M.Tech. (Chiropractic) / Please refer to full text to view abstract

A dissertation submitted in partial compliance with the requirements for the Masters Diploma in Technology: Chiropractic at Technikon Natal, 1996. / Lower back pain due to mechanical dysfunction is a common cause of pain and disability in mankind. Lumbar spine facet syndrome is a major aetiology in mechanical lower back pain / M

M.Tech.

Lumbar fusion performed among injured workers has dramatically increased over the past two decades, coinciding with the increased use of more advanced surgical technology. Despite recent changes in how this surgery is performed, few outcome studies have been conducted, particularly among workers compensation populations. In prior studies, several biopsychosocial risk factors were found to be predictors of functional outcomes of lumbar fusion. Considering the recent changes in lumbar fusion surgery, there is a need to identify how patient outcomes have changed among injured workers, and whether a biopsychosocial model continues to be predictive of outcomes. The current study aimed to address multidimensional patient outcomes associated with lumbar fusion and examine the relationship between presurgical biopsychosocial variables and outcomes by testing the predictive efficacy of a multiple variable model. Injured workers (N = 245) who underwent their first lumbar fusion between 1998 and 2007 were included in a retrospective-cohort study performed in two phases that involved coding presurgical information documented in patient medical charts in the Worker's Compensation Fund of Utah computer database (Phase 1) and administering a telephone outcome survey with patients at least 2 years post-surgery (Phase 2). Of the total sample, 45% (n = 110) of patients were contacted and completed follow-up outcome surveys on several measures of patient satisfaction, quality of life, fusion status, dysfunction level, disability status, pain, and general physical and mental health functioning. Results revealed injured workers reported a solid fusion rate of 89.0%, disability rate of 28.7%, and a poor outcome rate of 57.1%. Multiple linear regression analyses demonstrated an eight variable model was a statistically significant predictor of multiple patient outcomes. Involvement of a nurse case manger, vocational rehabilitation, and litigation at the time of fusion were the most prominent predictors across outcome measures, while age and depression history showed modest prediction of outcomes. Prior back operations, number of vertebral levels fused, and type of instrumentation showed no statistically significant prediction of outcomes. Results were evaluated and compared to prior lumber fusion studies on injured worker and fusion outcome literature, in general. Specific implications for our findings and limitations associated with this study were addressed.

Objetivo: Determinar la asociación entre la sobrecarga postural y dolor lumbar en conductores de “combis” de una empresa de transporte público. Materiales y métodos: Se realizó un estudio de tipo transversal-analítico donde la muestra estuvo formada por 208 conductores de “combis”. Se utilizó los cuestionarios Nórdico de Kuorinka, Bus Drivers Job Demands Scale y Rapid Upper Limb Assessment (RULA). Se aplicó Regresión de Poisson con varianza robusta y se calcularon Razones de Prevalencia (RP) crudas y ajustadas con un IC 95%. Resultados: La prevalencia de dolor lumbar fue 79,33% y se encontró que existe asociación con la sobrecarga postural según RULA, nivel 3 (RP 1,44 [IC 95% 1,05-1,99]) y nivel 4 (RP 1,72 [IC 95% 1,27-2,32]) en comparación a los conductores con nivel 2, luego de ajustar por índice de masa corporal (IMC), edad de los conductores, años de trabajo como conductor y horas diaria de trabajo. Conclusiones: Los conductores que están sometidos a mayor sobrecarga postural tienen más probabilidad de presentar dolor lumbar. / Aim: To determine the association between postural overload and low back pain in combis’ (van) drivers of a public transport company. Materials and Methods: A cross-sectional study among 208 “combi” drivers was conducted. Nordic Kuorinka Questionnaire, Bus Drivers Job Demands Scale, Rapid Upper Limb Assessment Scale (RULA) were administered. Poisson regression with robust variance and crude and adjusted Prevalence Ratios (PR) with 95% CI were compute. Results: The prevalence of low back pain was 79.33% and postural overload was associated with low back pain according to RULA, level 3 (PR 1.44 [95% CI 1.05-1.99]) and level 4 (PR 1.72 [IC 95% 1.27-2.32]) with respect to drivers with level 2, after adjustment for body mass index (BMI), age, years of work as a driver and daily hours of work. Conclusion: Drivers who had postural overload had more probability to present low back pain / Tesis

No description available.

For years, the human back has puzzled researchers with the complex behaviors it presents. Principally, the internal forces produced by back muscles have not been determined accurately. Two different approaches have historically been taken to predict muscle forces. The first relies on electromyography (EMG), while the second attempts to predict muscle responses using mathematical models. Three such predictive models are compared here. The models are Sum of Cubed Intensities, Artificial Neural Networks, and Distributed Moment Histogram. These three models were adapted to run using recently published descriptions of the lower back anatomy. To evaluate their effectiveness, the models were compared in terms of their fit to a muscle activation database including 14 different muscles. The database was collected as part of this experiment, and included 8 participants (4 male and 4 female) with similar height and weight. The participants resisted loads applied to their torso via a harness. Results showed the models performed poorly (average R2's in the 0.40's), indicating that further improvements are needed in our current low back muscle activation modeling techniques. Considerable discrepancies were found between internal moments (at L3/L4) determined empirically and measured with a force plate, indicating that the maximum muscle stress selected and/or the anatomy used were faulty. The activation pattern database collected also fills a gap in the literature by considering static loading patterns that had not been systematically varied before. / Master of Science

Falls from heights are the fourth leading cause of occupational injury and fatality in the United States. In particular, construction workers such as roofers are often exposed to high risk environments. Recent research has reported that a leading cause of falls among workers is a loss of balance. Therefore, in moving towards reducing the number of occupational falls, further investigation of balance and factors that influence postural control is necessary. The effect of neuromuscular fatigue has been addressed by many investigators; however, few studies have examined the effect of localized fatigue in muscles not located in the lower extremities. Because low back fatigue is so prevalent during manual labor, this investigation determined to study the effects of lumbar extensor fatigue on balance. Chapter 1 includes a complete review of current literature addressing the effects of muscular fatigue on measures of balance. Chapter 2 details an initial investigation of lumbar extensor fatigue on center of pressure (COP) based measures of postural sway and examines the effect of fatiguing rate. Chapter 3 examines the effects of different levels of lumbar extensor fatigue and expands on the previous investigation by examining center of mass (COM) movement and incorporating additional measures of postural control. The results of these investigations indicate that lumbar extensor fatigue affects both COP and COM measures of postural sway, and might also lead to an increased reliance on feedforward postural control mechanisms. These findings contribute to understanding of effects of fatigue on balance and may aid the future design of interventions aimed at fall prevention. / Master of Science

Thesis (M.Tech.: Chiropractic)-Durban University of Technology, 2008 / To evaluate the lumbar lordosis, lumbosacral angle, lumbosacral disc angle, lumbosacral lordosis angle, intervertebral disc angles and heights, interpedicular distances, sagittal canal diameters and the lumbar gravity line (selected radiographic parameters) in young to middle aged Indian females in Durban. To determine any association between the selected radiographic parameters and the age of the subjects, weight, height and body mass index of the subjects, occupation, smoking, previous pregnancy and leg length inequality (selected anthropometric and demographic factors). Methods: Sixty healthy, asymptomatic, young to middle aged, Indian females were recruited for this study. All subjects underwent a case history, a physical examination and radiographic evaluation (AP and lateral views) of the lumbar spine. SPSS version 15.0 (SPSS Inc., Chicago, Ill, USA) was used to analyze the data. Results: The mean (± SD) of the lumbar lordosis, lumbosacral angle, lumbosacral disc angle and lumbosacral lordosis angle was 49º (± 6º), 39º (± 8º), 12º (± 5º) and 143.2º (± 5º) respectively. For the lumbar intervertebral disc angles at L1-L2, L2-L3, L3-L4, L4-L5 and L5- S1 levels, the mean (± SD) was 6º (± 2º), 8º (± 2º), 10º (± 3º), 12º (± 4º) and 12º (± 5º) respectively. The anterior and posterior intervertebral disc heights at the respective vertebral levels were: L1-L2: anterior: 8 mm (± 2), posterior 5 mm (± 2); L2-L3: anterior: 10 mm (± 2), posterior 5 mm (± 2); L3-L4: anterior: 12 mm (± 2), posterior 5 mm (± 2); L4-L5: anterior: 14 mm (± 3), posterior 5 mm (± 2) and L5-S1: anterior: 13 mm (± 4), posterior 6 mm (± 2). The mean (± SD) of the interpedicular distance at the L1, L2, L3, L4 and L5 vertebral levels was 23 mm (± 2), 24 mm (± 2), 25 mm (± 2), 27 mm (± 2) and 31 mm (± 3) respectively. For the sagittal canal diameter at the L1, L2, L3, L4 and L5 vertebral levels, the mean (± SD) was 20 mm (± 5), 21 mm (± 3), 21 mm (± 3), 21 mm (± 3) and 19 mm (± 3) respectively. The lumbar gravity line intersected the sacrum in 67.3% of the subjects. In 29.1% of the subjects, the lumbar gravity line passed anterior to the sacrum while in 3.6% of the subjects, it passed posterior to the sacrum. iv A significant association was found between lumbar lordosis and the height of the subjects in this study (p = 0.004). A decrease in the intervertebral disc height at L5-S1 was associated with smoking (p = 0.005). A decrease in the intervertebral disc height at L4-L5 was associated with previous pregnancy (p = 0.016). Body mass index of 26–30 kg.m-2 was significantly associated with an increase in the intervertebral disc angles at L3-L4 (p = 0.028) and L4-L5 (p = 0.031). A decrease in the L5-S1 intervertebral disc angle was also significantly associated with smoking (p = 0.023). There was a significant association between previous pregnancy and an increase in the intervertebral disc angle at L3-L4 (p = 0.016). A significant association was found between the age of the subjects and the L5-S1 intervertebral disc angle (p = 0.007). Specifically it was the 23–27 year group and 33–37 year group who were significantly different from each other (p = 0.033). Conclusion: Similarities and differences were found in the mean values of the radiographic parameters measured in this study and those reported in the literature. A number of the selected anthropometric and demographic factors were associated with some of the lumbar radiographic parameters. Further studies are required to establish the clinical significance of these findings.

M.Tech. / Purpose: To determine what effects flexion distraction will have on males with chronic lumbar facet syndrome, in reference to intersegmental range of motion and pain. Method: Thirty male participants with chronic lumbar facet syndrome received flexion distraction technique. The trail consisted of seven visits over two to three weeks. Treatment was performed on the first to sixth visit, readings and questionnaires were completed on the first, fourth and seventh visits. Data collection was concluded before treatment on the mentioned visits. Subjective data consisted of the Oswestry Disability Index (ODI) and the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). Objective data included global lumbar range of motion measurements using the Baseline Digital Inclinometer, and segmental lumbar range of motion by means of the Radiographical Midplane Angle method. Results: Objectively, clinical significance of the intersegmental lumbar range of motion increased from the L1/L2 to the L4/L5 level (2.2% - 17.7%), but showed no statistical significance. In relation to the maximal motion possible at these levels, the increase in motion escalated from 0.8% at the L1/L2 segment to 9.2% at the L4/L5 segment. The global lumbar range of motion showed clinical significant increase in all of the ranges except for extension, however statistical significance was found in right lateral flexion only (p = 0.045). The greatest increase in motion was observed in left lateral flexion (15.72%) and a decrease in extension (3.72%) was illustrated. Subjectively, the group showed statistical significant improvement in both the SF-MPQ-2 (p = 0.000) and ODI (p = 0.000). Clinical meaningful change was noted throughout the subjective data, which resultantly showed a 66% and a 67% change in pain respectively. Conclusion: Flexion distraction has shown to have clinical significant effects on segmental and thus global range of motion, and great clinical meaningful change in pain levels and pain perception. Thus specific segmental mobilisation does affect the segmental motion.