M.Tech.

A dissertation presented to in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1996. / The aim of this study was to determine the effectiveness of adjustments versus mobilisation in the treatment of mechanical neck pain. It was hypothesized that treatment with adjustments over a three week period, with a further three week follow-up period, would be more effective than mobilisation in terms of improving the patients' cervical ranges of motion and their perceptions of pain and disability. / M

M.Tech. (Chiropractic) / This study was conducted in order to determine if Chiropractic Spinal Manipulative Therapy (SMT) to the lumbar spine and Sacroiliac joints can accelerate the recovery process of the Hamstring and Quadriceps femoris muscle and thus enabling the athlete to sustain endurance levels for a longer period of time. Participants used were recruited from the cycling community by means of word of mouth. Thirty participants that matched the inclusion criteria were included in the study. The participants were then randomly divided into two groups, a Test Group and a Control Group, of fifteen participants each. Motion and static palpation was used to detect spinal restrictions. The Test Group received Chiropractic SMT to the restricted lumbar vertebral segments and the Sacroiliac joints after the first test was completed. The participants then underwent a 30 minute recovery period after which they were re-tested. The Control Group received no treatment after the first test, but still had a 30 minute recovery period after which they were re-tested. Objective measurements were taken by making use of Cybex Isokinetic Dynamometer. The objective measurement indicated that there was an increase in muscle endurance of the Quadriceps femoris and Hamstring muscle groups for both the test and the Control Group. When the increase in Hamstring and Quadriceps femoris muscle endurance was compared between the Test and Control Group, it was the Control Group that showed a more significant increase in Quadriceps femoris muscle endurance which was greater than the increase of the Quadriceps femoris muscle endurance in the Test Group. The Control Group also showed a greater increase mean endurance of the Quadriceps femoris and Hamstring muscle. In conclusion to the study, muscle endurance in cyclists can be increased by rest alone and does not require Chiropractic SMT to restricted spinal segments.

Dr. C. Yelverton

M.Tech. / OBJECTIVE: The aim of this study was to determine the electromyographic effect of flexion distraction therapy of the lumbar spine on the Erector Spinae muscles in participants with lumbar facet dysfunction. STUDY DESIGN: Thirty participants with lumbar facet dysfunction underwent 6 flexion distraction therapy treatments on alternate days over a 2-week period (excluding weekends) to test the electromyographic effect on the Erector Spinae muscle. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: Thirty participants with lumbar facet dysfunction participated in this study. The participants were divided into two groups of fifteen participants each and matched according to age and gender. Group 1, the study group, received flexion distraction therapy to the restricted segments in the lumbar spine. Group 2, the control group, did not receive any flexion distraction therapy and rested during the duration of the treatment. METHODS: Lumbar Erector Spinae muscle electrical activity was tested before and after treatment one, three and six using surface electromyography (sEMG). One pair of bipolar electrodes was placed bilaterally over the Erector Spinae muscles at the level of L3. Participants were asked to lie down in a prone position with their arms next to their sides. They were then instructed to perform five maximum voluntary lower back extension exercises by lifting their chests and shoulders as high off the plinth as possible. Each contraction lasted five seconds, with a rest period of ten seconds between each contraction. The average rest and work surface electromyography readings were recorded, analysed and compared for reference. Information regarding the intensity of the pain experienced by the vii subjects was also collected at the start of treatment one, three and five using the Numerical Pain Rating Scale. RESULTS: Comparison of the results indicated a statistically significant difference between the two groups and their responses to the treatments. Subjectively, a statistically significant improvement was observed in Group 1 between the third and the sixth treatments and the first and the sixth treatments, with an overall 80% improvement in pain, thus demonstrating the medium to long term effects of flexion distraction therapy. Objectively, Group 1 demonstrated a statistically significant medium to long term improvement in the resting rate of the Erector Spinae muscles as observed between the first and sixth treatments. Statistically, the two groups responded differently over time with regards to the contraction ability of the Erector Spinae muscle. A statistically significant and immediate improvement was observed in the sixth treatment in Group 1, thus further supporting the long term effects and benefits of flexion distraction therapy. CONCLUSION: In light of these findings it can be concluded that flexion distraction therapy, as represented by Group 1, demonstrated favourable treatment results in terms of the pain experienced by the subjects, the resting rate and contraction ability of the Erector Spinae muscles. The trends observed in this study should be used and tested in future research studies of a similar nature incorporating larger sample groups.

M.Tech. (Chiropractic) / The purpose of the study was to compare the effectiveness of a cervical support pillow in conjunction with correcting abnormal cervical spine biomechanical function (by intervention of high-speed, low-amplitude spinal manipulation in the cervical spine) versus correcting abnormal cervical spine biomechanical function alone, to determine which is the most effective treatment protocol for cervicogenic headache. Thirty-two subjects suffering from frequent, chronic headaches who fulfilled the International Headache Society criteria for cervicogenic headache participated in the investigation. These subjects were recruited from 70 headache sufferers who responded to newspaper and poster advertisements. Patients were randomly assigned to one of two groups as they enrolled for participation. The sixteen patients in group one received cervical spine manipulation twice a week for three weeks. The other sixteen patients received cervical spine manipulation twice a week for three weeks and used a cervical support pillow for sleeping over the three-week period. The main outcome measures included the following: Patients completed a daily headache diary. This monitored the change from week one to week three in analgesic use per day, headache intensity per episode, headache frequency per week and number of headache hours experienced per day. Cervical active range of motion readings were taken at all consultations prior to treatment, using a goniometer. A Neck Pain and Disability Index (Vernon- Mior) Questionnaire and a Numerical Pain Rating Scale 101 were completed by each patient at the initial, second, fourth and sixth visits. In conclusion, it cannot be denied that the combination of a cervical support pillow and correction of cervical spine joint complex dysfunction using standard chiropractic manipulative techniques is a more effective treatment protocol for the management of cervicogenic headache, as it has a far greater benefit with regard to improving the ranges of motion of the cervical spine and a similar effect in improving patient's perception of pain intensity, headache frequency, headache duration and level of functional disability as related to cervicogenic headache, than manipulation of joint complex dysfunction in the cervical spine alone. The short-term symptomatic relief and long-term goals of chiropractic management for cervicogenic headache with specific chiropractic spinal manipulative therapy may be improved by combining the use of a cervical support pillow to this already beneficial and effective protocol.

M.Tech. (Chiropractic) / The object of this study was to compare two chiropractic treatment approaches to each other in the management of migraine without aura. It was hypothesised that a combination of upper cervical and upper thoracic chiropractic manipulative therapy would be more effective than upper cervical chiropractic manipulative therapy alone. Migraine without aura was diagnosed according to the criteria of the International Headache Society (1988) and based on a structured case history, physical examination as well as regional orthopaedic and neurological examinations. Forty-one (41) subjects were randomly allocated to one of the two treatment groups in this single blind, randomised trial. Thirty-three patients completed the trial. Both groups received their respective chiropractic manipulative treatments twice a week for a total period of four weeks. During this time and a period of eight weeks thereafter, each patient kept a daily headache diary, noting migraine frequency, duration, headache intensity and associated analgesic pill consumption. Statistical analysis of the collected data involved inter-group comparisons of the above mentioned variables using Mann-Whitney Rank Sum tests, and intra-group comparisons of the above. mentioned variables using Wilcoxon Signed Rank tests at a 95% level of confidence. Intra-group analysis of the data revealed statistically significant (P < 0.05) decreases in migraine frequency and headache intensity for both groups. Migraine duration followed a similar pattern but for a sudden increase in duration in the third month for the group receiving a combination of upper cervical and upper thoracic chiropractic manipulative therapy. Inter-group analysis of the data established no statistically significant differences (P > 0.05) between the two treatment groups before or during the study. Throughout the study, there was a notable difference in average analgesic pill consumption between the two groups. The results indicate that both chiropractic manipulative therapy approaches had positive effects on the frequency, duration and headache intensity of migraines without aura. The effect of chiropractic manipulative therapy on the associated analgesic pill consumption is speculative, since there was no pre-treatment assessment of analgesic pill consumption. The sudden increase in migraine duration during the third month for the group that received both upper cervical and upper thoracic manipulation may be due to this treatment being less effective than upper cervical manipulation alone. The significance of this sudden increase will need to be established by future studies. Neither one of the two chiropractic treatment protocols applied in this study fared significantly better than the other. It is suggested that future studies consider any disability associated with migraines without aura. A pre-treatment trial period would provide reliable pre-treatment statistics for the variables investigated during such a trial and larger samples would represent the overall migraineur population better. It is suggested that a third group, receiving only chiropractic manipulative therapy to the upper thoracic spine, also be included.

M.Tech. / The aim of this single blinded clinical trial was to determine the most effective myofascial dry needle insertion time for the relief of active trigger points in the trapezius muscle. It was hypothesised that at least one of the three time frames chosen in this study; namely 30 seconds, 1.5 minutes and until the patients pain referral ceased, would prove to be the most effective time to increase the patients pressure tolerance and decrease their subjective perception of pain. Thirty six patients who presented with bilateral active trapezius trigger points and who fell into the inclusion-exclusion criteria of this study were recruited from in and around the University of Johannesburg. Once selected for the study the patients, whose ages ranged from 18 to 40 years of age, where randomly divided into two groups of eighteen. In this study each patient served as their own control. The left and right sides where randomly assigned to either being the control side (needled for 30 seconds) or the experimental side (needled for 1.5 minutes or until the pain referral stopped). Because of this further randomisation, the two groups of eighteen were divided in to four groups of nine: Group one: Right side was the control and the left side was needled for 1.5 minutes. Group two: Right side was the control and the left side was needled until the patients pain referral ceased. Group three: Left side was the control and the right side was needled for 1.5 minutes. Group four: left side was the control and the right side was needled until the patients pain referral ceased. The patients received a once off treatment, where they were needled bilaterally with the control side being needled for 30 seconds and the experimental side being needled for either 1.5 minutes or until the pain referral stopped. The patients were required to come back for a follow-up assessment two days later. Objective measurements were obtained by using the algometer, which measured the pressure threshold of the left and right trapezius before the needling treatment, immediately after the treatment and on the two day follow-up visit. Three reading were taken at each time interval. vi Subjective measurements were obtained by using the visual analogue scale (VAS) and a subjective pain and discomfort questionnaire which patients were required to complete before the treatment, immediately after the treatment and at the two day follow-up visit. The data was statistically analysed using the Kruskal Wallis Test and the Wilcoxon Signed Ranks Test. For the inter-group analysis for average algometer readings, due to the small sample size, only group one and group four showed statistically significant changes in the average algometer readings over time. In group one the control side showed the greatest change, and in group four both the control and the experimental (which was needled until the pain referral ceased) showed a change in average algometer readings. Although the statistical evidence is inconsistent, there was a general trend of improvement seen over all four groups in terms of the average algometer readings over time. Subjectively it was seen that all four groups had a statistical decrease in the patients perceived pain with the VAS, with group four showing the most significant change over the three time variables (pre to post, post to follow-up and pre to follow-up). Group one had a statistical change from the pre reading to the post reading. Group two had a statistical change from the pre reading to the follow-up reading. Group three had a statistical change from the pre reading to the post reading. It was noted from the subjective pain and discomfort questionnaire that the patients who where needled for 30 seconds experienced a persistent stiffness and pain (although less than what they experienced before) immediately after the treatment and on their two day follow-up visit. This contrasted with the patients who were needled for 1.5 minutes and until the pain referral ceased (which averaged at 1 minute for group two and four) who experienced more relief immediately after the treatment and on the two day follow-up visit. From these results it is seen that even though objectively both the 30 second time frame and the longer time frame proved to increase pressure threshold, subjectively the patients who were needled for the longer time felt more relief than those who were needled for the shorter time frame.

M.Tech.

M.Tech.