serious specific underlying pathology. Chiropractors used to request routine radiographs as part of their diagnostic work-up, however limited correlation currently exists between radiographical findings and clinical symptoms in non-specific mechanical thoracic spine pain. The overutilization of plain film radiographs worldwide emphasises the need to investigate which clinical conditions in patients with TSP are sent for radiographs and if they were ethically indicated. Literature is currently limited on the role of thoracic spine x-rays and their influence on the management of patients with TSP. Objectives: The objectives of this retrospective study were: 1) to record the consultation at which thoracic spine radiographs were requested by the student or clinician and the reasons therefore, 2) to determine the number of incidental radiographic findings in the selected patients‟ radiographs, 3) to determine the suspected clinical diagnosis and management of the selected patients prior to referral for thoracic spine radiographs, 4) to determine any change in the clinical diagnoses and management following radiographic reporting of the selected patient‟s radiographs, 5) to determine the correlation between the suspected clinical diagnosis and the radiographic diagnosis of patients with thoracic spine pain. Method: The archives of the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) were searched for all available thoracic spine radiographs and corresponding patient files of patients who presented to the clinic with thoracic spine pain from 1 January 1997 to 31 December 2014. The ABCS (Alignment, Bone, Cartilage, Soft tissue) System was utilised to record data of the radiographs without any knowledge of the patient‟s main compliant. The corresponding patient files were then evaluated with selected clinical variables being recorded. Statistical analysis and interpretation included frequency counts, percentages, mean, standard deviation and ranges for the descriptive objectives. The radiographic and clinical diagnoses were then compared in a two-by-two table to determine any possible relationships in diagnoses of patients with thoracic spine pain. Results: Thirty clinical files and their corresponding thoracic spine radiographs were analysed in this study. The mean age of the patients was 43.6 (± 19.1) years with a gender distribution of 40% males and 60% females. Statistical testing using paired t-tests in order to assess the correlation between the clinical and radiological diagnoses was not possible, as the categories were too different. The most frequent primary radiological diagnosis was both old trauma and scoliosis at 33.3%, followed by thoracic spondylosis at 20%. The majority of thoracic spine radiographs were requested at the initial consultation. The most common reasons for radiographic referral were severe, progressive TSP at 58.6%, trauma at 48.3% and persistent, localised TSP for more than four weeks at 37.9%. The diagnosis remained unchanged in 70% of the patients following radiographic examination. However, in 30% of the cases the clinical diagnosis was changed following radiographic examination. Most patients were diagnosed with non-specific mechanical causes of thoracic spine pain. A wide variety of treatment modalities were utilised before and after radiographic examination, including soft tissue therapy, electro modalities, spinal manipulative therapy and dry needling. A total of 66.6% of the patients in the study had changes made to their management protocol following radiographic evaluation. There was a greater use of spinal manipulative therapy, following radiographic evaluation at 56.7% versus only 26.7% of cases prior to radiographic imaging. Conclusion: Thoracic spine radiographs have little impact on the diagnosis and management of patients with thoracic spine pain as the majority of clinical diagnoses were non- specific mechanical causes of thoracic spine pain. Thoracic spine radiographs were influential in the diagnosis and management of 30% of the cases. Thoracic spine radiographs may therefore be over-utilised at the DUT CDC. However, the use of spinal manipulative therapy more than doubled following radiographic evaluation of the thoracic spine in patients with thoracic spine pain. / M

M.Tech. / Purpose: This randomised, controlled, comparative pilot study was undertaken in order to investigate the effectiveness of the chiropractic manipulation alone, the chiropractic manipulation followed by heat therapy or the chiropractic manipulation followed by cryotherapy in the treatment of cervical facet syndrome. It was hypothesised that all three treatment protocols would be effective, but that applying chiropractic manipulation followed by heat therapy would be the most effective protocol in the treatment of cervical facet syndrome. Method: Forty-five participants were recruited by means of advertisements posted around the University of Johannesburg Doornfontein campus and surrounding businesses. Only those participants who conformed to the inclusion criteria were accepted to form a part of the study. The forty-five participants were randomly placed into three groups of fifteen each. Procedure: Group 1 received chiropractic manipulation only as their treatment protocol. Group 2 received chiropractic manipulation followed by heat therapy as their treatment protocol and group 3 received chiropractic manipulation followed by cryotherapy as their treatment protocol. Each participant received six treatments over a two week period and attended a follow-up consultation in the third week. The follow-up consultation was used to assess the lasting effects of the treatment protocol. Results: The objective data in the form of cervical range of motion was obtained by means of the Cervical Range of Motion instrument. The subjective data was collected by means of the Vernon-Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale. At the end of the trial, statistical analysis was performed to determine whether one treatment protocol was more effective compared to the other treatment protocols. The results indicated that group 2 (Chiropractic manipulation followed by heat therapy) proved to be the most effective treatment protocol. Although the other treatment protocol as well as the control group showed good objective results. Subjective results showed that although all three groups showed statistically significant results, group 2 showed the best results. Thus it is noted that in order to achieve a potentially lasting increase in range of motion and a decrease in pain and disability, the treatment protocol used for group 2 should be the treatment of choice. Conclusion: Trends indicate the most effective treatment protocol in the treatment of cervical facet syndrome is when chiropractic manipulation is followed by heat therapy. The advantage of this combination is that each treatment modality is used to its full potential, thereby providing the patient with the best results in terms of lasting benefits.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Chronic non-specific low back pain (CNSLBP) is a common ailment treated by chiropractors. Most chiropractors focus on the localised lumbar area of pain. Other chiropractors focus on restoring function to compensating articulations in the ‗full kinematic chain‘ by assessing and treating the lower extremity in conjunction to the low back. Patients with LBP often exhibit decreased hip-related ranges of motion that may result in future LBP, relapse and a prolonged recovery time. Studies investigating the effect of treating the kinematic chain in relation to LBP are limited and the literature, although widely taught and practiced, is largely anecdotal. Chiropractic manipulation has shown to be effective in the treatment of LBP and many lower extremity conditions. Objectives: This study set out to determine if a combination of low back and hip manipulation would result in a more beneficial outcome for the participant, suffering with CNSLBP, than low back manipulation alone in terms of objective and subjective outcomes. Method: The study was a randomised controlled clinical trial which, through purposive sampling, consisted of 50 participants with CNSLBP and hip joint dysfunction. The participants were randomly divided into two groups of 25 each [A and B]. Group A received low back manipulation alone and Group B received combined low back and hip manipulation. Subjective data was obtained through the Oswestry Low Back Pain Disability Index (ODI) and the Numerical Pain Rating Scale (NPRS). Objective data was obtained through the use of a Force Dial Algometer and an Inclinometer. Data collection occurred at the first, third and fifth consultations and was coded and analysed using IBM SPSS version 24.0. A p-value value of less than 0.05 was considered to be statistically relevant. Results: Intra-group testing showed that there was a significant difference over time, within both groups, with regards to internal rotation and external rotation of the hip, flexion of the lumbar spine, increased pain tolerance in Algometer tests, decreased NPRS values and decreased ODI scores. Within Group A, the mean scores for hip flexion reflected a more significant increase over time than those of Group B. Within Group B, the mean scores for left and right rotation of the lumbar spine reflected a more significant change over time than those of Group A. Inter-group testing showed no significantly differential treatment effect for any of the subjective and objective outcomes. This means that both treatments were equally effective and the hypothesis, that suggested that Group B would improve more than Group A, was incorrect. Conclusion: Both treatment groups improved subjectively and objectively with regards to CNSLBP. Inter-group testing showed that statistically, and for all outcome measurements, there were no significant differences between the two treatment group‘s results. This suggested that there was no additional benefit in combining hip joint manipulation with low back manipulation in the treatment of CNSLBP. / M

Submitted as the dissertation component in partial fulfilment of the requirements for the degree of a Masters in Technology in Chiropractic in the department of Chiropractic and Somatology, Durban University of Technology, Durban, South Africa, 2017. / Background: Hip pain is a common problem. Motion palpation is a manual technique applied by the hands in various degrees of joint motion that specifically evaluates range of motion in relation to specific anatomical landmarks, joint play and end feel. Motion palpation remains one of the most used diagnostic techniques and yet it remains unclear whether or not it is a reliable, sensitive and specific tool; especially in the hip joint. Objectives: This study assessed intra- and inter-examiner reliability and clinical responsiveness of motion palpation when it is used as a diagnostic tool in patients with non-specific unilateral anterior hip pain and unilateral asymptomatic hip joints. Methods: Ten participants, between the ages of 18 and 60, were included in this study (three ballet dancers, three golfers and four participants from the general population). The participants were assessed randomly by three blinded examiners. All of the participants then received one adjustment delivered by the researcher (half on the symptomatic side and half on the asymptomatic). The participants were then re-assessed. Data was recorded on a data collection sheet and analysed using SPSS version 23. Intra-examiner reliability and clinical responsiveness were analysed using McNemar’s test and the Chi-Square Test of Independence. Inter-examiner reliability was analysed using Fleiss’ Kappa. Results: Intra-examiner reliability showed to be markedly better on the left-hand side for all three examiners. Kappa scores for inter-examiner reliability varied from none to perfect. The average pairwise agreement scores ranged from 33.3% to 100% at the first assessment, and from 46.6% to 100% in the second assessment. A mean and standard deviation were calculated for the pairwise agreements which represented the sensitivity and specificity respectively. Both showed improvement between the first and second assessments which is positive for inter-examiner reliability. Clinical responsiveness was shown to be absent for examiners A and B but was present for examiner C on the left. Conclusion: This study found that, contrary to the expectations of many clinicians, motion palpation has limited to poor levels of intra-examiner reliability, inter-examiner reliability and clinical responsiveness. This is however limited by the small sample size and methodological limitations in this study. Therefore, the role of palpation as a diagnostic tool used in the diagnosis hip dysfunction may be limited. / M

submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Rugby union is one of South Africa’s most popular sports; it requires high levels of skill and fitness and is played at a high intensity and speed which allows for a greater risk of injury. The high risk of injury is said to be due to the nature of the physicality of rugby. It is because of this high risk of injury that several adaptations of rugby have since developed which rely more on speed and agility than physicality. These adaptations include tens or ten-a-side rugby, sevens or seven-a-side rugby and finally touch rugby, which is played with six players a-side. Each adaptation has its own set of rules and is played differently to the traditional rugby union or fifteen-a-side rugby. Hence, in these adaptations the physicality is said to decrease with a resultant increase in demand for speed and agility. The reduction of physicality and increase in the need for speed and agility would imply that the nature of injuries sustained will be different to those sustained in traditional rugby union. Objectives To develop a profile of injuries that describe the type, anatomical location and mechanism of injuries sustained in tens, sevens and touch rugby; to compare the injuries sustained between the three groups; and, to analyse management strategies utilised by chiropractic students at the 2014 Durban ‘Rugby Rush Tournament’. Additionally this study aimed to provide recommendations to the injury reporting form utilised. Method This study was a retrospective, quantitative, descriptive study based on the Chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of injury and treatment profiles. Participants who made use of the chiropractic treatment facility were required to complete the informed consent section of the injury reporting form. The chiropractic intern was required to complete the remainder of the form pertaining to the participant, complaint and treatment information. This study was limited to event participants to allow for subgroup analysis. The forms were then captured and analysed. Results The data collected consisted of a total of 345 individual patient forms which indicated 626 visits for a total of 733 complaints. The average participant age was 24 ± 5.58. The study found muscle strains (41.5%), SI Syndrome (17.6%) and Joint sprains (15.0%) to be the most frequent diagnoses. A history or previous injury or trauma was reported in 18.7% and 7.40% respectively. Acute injuries accounted for 64.3% and 35.7% were recorded as chronic in nature. The most frequent mechanism of injury was that of overuse (81.9%) and trauma accounted for 17.2% of injuries. The lumbar region (26.1%), thigh (20.7%) and shin/calf (15.6%) were the most commonly reported regions of complaint. Manipulation (58.8%), massage (32.0%) and stretch PNF (27.9%) were the most frequently used treatment protocols. Strapping was utilised in 21.1% of injuries of which 5.20% was applied to the muscle and 13.6% was applied to the joint. No comparison was made using the sevens subgroup as there were insufficient records, thus only tens and touch players were compared. A borderline non-significant difference (p = 0.057) was noted between the type of player and the history of previous trauma. Tens players were more likely to have a history of trauma compared to touch players. A significant difference (p = 0.001) was found between the type of athlete and mechanism of injury. Overuse was more common in touch players whereas trauma was more common in tens players. Due to statistical inconsistencies no significance tests were applicable to compare the type of player and region of complaint. Recommendations were proposed in order to avoid this in future research. Conclusion This study provides a base of knowledge regarding the injuries that were presented to the chiropractic treatment facility at the 2014 Durban ‘Rugby Rush Tournament’ and the management strategies utilised by the chiropractic interns at the event. This research provides insight into injury profiling of tens, sevens and touch rugby players. There were several recommendations proposed for future researchers in order to expand on this field of knowledge.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Rhythmic Gymnastics is a sporting discipline involving the use of an apparatus (hoop, ball, clubs, ribbon or rope) to a choreographed routine with music. It requires agility, grace, co-ordination and most of all flexibility. Safety in Rhythmic Gymnastics is questionable when one takes training hours and the extreme flexibility required into consideration. An awareness and understanding of the prevalence and risk factors in Rhythmic Gymnastics will allow event organisers, medical personnel, managers, and coaches to adapt training approaches that will minimize the development of injuries. This information will also aid in developing monitoring systems to prevent adaptation injuries, which will lead to safer training and better management of gymnasts Objectives: This study aimed to investigate the prevalence of musculoskeletal injuries in rhythmic gymnasts within the eThekwini municipality and to identify selected factors associated with an increased risk of injury, in order to improve the management of gymnasts. Methods: A quantitative, descriptive questionnaire-based survey with a Beighton Score assessment was conducted on 67 Rhythmic gymnasts in the eThekwini municipality. Statistical analysis was performed on the results obtained from the questionnaire and the Beighton Score using IBM SSS version 23.0. The Chi-squared test was used (Fisher’s Exact Test was used when the Chi-squared test was violated); A p value of less than 0.05 was considered as statistically significant. Graphical representation of scores by groups was done using various types of tables and graphs. Risk factors for injuries were assessed using logistic regression. Factors were entered individually into the model to determine the co- efficients and odds ratios. Trend tests were computed in order to better assess associations between specific factors and injury. Results: A 100% response rate was achieved in this study. The average age of the participants was 12.3 years (95% CI= 11.7-12.8), average height was 148.5 centimetres (95% CI= 145.1-151.9), average weight was 41.0 kilograms (95% CI= 38.3-43.7), the average level of performance was 4.9 (95% CI= 4.1-5.8) and the average Beighton Score was 5.8 (95% CI= 5.3-6.3). The most commonly previously injured areas were the ankle (n=25) (14.0%), hip and knee (each n=19) (each 10.6%) and the low back (n=18) (10.1%). When considering the two most severe previous injuries the results stay similar, with the ankle being most commonly injured (n=15) (28.0%), followed by the hip (n=9) (17.0%) and the knee (n=6) (11.0%). When considering current injuries, the most commonly injured area is the knee and low back (each n=11) (each 14.5%), and the hip and ankle (each n=9) (each 11.8%). From the above it can be deduced that RG results in more injuries to the lower limb than the upper limb, or core/abdomen or the spine. The most common types of RG injury were muscle strains (n=16) (23.9%), followed by unsure (n=9) (13.4%) and joint sprains (n=8) (11.9%). The most common cause of injury for both previous and current RG injuries were overstretching and overuse ((n=23) (34.3%) for previous injuries; (n=15) (22.4%) for current injuries). Risk factors for injury were significant for the following: training hours per week (36.5 times for 5-8 hours of training per week; 15.7 times for under five hours of training per week; both when compared to more than 8 hours) and lack of balance skills included in RG training (4.5 times more likely than not). When considering treatment option used to keep the body in a good condition, a participant was 4.3 times more likely to utilize home remedies than any other treatment option. Trend tests noted that there is an increase in the mean of injuries as one goes up in age, up until a certain age (13-14 years of age for current injuries; 15-16 years of age for previous injuries), thereafter, there is a decease. Trend tests were also constructed for training hours per week; there was a directly proportional relationship between training hours per week and injury. Conclusion: When considering risk of injury in RG, many of the risk factors cannot be modified (such as age). Those risk factors that can be modified (such as training amount and components of training) should be considered by gymnasts and their coaches in order to implement strategies that could prevent injury. / M

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / INTRODUCTION: Neck pain is considered to be one of the most disabling conditions, with a universal prevalence among youth, adult and elderly populations. However, despite its disabling nature and its high prevalence there is still much uncertainty surrounding the aetiology of the pain and the extent to which the condition is influenced by the intrinsic and extrinsic characteristics of an individual. While there is growing evidence to support the notion that marked bio-psychosocial associations exist with neck pain, this literature is heavily weighted toward an adult and a developed nation context leaving developing nations and the student population largely under-researched in comparison. Moreover, while a high prevalence of neck pain and its associated risk factors exist in the student population among health sciences and non-health sciences programmes, across many levels of study, the literature is ambivalent about which faculty and level of study is more at risk, if any. The first year of university stands out among the rest in that the students undergo a significant transition and are required to adapt to a new environment and style of learning compared to what they have been used to. Furthermore, students have been observed to exit first year with higher levels of distress than were present in the beginning of the year, suggesting that this unique environment may influence the psychosocial well-being of students. The extent and strength of this relationship is yet to be determined in a South African tertiary educational context and this is even more true of the first year student population at the Durban University of Technology. Research on the unique bio-psychosocial factors of these students would provide a more holistic understanding of the extent to which these factors exist and the role they play in the general well-being of the students and in the development of neck pain. AIMS AND OBJECTIVES: This study aimed, firstly, to determine the prevalence and psychosocial risk factors of neck pain in registered first year Faculty of Health Sciences students at the Durban University of Technology and, secondly, to determine the association between neck pain presentation, demographic characteristics, socio-demographic and psychosocial risk factors. The outcomes of this study could possibly have a threefold benefit (for the student, the institution, and the chiropractic profession at large). RESEARCH DESIGN: A quantitative, descriptive, cross-sectional survey design was adopted in this research. This design was chosen as it was believed to be the best suited to achieving the aims and objectives of the study. RESEARCH METHODOLOGY: Neck pain questionnaires were administered to the first year Faculty of Health Sciences students at the Durban University of Technology towards the end of the academic year in order to determine the prevalence of neck pain and its associated demographic, socio-demographic, and psychosocial risk factors. There was a final sample size of 135 participants achieving a response rate of 54.7% for the study. Data was captured by the researcher and sent to a statistician for statistical analysis. RESULTS: A high prevalence of neck pain was found among the students (72%) with symptoms of depression (59.8%), anxiety (68.1%), and stress (53.6%) also being highly prevalent among this group. However, when neck pain was quantified by its characteristics the related impact was comparatively low. There was a common theme observed in the results highlighting the association between stress and neck pain, with stress furthermore being determined as an independent risk factor for neck pain (p = 0.023) with an odds ratio of 1.1. This result was not surprising, however, considering the stressors which emerged in the results highlighting factors such as transport protests, student protests, upcoming tests and financial aid as stress causing factors among the participants. The results provided valuable insight which enabled recommendations to be made about the direction of future research as well as recommendations for the Institution and the Chiropractic profession in the approach and management of students enrolled in tertiary education and with neck pain. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Rugby union is one of South Africa’s most popular sports; it requires high levels of skill and fitness and is played at a high intensity and speed which allows for a greater risk of injury. The high risk of injury is said to be due to the nature of the physicality of rugby. It is because of this high risk of injury that several adaptations of rugby have since developed which rely more on speed and agility than physicality. These adaptations include tens or ten-a-side rugby, sevens or seven-a-side rugby and finally touch rugby, which is played with six players a-side. Each adaptation has its own set of rules and is played differently to the traditional rugby union or fifteen-a-side rugby. Hence, in these adaptations the physicality is said to decrease with a resultant increase in demand for speed and agility. The reduction of physicality and increase in the need for speed and agility would imply that the nature of injuries sustained will be different to those sustained in traditional rugby union. Objectives To develop a profile of injuries that describe the type, anatomical location and mechanism of injuries sustained in tens, sevens and touch rugby; to compare the injuries sustained between the three groups; and, to analyse management strategies utilised by chiropractic students at the 2014 Durban ‘Rugby Rush Tournament’. Additionally this study aimed to provide recommendations to the injury reporting form utilised. Method This study was a retrospective, quantitative, descriptive study based on the Chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of injury and treatment profiles. Participants who made use of the chiropractic treatment facility were required to complete the informed consent section of the injury reporting form. The chiropractic intern was required to complete the remainder of the form pertaining to the participant, complaint and treatment information. This study was limited to event participants to allow for subgroup analysis. The forms were then captured and analysed. Results The data collected consisted of a total of 345 individual patient forms which indicated 626 visits for a total of 733 complaints. The average participant age was 24 ± 5.58. The study found muscle strains (41.5%), SI Syndrome (17.6%) and Joint sprains (15.0%) to be the most frequent diagnoses. A history or previous injury or trauma was reported in 18.7% and 7.40% respectively. Acute injuries accounted for 64.3% and 35.7% were recorded as chronic in nature. The most frequent mechanism of injury was that of overuse (81.9%) and trauma accounted for 17.2% of injuries. The lumbar region (26.1%), thigh (20.7%) and shin/calf (15.6%) were the most commonly reported regions of complaint. Manipulation (58.8%), massage (32.0%) and stretch PNF (27.9%) were the most frequently used treatment protocols. Strapping was utilised in 21.1% of injuries of which 5.20% was applied to the muscle and 13.6% was applied to the joint. No comparison was made using the sevens subgroup as there were insufficient records, thus only tens and touch players were compared. A borderline non-significant difference (p = 0.057) was noted between the type of player and the history of previous trauma. Tens players were more likely to have a history of trauma compared to touch players. A significant difference (p = 0.001) was found between the type of athlete and mechanism of injury. Overuse was more common in touch players whereas trauma was more common in tens players. Due to statistical inconsistencies no significance tests were applicable to compare the type of player and region of complaint. Recommendations were proposed in order to avoid this in future research. Conclusion This study provides a base of knowledge regarding the injuries that were presented to the chiropractic treatment facility at the 2014 Durban ‘Rugby Rush Tournament’ and the management strategies utilised by the chiropractic interns at the event. This research provides insight into injury profiling of tens, sevens and touch rugby players. There were several recommendations proposed for future researchers in order to expand on this field of knowledge. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: The increasing cost and prevalence of chronic low back pain (LBP), has resulted in more resources being devoted to its treatment and management than ever before, despite only approximately 10% of acute cases progressing to chronicity. Determining prognostic factors for the short-term improvement of acute and chronic patients with LBP has become a research focus area to try and identify baseline factors that may affect a patients’ improvement with conservative treatment. Internationally studies have been conducted in developed countries however similar studies are lacking in developing settings like South Africa. It is unclear if the prognostic factors identified would be similar across populations. Thus, this study aimed to determine if pain, disability (social and physical), anxiety, depression, work fear-avoidance and locus of control, were associated with short-term prognosis, as determined by self-reported improvement using a Patients Global Impression of Change (PGIC) scale, in acute and chronic LBP patients attending the Durban University of Technology Chiropractic Day Clinic (DUT CDC). Method: Consecutive patients seeking treatment at the DUT CDC with a new episode of non-specific LBP, who met the study criteria, were approached for participation in the study. On agreeing to participate they were given the Bournemouth Questionnaire (BQ), a demographic questionnaire and a letter of information and consent (LOIC) at the initial consultation by student chiropractors. Those participants that were still attending treatment at the 4th/5th and tenth visit were required to complete the BQ and the PGIC. Results: A hundred participants were enrolled in the study, 65% had acute LBP and 52% were male. Only 20% of the initial group were still attending treatment at the 4th/5th follow-up. Baseline comparisons of those with acute and chronic pain revealed no significant difference in gender or age. Acute patients at the initial visit had higher levels of disability (social and physical), anxiety, depression and fear-avoidance beliefs than the chronic pain participants. At the 4th/5th treatment, the acute pain patients showed a significant decrease in pain (p=0.002) and disability (p=0.032), with all other measures decreasing from baseline measures. Similarly, chronic pain participants had a significant decrease in pain (p=0.038) but a significant increase in depression (p=0.015) scores, with all other prognostic factors being rated higher than at the initial consultation. The majority of participants (85%) in this study reported a clinical improvement in their LBP. In the acute pain sufferers, all but one participant reported improvement, thus identification of prognostic factors or this group was not possible. In the chronic pain participants, no factors were identified as prognostic for improvement, regardless of the low numbers still attending at the 4th/5th visit. Conclusions: Trends suggested that chronic pain sufferers were less likely to report decreases in the prognostic factors (except for pain), when compared to the acute pain participants. In the chronic LBP participants, no factors were associated with improved prognosis. The predictive value in determining which patients were less likely to improve was limited in the current study due to a small sample size. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Iliotibial band friction syndrome is a common dysfunction seen in athletes. Athletes develop biomechanical changes yet still continue with their sport. However, this syndrome limits their ability to participate at peak performance. This study determined which participants benefitted in terms of biomechanical and clinical outcomes in one of four groups: ankle joint, superior tibio-fibular joint, sacroiliac joint or a combination manipulation group (which contained any two of the three joint restrictions). Methods: This Durban University of Technology Institutional Research and Ethics Committee approved prospective clinical trial, utilised stratified sampling, with 48 participants across four groups: ankle (14); superior tibio-fibular (11), sacroiliac (12) and combination (11). The participants underwent six treatments in three weeks. Data collection occurred before consultations one, three, five and seven. The data included primary measures of the knee score questionnaire (KSQ), the algometer, the visual analogue scale (VAS) and the secondary measures of the Feiss line, the heel leg alignment, bilateral leg length, Q angle and tibio-femoral angle. All data was computed utilising the ANOVA testing, with a p-value <0.05 being significant and a 95% confidence interval. Pearson’s correlations were completed for intragroup associations between primary and secondary outcome measures. Results: The intragroup analysis revealed that all groups had significant changes in the KSQ and VAS, with the exception of the sacroiliac joint manipulation group (KSQ outcome not significant). Intergroup analysis revealed no differences between the groups with the exception of the combination group, which showed a significant increase in the tibio-femoral angle. Most commonly, the Pearson’s correlation revealed that changes in leg length were related to differences in primary outcome measures, irrespective of the group being tested. Conclusion: The outcomes of this study indicated that manipulation of the distal kinematic chain improved alignment and clinical outcomes to a greater degree than manipulating proximal restrictions. It is suggested with caution (due to limited sample size) that patients should first have their distal kinematic chain manipulated before more proximal joints are manipulated to achieve better outcomes. / M