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.

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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.

The purpose of this study was to explore the effectiveness of chiropractic manipulative therapy on the wrist, in treating lateral epicondylitis. It also aimed to determine the effectiveness of Mills’ manipulation applied to elbow, and whether adjusting both the elbow and the wrist would be more effective than simply adjusting the elbow or the wrist in isolation. Thirty patients suffering from lateral epicondylitis who conformed to specific diagnostic criteria were accepted for the trial. The patients were stratified according to age and sex and placed into three groups of ten. The first group received chiropractic manipulative therapy directed to the wrist. The second group received chiropractic manipulative therapy directed to the elbow complex, and the third group received chiropractic manipulative therapy directed at both areas. The treatment consisted of four sessions over a period of 2 weeks. The groups were assessed and compared in terms of objective and subjective measurements to determine the most beneficial treatment. The data was collected at the beginning of each treatment session. Subjective data consisted of the Numerical Pain Rating Scale 101 (Vernon in Liebenson, 1996:61) and the short form Mc Gill Pain Questionnaire (Melzack, 1987:192), which assessed patients’ discomfort levels. Objective data was collected by means of the Jamar Grip Strength Dynamometer (Kaufman, 2000:619) and the Pressure Algometer (Fischer, 1987:213), which measured the grip strength and pressure pain threshold respectively. The results showed that both wrist and Mills’ manipulation in isolation as well as in combination are beneficial in treating lateral epicondylitis, in that they all showed subjective and objective improvements. The Mills’ manipulation alone and in combination with wrist manipulations had superior clinical effects compared to the wrist manipulations in isolation. The statistical results of the inter-group analysis revealed that there was no significant difference between the outcomes of the wrist manipulation, Mills’ manipulation and combined treatment protocols and therefore none are expressly recommended above the other. / Dr. C. Yelverton Dr. C. Lyons

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

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

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