Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis. / 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: Musculoskeletal disorders (MSDs) are a significant and common occupational health concern, consequently impacting work attendance and performance. High prevalence rates of MSDs have been reported amongst school teachers. Studies have linked these higher prevalence rates to typical daily teaching activities including prolonged standing, awkward postures, heavy lifting, bending and repetitive movements. Objectives: To determine the prevalence of neck, shoulder and low back pain among primary school teachers in the Central Durban area; to identify any risk factors associated with neck, shoulder and low back pain; and to establish the relationship, if any, between the prevalence and risk factors of neck, shoulder and low back pain among primary school teachers. Methods: This was a quantitative, descriptive and cross-sectional study, conducted in 12 selected public primary schools within the Central Durban area. Volunteers who met the inclusion criteria (n = 97) were invited to complete self-administered questionnaires. Results: Of the 97 completed questionnaires 83.1 percent (%) reported neck and shoulder pain and 71.0% low back pain. Neck and shoulder pain were significantly associated with a forward-bent head posture (p = 0.001), ethnicity (p = 0.001), and history of a severe trauma/injury (p = 0.006). Similarly, significant associations were noted with regards to medical conditions (p = 0.006), a backward-bent head posture (p = 0.016), lifting of heavy loads (p = 0.045) and treatment for severe injury (p = 0.047). Associations were also noted between low back pain and prolonged standing (p = 0.000), ethnicity (p = 0.008), transportation methods (p = 0.023), medical conditions (p = 0.031) and a history of a severe trauma/injury (p = 0.049). Conclusion: This is a first South African study, to our knowledge that highlights increased prevalence rates for both neck and shoulder pain and low back pain amongst teachers, with a variety of associated risk factors. This draws attention to the urgent need for intervention programs to be implemented to prevent/reduce the development of musculoskeletal pain amongst teachers. / M

Mini-dissertation in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, in the Department of Chiropractic at the Durban University of Technology, 2009 / The aim of this study was to investigate the relative effectiveness of Transeva and spinal manipulative therapy for mechanical low back pain. The objectives evaluated the effectiveness of only administering Transeva therapy alone, or Spinal manipulative therapy alone as well as Transeva therapy with Spinal manipulative therapy on mechanical low back pain with respect to the patients’ subjective and objective responses to the respective treatment group. The final objective was to correlate the subjective and objective data collected to determine the effectiveness of each of the therapies in comparison with another. Design: A sample of thirty patients diagnosed with mechanical low back pain were accepted into the study. These patients were randomly divided into three groups of 10, which received different treatment protocols for mechanical low back pain. Outcome Measure: The following outcomes were measured; a decrease in pain (measured with the Numerical Pain Rating Scale (NRS), a decrease in disability (measured with the Roland-Morris Questionnaire), a decrease in local tenderness (measured with the pressure Algometer) and an increase in lumbar range of motion (measured with the Inclinometer). The data was collected prior to treatment one, prior to treatment four and at the sixth follow-up visit. Results and Conclusion: All groups improved with the treatments they received; however, no single treatment was statistically better than any other treatment intervention tested. However, the Spinal manipulative therapy group had a statistically significant faster reduction in pain on the NRS readings with p=0.048.

Dissertation submitted in partial compliance with the requirements for the Masterà ¢ s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / Objectives: To determine the short-term effect of an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of spinal manipulation (SMT) and ribcage mobilisation on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of a combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. Methods: Forty-five chronic moderate asthmatics who met all the inclusion criteria of the study were divided into three groups of fifteen each. Group A received a short-acting 2-agonist bronchodilator, Group B received SMT and ribcage mobilisation and Group C received a combination of SMT, ribcage mobilisation and a short-acting 2-agonist bronchodilator. Baseline measurements and testing included chest wall expansion and the lung function parameters FEV1, FVC and FEV1/FVC%. These measurements were repeated 15 minutes post-intervention. Data was analyzed using SPSS version 15.0. Results: There were no statistically significant changes between pre- and post-intervention in the short-acting 2-agonist bronchodilator group with respect to any of the chest wall expansion measurements. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group (p = 0.008). There was a statistically significant increase in the mean pre- and post-intervention axillary chest wall expansion (p = 0.014) as well as the mean of the half-way measurement (p = 0.014) and the overall mean chest wall expansion value (p = 0.001) following SMT and ribcage mobilisation. There were no statistically significant changes in any of the lung function parameter values following SMT and ribcage mobilisation. There was a significant increase for the half-way measurement in chest wall expansion (p = 0.018) in the combination of SMT, ribcage mobilisation and the inhaled, short-acting 2-agonist bronchodilator group. There were no statistically significant changes in any of the lung function parameter values in the combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator. For FEV1, the effect in the short-acting 2-agonist bronchodilator group vs. the SMT and ribcage mobilisation group was statistically significant (p = 0.018). There was no statistical difference in any of the chest wall expansion measurements and FVC and FEV1/FVC% parameters between all three groups. Conclusions The results did not point specifically to one intervention over another for all outcomes. SMT and rib mobilisation had no effect on the lung function parameters, at least in the short term. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Health care practitioners have known for some time that patients benefit from specific manual intervention effects, but also from the manner in which these are presented. The latter at times having as much impact on patient health as the former. Thus the purpose of this study was to determine the effect of the clinical ritual during instrument assisted adjusting whilst managing mechanical lower back pain. The study was a randomized prospective study comprising of sixty participants aged 18-59. These individuals were randomly allocated into two groups of thirty and then further stratified to control for gender. Both Groups were diagnosed according to the Activator Methods Chiropractic Technique (AMCT), however the tension was set at maximum for group A, whilst the device was set to the minimum tension for group B. Each patient received three treatments and one follow up visit over a two-week period. Subjective data was collected at the first, third and follow up visit. Subjective data was recorded using the Visual Analogue Scale, the Numerical Pain Rating Scale, the Roland Morris Questionnaire and the Short-form McGill Pain Questionnaire. Outcomes were analysed through with the SPSS statistical package at a 95% level of confidence. After analysis of the collected data it was found that there was no statistical difference between the groups, but there was a non-specific trend suggesting a better outcome in the full tension activator group (Group A). Thus, the research indicated that patients perceptions, the patient-practitioner relationship, and the assumption of an outcome of success as well as the power of placebo or non-specific effects play a large role in the managing of lower back pain in a chiropractic environment.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Low back pain is a common condition and affects most people at least once in their lives. The causes of low back pain (LBP) are numerous and may include non-specific mechanical causes, or specific causes which may be of a more serious nature. Researchers have tried to link specific history and physical examination findings with certain disorders, but as of yet, have been unsuccessful. Research has shown that x-rays may be over utilized and the guidelines for referral are not always adhered to. Furthermore, there is a paucity of literature on the role of x-rays in influencing the management of patients with low back pain. Objectives: The objectives of this retrospective study were: 1) to determine the relationship between the clinical and the radiographic diagnoses of patients with LBP, 2) to record the consultation at which a lumbar spine x-ray was requested by the student or clinician and the reasons thereof, 3) to record the suspected clinical diagnoses and management of the selected patients prior to referral for lumbar spine x-rays, 4) to determine the number of incidental radiographic findings in the selected patients’ x-rays, and 5) to determine any change in the clinical diagnoses and management following radiographic reporting of the selected patients’ x-rays. Method: The Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) archives were searched for lumbar spine radiographs and the corresponding patient files of patients who presented with LBP from 1 January 1997 to 31 July 2010. Data collection was in a stepwise process with the anteroposterior and lateral lumbar spine x-rays being read first, without any knowledge of the patient’s main complaint and then the corresponding patient files were evaluated and selected clinical variables were recorded. Statistical analysis included the use of frequency counts, percentages, mean, standard deviation and range for the descriptive objectives. Diagnoses were categorized into specific groups and indicator variables were used to construct two-by-two tables of absence or presence of radiographic vs. clinical diagnosis for each specific diagnosis to determine any possible associations. Results: The mean age of the patients was 43.9 (± 16.9) years and the number of male and female patients were 40 and 34 respectively. It was not possible to correlate the clinical and radiographic diagnoses because the categories were too different for any statistical test to be performed. Spondylosis was the most common radiographic finding. The majority of the lumbar spine x-rays were requested at the first consultation. No suitable reason for obtaining the x-ray was provided in 14.6% of the x-rays requested and 20.7% were requested to examine for an unspecified pathology. Of the 74 patients in this study, 44 patients did not have a change in diagnosis, which means that 59.5% of the diagnoses stayed the same after x-ray examination. However, in 30 (40.5%) of cases the clinical diagnosis was changed following x-ray examination. This may indicate an overuse of x-rays at the CDC. Most patients were diagnosed with the non specific mechanical causes of low back pain. A wide range of treatment modalities were utilized both before and after x-rays were taken, including soft tissue therapies, electrotherapies and spinal manipulation. Following x-ray imaging there was a greater use of spinal manipulation ie. 62% versus only 39% of cases prior to imaging. Conclusion: Lumbar spine x-rays may be over utilised at the CDC but their findings were influential in the diagnosis and management in 30 (40.5%) of the patients. The majority of the clinical diagnoses were of the mechanical or non-specific causes of low back pain. / Durban University of Technology.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial Pain Syndrome is a condition characterized by the development of hyperirritable foci in muscle. Treatments include modalities such as cryotherapy, electrotherapy, ultrasound, ischeamic compression and dry-needling, the latter of which is reported to be the most effective. A side-effect of dry-needling is post-needling soreness which results from bleeding in the area of needle insertion. The application of heat as a therapy to an injured area has been reported to decrease pain by blocking nociceptors, decreasing muscle spasm, and increasing connective tissue extensibility. Objectives: To determine the relative effectiveness of heat therapy immediately after dry-needling versus dry-needling alone on post-needling soreness in the deltoid muscle of asymptomatic subjects. This was done in terms of subjective and objective clinical findings. Methodology: This study was designed as a randomised, parallel-controlled clinicaltrial. Thirty asymptomatic subjects were used. Each subject acted as their own control in that both the left and right arms of each subject were dry-needled. One of the arms received heat therapy after the dry-needling procedure while the other arm acted as a control. Algometer readings, a Numerical Pain Rating Scale-101 (NRS- 101) and a 24 Hour Pain Diary were used as assessment tools. Algometer and NRS-101 readings were taken before and after the dry-needling procedure and during the 24 hour follow up visit. Subjects used a 24 hour pain diary which was filled out at 3 hour intervals, to record the development of post-needling soreness. Independent samples t-test and Pearson’s chi square test were used to compare age and gender between the treatment groups. Repeated measures ANOVA testing was used to compare the effect of heat treatment with no heat treatment in the 60 arms over the three time periods of assessment for the outcomes which were 4 5 measured as continuous variables (NRS-101 and algometer). For binary outcomes such as the presence or absence of pain at any time point, Fisher’s exact tests were used to compare the heat treated with the control arms in the left and right arms separately. A p value of less than 0.05 was considered as statistically significant. Results: Both the objective and subjective measurements from the heat intervention and control groups revealed the development of post-needling soreness. There was a slight trend of heat therapy decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary) and objective (algometer) findings which was however, not found to be statistically significant. Conclusion: Although the results of the study revealed no statistical evidence of a beneficial effect of heat therapy on objective or subjective findings clinical significance could not be excluded due to the observed trend of heat therapy decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary) and objective (algometer) findings. Further investigation is recommended.

Mini-dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Purpose: Patellofemoral Pain Syndrome is a common condition in all age groups, with a multifactorial etiology. This study aimed to investigate the association between the Quadriceps femoris muscle group, Hamstring muscle group and Adductor muscle group, and to establish the relationship between myofascial trigger points (MFTP’s) in these muscle groups and patellofemoral pain syndrome (PFPS). Methods: A cross-sectional, observational, quantitative non-intervention clinical assessment study was conducted at the Chiropractic Day Clinic at Durban University of Technology (DUT), to determine the extent of the PFPS, the MFTPs and thus the relationship between the two. The study included eighty patients with PFPS, who were recruited by convenience sampling. The results were captured using Microsoft excel and SPSS version 15.0 was used to analyze the data. Results: Quadriceps femoris muscle group MFTPs were noted in 92.5% of the patients (most prevalent being Vastus medialis TP1 (63.8%), Vastus lateralis TP1 (33.8%) and Vastus intermedius at 27,5%). Least common was Vastus lateralis TP2 only presenting in 2,5% of the patients. Hamstring muscle group MFTPs were found overall in 86.3% of patients (most prevalent being in Biceps femoris muscle (66%), and least prevalent being in Semitendinosus muscle (11,3%)). MFTPs were present in 64% overall of the Adductor muscle group (Adductor magnus muscle being the most common). Significant associations were made between the presence of MFTPs in the Vastus lateralis TP2 (p=0.00), Vastus medialis TP1 (p=0.046; 0.005; 0.004), the NRS and the PPSS. Also significant was the relationship between the NRS, PPSS and the Semimembranosus and Adductor magnus muscles indicated that these muscles were the most likely causes of pain even though they had fewer MFTPs than other comparable muscles. Conclusion: The outcomes of this study supports previous research indicating that an extensor dysfunction of the Quadriceps femoris muscle group may be of MFTP origin and indicates that other muscles in the thigh require further research indicating their role in the development of PFPS.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background : A lack of peaceful sleep and adequate neck support during sleep has been described as a significant contributing factor to the development of chronic non-specific neck pain. Health-care practitioners often prescribe a cervical pillow for the treatment of chronic non-specific neck pain despite the ambivalent findings of several studies. Recently Simmons South Africa introduced the Simmons Beautyrest® pillow which it claims is able to support the cervical spine and promotes a restful sleep. This study, therefore, set out to determine the potential of the Simmons Beautyrest® pillow in alleviating chronic non-specific neck pain. Objective : This study aimed to determine the effectiveness of the Simmons Beautyrest® pillow compared to the participant’s usual pillow (the control) in terms of objective and subjective findings in the management of chronic non-specific neck pain. Methods : Forty individuals, aged 18 to 45 years of age, experiencing chronic non-specific neck pain were recruited via convenience sampling. The study was a single-blinded, cross-over interventional study. All participants underwent a case history, physical and cervical orthopedic examination. Objective (algometer and Cervical Range of Motion measurements) and subjective (Numerical Pain Rating Scale, Neck Disability Index, Sleep and pain diary) outcome measures were obtained at each of the five consultations over a four week period, with the cross-over occurring after two weeks. SPSS version 18.0 was used to analyze the data. Demographic data was analyzed using the Chi square tests and t-tests. The consultations were averaged for each phase of the cross over design to result in a two treatment, two period cross over design. Repeated measures ANOVA testing was used to evaluate the effect of the intervention on subjective and objective measurement according to the method of Dallal (Esterhuizen, 2011). The sleep and pain diary data was analyzed using repeated measures ANOVA and Wald chi square test. Results : A significant difference in the perceived comfort levels between the two pillows (p < 0.001) was observed with the Simmons Beautyrest® pillow having a higher comfort rating. A significant decrease in NRS scores (p = 0.018); NDI scores (p < 0.001); and NRS scores on awakening (p < 0.001); neck stiffness rating on awakening (p < 0.00); headache rating on awakening (p = 0.043) was observed in relation to the Simmons Beautyrest® pillow. A significant improvement (p = 0.001) in algometer readings was observed when using the Simmons Beautyrest® pillow when compared to participants usual pillow. A significant increase in mean right lateral flexion measurements was observed in both groups when using the Simmons Beautyrest® pillow (p = Conclusions : The Simmons Beautyrest® pillow was effective in improving chronic non-specific neck pain. It was regarded as comfortable and provided relief with regards to the clinical features of non-specific neck pain. / Simmons South Africa Company

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Health care practitioners have known for some time that patients benefit from specific manual intervention effects, but also from the manner in which these are presented. The latter at times having as much impact on patient health as the former. Thus the purpose of this study was to determine the effect of the clinical ritual during instrument assisted adjusting whilst managing mechanical lower back pain. The study was a randomized prospective study comprising of sixty participants aged 18-59. These individuals were randomly allocated into two groups of thirty and then further stratified to control for gender. Both Groups were diagnosed according to the Activator Methods Chiropractic Technique (AMCT), however the tension was set at maximum for group A, whilst the device was set to the minimum tension for group B. Each patient received three treatments and one follow up visit over a two-week period. Subjective data was collected at the first, third and follow up visit. Subjective data was recorded using the Visual Analogue Scale, the Numerical Pain Rating Scale, the Roland Morris Questionnaire and the Short-form McGill Pain Questionnaire. Outcomes were analysed through with the SPSS statistical package at a 95% level of confidence. After analysis of the collected data it was found that there was no statistical difference between the groups, but there was a non-specific trend suggesting a better outcome in the full tension activator group (Group A). Thus, the research indicated that patients perceptions, the patient-practitioner relationship, and the assumption of an outcome of success as well as the power of placebo or non-specific effects play a large role in the managing of lower back pain in a chiropractic environment. / M