M.Tech.

M. Tech. / There is still much to be learnt about proprioception and it’s role in postural control mechanisms. Joint position sense accuracy has been developed as a means to evaluate proprioception and extensive studies have been performed on patients with chronic neck pain. To date, there has been limited research that has been conducted on the various therapeutic modalities, which may affect joint position sense accuracy and proprioception. However, no research has been performed on patients who are asymptomatic, to determine the true effects of Chiropractic cervical adjustive therapy on joint position sense accuracy and proprioception. Chiropractic Cervical adjustive techniques are delivered by hand and bring about neurophysiological change within the nervous system. It is not known exactly how long the effects of the Chiropractic adjustment lasts and it is only speculated that the shortterm effects are over a twenty minute period, as cavitation of the joint occurs (Gatterman, 2005; Herzog, 2000). The purpose of this research was to determine if Chiropractic cervical adjustive therapy of the cervical spine could produce an immediate effect on joint position sense accuracy, in participants who were asymptomatic and only presenting with hypomobile joint dysfunction. A random sample of 60 participants, presenting with no history of pain, were assessed for hypomobile joint dysfunction. All participants underwent a full Case History, Pertinent Physical examination and a Regional Examination of the Cervical Spine. Each participant had to complete the Subject Information and Consent Form. The participants were randomly divided into two groups. Group A received Chiropractic cervical adjustive therapy and Group B received detuned ultrasound, and was therefore the control group. The cervical range of motion (CROM) device was placed on the participant’s head, aligned on the bridge of the nose and ears. It was secured, behind the head, by a velcro strap. The CROM device was also mounted with a laser beam device. This enabled objective readings to be recorded, as each participant performed the Cervicocephalic Kinesthetic Sensibility Test. The procedure required the participant to alternatively rotate their head to the left and then to the right, as objective readings was recorded. Readings were taken before treatment was administered and then again after treatment was administered. The pre-treatment scores and post-treatment scores between the two groups were compared, using the paired samples test. The objective analyses showed that Group A (adjustment group) showed better results in improved joint position accuracy, in comparison to Group B (control group). The preliminary findings of this study show that Chiropractic cervical adjustive therapy has an immediate effect on joint position sense accuracy. This has major implications with respect to the vital role that Chiropractic cervical adjustments may have, on maintaining proprioceptive input and postural control mechanisms. The duration, by which Chiropractic cervical adjustive therapy effects joint position sense accuracy is unknown and further investigation into this, is still required.

M. Tech. / A study was undertaken at the Chiropractic Clinic at the University of Johannesburg in Doornfontein on the effects of chiropractic spinal therapy and the autonomic nervous system with specific reference to the eye and the effects on the visual fields. The purpose of this study was to determine the immediate effects of chiropractic adjustments on the visual fields in comparison to a placebo group in individuals with asymptomatic cervical facet joint dysfunction at the atlanto-occipital joint complex. This was achieved through the examination of peripheral visual field testing using the Humphrey Field II 740 analyser. The sample size and selection of subjects were recruited at the University of Johannesburg clinic in Doornfontein and conducted over a period of four months. These patients were recruited by the use of advertisements placed in the Chiropractic Day Clinic on the Doornfontein Campus and by word of mouth. Any patient volunteering for the study had to meet the inclusion criteria. The inclusion criteria required the patients to present with asymptomatic cervical facet joint dysfunction at the atlanto-occipital joint complex. They were also to be between the ages of eighteen and thirty five years of age, have 20/20 vision as determined by the Near Snellen Chart and have no contra-indication to the chiropractic adjustment. For all research patients, the same treatment protocol was adhered to Objective data was obtained by the Humphrey II Field Analyzer, model 740, which determined the patients’ visual fields before and after the chiropractic adjustments and placebo treatment was administered. The objective results of this dissertation demonstrated that there was no statistical significance between the male and female groups. However the results collected vii may suggest that there was a minimal increase in responsiveness following placebo the treatment. In conclusion, it was shown that no statistical difference occurred with regards to the immediate effects of the chiropractic adjustment on the visual fields in comparison to the placebo group in individuals with asymptomatic cervical facet joint dysfunction at the atlanto-occipital joint.

M. Tech. / The aim of this study was to determine whether using the Powerball™ as a form of resistance training for the hand and wrist, had the effect of increasing grip strength. In the study there were 20 male and 20 female participants. The participants had to be between the ages of 20 and 30 years to participate in the study. There was a Wrist and Hand Regional performed on all the participants to ensure there were no wrist or hand pathologies which would exclude them from the study. Participants trained with the Powerball™ three times a week for four weeks. Each training session with the Powerball™ lasted five minutes for each hand and was done under the supervision of the researcher. Grip strength measurements were taken with the Jamar grip strength dynamometer. Grip strength readings were taken prior to the 1st training session with the Powerball™ while a further two readings were taken prior to the 7th training session and after the 12th training session with the Powerball™. The results for the 40 participants showed a grip strength improvement of 4.77kg for the right hand and 4.03kg for the left hand. The 20 male participants had a grip strength improvement of 4.85kg for the right hand and 4.55kg for the left hand while the 20 female participants improved by 4.68kg for the right hand and 3.5kg for the left hand overall. It was concluded that participants using the Powerball™ showed an overall increase in grip strength and that it may have possible benefits as a strengthening and rehabilitative tool for the wrist and hand.

This unblinded, non-randomised pilot study was conducted in order to determine if diversified chiropractic manipulation and/or sacro occipital technic adjustments of the sacroiliac (SI) joint could increase the short-term strength of the gastrocnemius muscle. Ninety asymptomatic male patients between the ages of 20 and 30 years participated in the investigation. These patients were recruited by the use of posters that were placed in strategic areas around the Technikon Witwatersrand campus. The patients were randomly placed into one of three groups of thirty. Group FA (force adjustment) received force, side-lying, diversified sacroiliac adjustments to the sacroiliac joint. Group NA (non-force adjustment) received non-force sacro occipital technic (SOT) adjustments to the same area by means of SOT blocking technique. The third group. Group C (control) received detuned ultrasound over the SI joint. Each patient received only one treatment. The inclusion criteria required that the patient had to be male, fall inside the above age range, and presented with asymptomatic sacroiliac joint dysfunction. This was determined either by diversified chiropractic motion palpation or SOT category analysis. Only category one patients were used in this study. The objective data was collected using an isometric dynamometer. The gastrocnemius muscle strength was measured with the dynamometer before and after the treatment. The objective results indicated that there was a statistically significant increase in gastrocnemius muscle strength in both of the experimental groups. In conclusion, it has been shown that both force and non-force adjustments positively effect active muscle strength. In this case it was shown that these types of adjustments to the SI joint caused an increase in active gastrocnemius muscle strength. It is suspected that the inhibition of the motor neuron, via the capsular stretch reflex, plays a major role in the effect seen in this study. This gives further information about the underlying mechanisms of the chiropractic adjustments and may support the role of non-force techniques in treating patients. / Dr. Chris Yelverton Dr. Malany Moodley

This unblinded, controlled pilot study was undertaken to determine if cervical spine adjustments had an effect on improving the low back pain in the workforce of the corporate environment. Subjects were treated at the Technikon Witwatersrand chiropractic day clinic in Johannesburg, South Africa. Thirty corporate employees suffering from low back pain were selected for this study. Subjects were recruited using posters put up at the Technikon Witwatersrand campus and at companies in and around Johannesburg. The patients were divided into three groups of ten. One group received chiropractic adjustments of the cervical spine. The second group received chiropractic adjustments of the lumbar spine and sacroiliac joints. The third group received a combination of chiropractic adjustments of the cervical spine, lumbar spine and sacroiliac joints. Patients were treated nine times over a four-week period. Objective data was recorded using a Digital Inclinometer to measure lumbar spine range of motion. Subjective data was obtained by participants recording their progress on the Oswestry Back Disability Index and Visual Analogue Pain Scale. The results showed that there was a statistically significant improvement in the pain and disability experienced by the patients in all three groups for the subjective measurements. There was however no statistically significant increase in range of motion in the lumbar spine for all three groups according to the objective measurements. This study concluded that cervical spine adjustments had a positive effect on improving the low back pain and disability experienced by the workforce in the corporate environment. / Dr. Barrett Losco Dr. Pauline Moolman

OBJECTIVE: To determine the most effective chiropractic treatment protocol in the management of chronic non-complicated low back pain. This was determined by comparing subjective and objective results gained from two treatment protocols, one of which included corrective spinal manipulative therapy directed towards the lumbar spine and pelvis with the implementation of an independent home prescribed rehabilitation program. The second treatment protocol consisted of a combination of corrective spinal manipulative therapy directed towards the lumbar spine and pelvis with the implementation of a spinal rehabilitation program under the close supervision and guidance of the researcher. DESIGN: The study was a clinical trial, which consisted of two groups of 15 patients each. These patients were procured using information pamphlets and advertising posters and were selected on the basis of particular inclusion and exclusion criteria. In addition, the selected candidates were also required to have a static isometric back extensor endurance test of 55 seconds and less as well as a decreased lumbar range of motion in the sagittal plane. INTERVENTION AND DURATION: Once the patients were randomized into two groups, the respective treatment protocols were implemented over a six week period. The control group was prescribed with a home exercise spinal rehabilitation program and the experimental group received a supervised spinal rehabilitation program. Both groups received chiropractic manipulation to the lumbar spine and pelvis to restore mobility and correct the mechanical dysfunction in the hypomobile joint. The frequency of follow-ups for this study was three times weekly for the first and second weeks, twice weekly for the third and fourth weeks, and then once weekly for the fifth and six weeks. MEASUREMENTS: Objective measurements included lumbar spine flexion and extension range of motion and Sorenson’s test. Subjective measurements were the Oswestry Low Back Pain and Disability Index and Numerical Pain Rating Scale 101 questionnaires. Measurements were taken at the first, sixth and twelfth consultations. CONCLUSION: The aim of this study was to determine whether chiropractic care in conjunction with a supervised “in-office” spinal rehabilitation program would prove to be a more effective method in decreasing low back pain measurements and indices when compared to a home prescribed exercise program in the management of chronic low back pain. Although the supervised group did show improvements on the areas indicated, none of the two groups showed statistically significant differences. Therefore it can be concluded from the results of this study that the home exercise group demonstrated as good a response as the supervised exercise group thus highlighting the positive effects of the adjustment alone. / Dr. E. Garlick Dr. B. Losco

M.Tech. (Chiropractic) / Purpose: The purpose of this study was to determine if inversion therapy is beneficial for participants with lower back pain and if there is an additive effect when combining it with manipulation. Three treatment approaches were utilized: inversion therapy, lumbar spine manipulations and a combination of inversion therapy with lumbar spine manipulations. Method: Thirty participants who qualified for the study were randomly divided into three equal groups consisting of ten participants each. Depending in which group the participant was allocated, determined if they received lumbar spine manipulation (Group 1), inversion therapy (Group 2), or a combination of inversion therapy performed after the lumbar spine manipulation (Group 3). Procedure: Each participant was treated a total of six times over a course of three weeks, furthermore there was a seventh day of final data collection. The measurements were taken on the first, fourth and seventh visit. Subjective measurements consisted of the numerical pain rating scale (NPRS) and the Oswestry Low Back Pain Disability Index. Objective measurements were done with the inclinometer (lumbar range of motion) and the flexicurve (lumbar lordosis measurement). Results: It is clear that there were statistically significant improvements in all three of the groups in both the NPRS and the Oswestry disability index. The inversion therapy group performed the best with the NPRS and the Oswestry disability index, with the spinal manipulation and combination group following narrowly. However, there were no statistically significant differences on the intergroup analysis with regards to the subjective results. The results of the subjective measurements indicated that there was a relative decrease in lumbar spine lordosis measurements, over the trial period, but with no statistical significance. With the lumbar range of motion-flexion measurements it was clear that the spinal manipulation group and the inversion therapy group had superior results compared to the combination group, with both indicating statistical significance over the trial period. Extension, lateral flexion and rotation did not show any statistical significance over the trial period. Conclusion: There were statistically significant improvements within each of the three groups on intragroup analysis, but no statistically significant differences were found on intergroup analysis. Therefore, none of the groups could be singled out as being the superior treatment for mechanical lower back pain. All three groups’ demonstrated improvement. There was no significant additive effect by combining the two treatments. Therefore there is no benefit to adding inversion therapy to the treatment protocol. Manipulation alone demonstrated to have similar effects. However, should a patient not be able to see a chiropractor for treatment, home based inversion therapy can be beneficial. A concern that should be addressed is that home based treatment wouldn’t be supervised and as such it is not advised to do without some form of professional management. Inversion therapy can definitely be utilized as a home based treatment option for a patient with LBP, patients that can’t make use of regular chiropractic care due too logistical or financial restraints will benefit from inversion therapy home usage. Home usage will provide the patient with regular general traction therapy and can result in patient pain relief, increase overall functioning of the patient and the patient compliance may improve.

M.Tech. / Dancing, over the years has become a highly competitive sport with demanding levels of fitness and flexibility needed in order to progress to a professional level (DeMann, 1997). With lower back pain becoming a common occurrence in dancers, both physical as well as emotional stress is placed on the dancer and their lower back (DeMann, 1997). The aim of this study was to compare the effectiveness of Chiropractic adjustments on the lumbar spine and Sacroiliac joints, stretching certain muscle groups or the combination of the two treatment protocols on Freestyle dancers with chronic lower back pain with regards to pain, disability and lumbar spine and pelvis range of motion. Thirty female participants between the ages of thirteen and twenty five years were recruited to participate in this study. Successful participants were then randomly placed into one of three groups, of ten participants each, which would receive different treatment protocols according to their group allocation. Group 1 underwent Chiropractic adjustments to the lumbar spine and Sacroiliac joints, Group 2 received stretching exercises to the Quadratus lumborum muscle; gluteal muscles consisting of Gluteus maximus, medius and minimus; Piriformis; Psoas; Hamstring and Multifidus muscles only and Group 3 received a combination of the treatment protocols. Participants in all three groups were assessed using the Numerical Pain Rating Scale and the Roland-Morris Disability Questionnaire for subjective readings; the Digital Inclinometer was used for objective readings of ROM. All treatments were performed at the Riviere Academy of Dance under the supervision of a qualified Chiropractor. The results concluded that the benefits of an adjustment alone, stretching alone as well as the two treatments combined showed a reduction of pain and increase of ROM, when managing a dancer with lower back pain. Not one treatment was shown to be more beneficial than the other.

Dissertation completed in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: Mechanical neck pain is a common complaint characterized by pain, limited range of motion and myofascial trigger points. The most common treatments for it are manual therapy and drug therapy. The former includes massage and exercise therapy and more specific to this study spinal manipulation and dry needling. The latter includes non-steroidal anti-inflammatories (NSAIDs) and analgesics. Manipulation assists in increasing range of movement and reduces muscle spasm, while dry-needling inactivates trigger points and decreases local and referred pain. NSAIDs reduce pain and muscle spasm by inhibiting inflammatory pathways. Traumeel®S is a commonly used, safe and well tolerated homoeopathic anti-inflammatory with similar efficacy as NSAIDs but without the adverse gastrointestinal effects. It has also been shown to be highly effective in the treatment of myofascial pain. Methodology: This study was designed as a randomized comparative clinical trial. Fourty participants between ages 18-55 years of age were randomly allocated to two groups of twenty participants each. Group A received spinal manipulation and dry needling in trapezius trigger point two; while Group B received spinal manipulation and Traumeel®S solution injection in trapezius trigger point two. The study took place over a period of two weeks and involved four consultations. Subjective and objective readings were taken at every consultation. Subjective tools included the Numerical pain rating scale (NRS) and Canadian Memorial Chiropractic College (CMCC) neck disability index. Objective tools included the pressure algometer and cervical range of motion (CROM-II) goniometer. SPSS version 20.0 was used in the data analysis. A p-value of <0.05 was considered as statistically significant. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that the effectiveness of spinal manipulation and dry needling versus spinal manipulation and Traumeel®S Injectable solution in the treatment of mechanical neck pain associated with trapezius myofascial trigger points is equivalent to each other. No statistically or clinically significant changes were noticed between the groups.