Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, South Africa, 2013. / Background: Lateral ankle sprains and the sequelae of Chronic Ankle Instability Syndrome (CAIS) are common, reaching a peak prevalence of 85%. Manual joint manipulation is an intervention utilised for CAIS. Manipulations are applied either manually or via a mechanical device. The Activator Adjustment Instrument (AAI) is commonly applied to extremities; however, a paucity of research exists, in respect of extremity conditions. Thus this study compared an AAI manipulation with a manual long-axis distraction manipulation (diversified technique) in the treatment of CAIS. Method: This ethics approved, quantitative, randomised controlled clinical trial, of 40 participants allocated between two groups. After receipt of informed consent participants were evaluated against the inclusion criteria and baseline measures were taken. One treatment of either manual or activator manipulation was followed by a measurements-only consultation within 48 hours. A p-value <0.05 was considered statistically significant. Intra- and inter-group analyses were done utilising repeated measures ANOVA tests. Results: Both groups showed a statistically significant improvement on all outcome measures over time, but neither group showed a significant improvement over the other. A trend in the inter-group comparisons reflected parallel improvements in the Algometer, Berg Balance Scale and the dorsiflexion range of motion (objective measures) and non-parallel improvements in the Numerical Pain Rating Scale and Foot and Ankle Disability Index. Conclusion: The results suggested a trend towards subjective improvement in the AAI group, which may have been influenced by the novelty of the AAI. Further research with larger sample sizes and more homogenous participant groups are needed to verify this outcome.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 1 v. (various pagings) / Mechanical low back pain is one of the most common clinical disorders that most people seek help for (Painting et al. 1998:110). Epidemiological studies indicate a lifetime prevalence of low back pain ranging from 60 to 80% with an annual incidence of approximately 30% (Mosheni-Bandepi et al., 1998). The Sacroiliac (S.I.) joint is a significant source of pain in patients with chronic low back pain and it therefore warrants further study (Schwarzer et al. 1995:31). S.I. syndrome is defined as pain over the S.I. joint in the region of the posterior superior iliac spine, which may be accompanied by referred pain over the buttock, greater trochanter, groin, posterior thigh, knee, and occasionally to the postero-lateral calf, ankle and foot (Kirkaldy-Willis, 1992:123). Research indicates that there seems to be a correlation between low back pain, more specifically S.I. pain and hip rotation (Ellison et al. 1990, Cibulka et al. 1999, Fairbank et al. 1984). Cibulka et al. (1998) found that patients with lower back pain who were classified as having signs suggestive of S.I. regional pain had significantly more external rotation than internal rotation on the posterior innominate side i.e. side of S.I. dysfunction (approximately a 20 difference). Manipulation is recognised as an effective means of treating mechanical low back pain, with respect to both Lumbar Facet Joint Syndrome and S.I. Joint Syndrome (Assendelft et al. 1992 and Koes et al. 1996). Kirkaldy- Willis (1992:123) states that manipulation is the most certain way of relieving the symptoms of S.I. syndrome. This investigation aimed to determine the effect of a sacroiliac joint manipulation on hip rotation ranges of motion (active and passive motion) in patients with chronic sacroiliac syndrome in terms of objective measures.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 xiv, 86 leaves / The purpose of this study was to evaluate the efficacy of Chiropractic Manipulative Therapy in the management of Attention Deficit Hyperactivity Disorder in children.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2005. xii, 51 leaves : ill. (some col.) ; 30 cm / According to the recent literature the application of non-steroidal anti-inflammatory drugs (NSAIDS) is the mainstay and first line of conventional treatment for many types of pain, including that of spinal origin (DiPalma and DiGregorio 1994; Dabbs and Lauretti 1995; Koes et al. 1997). NSAID therapy has inherent side effects (Goodman and Simon 1994), however, given the risks involved, they are still of value as an adjunct to spinal manipulation (Crawford 1988), which has been shown to have less side effects and be more effective than conventional NSAIDS (Dabbs and Lauretti 1995; Giles and Müller 1999). A homeopathic alternative to NSAIDS is Traumeel S, it fulfils all the criteria for a locally acting therapeutic medication, with promotion of the natural healing process, and minimum side effects (Zell et al. 1989). A study by Hepburn (2000) compared the relative efficacy of Traumeel S against NSAIDS in the treatment of cervical facet syndrome. Hepburn concluded that there was statistically no difference between the two therapies. It could therefore be inferred that Traumeel S may be a valid alternative to NSAID therapy in the treatment of cervical facet syndrome. This study tested this hypothesis by comparing the effectiveness of spinal manipulation with the concurrent administration of oral Traumeel S against spinal manipulation alone in order to assess the potential benefit of combining Traumeel S with manipulation.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 1 v. (various pagings) / In recent years, sacroiliac syndrome has been widely accepted by many different health professions as one of the major contributors to mechanical low back pain. Manipulation to effect the relief of the condition has thus far proven to be one of the most effective methods. However, comparatively little research has been done on the different forms of physical therapy that can be used in conjunction with a manipulation so as to maximise its effect. This study focussed on the use of ischaemic compression (a well-accepted technique for the treatment of myofascial trigger points) of the gluteus medius muscle.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006. 130 leaves. / The purpose of this investigation was to evaluate the efficacy of the adjustment of the first rib as an adjunct to the manipulative treatment of mechanical neck pain, according to subjective and objective clinical findings. The results of this study would indicate to Chiropractors which specific types of adjustments, used for the treatment of mechanical neck pain, would potentially increase the cervical range of motion and / or decrease pain experienced by the patient and thus lead to a more effective treatment protocol. The outcome of the study will help clinicians select the more appropriate treatment for patients based on the subjective and objective outcomes.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007. xii, 72, 12 leaves / Aims and Objectives: The aim of this study was to determine whether spinal manipulation affects the perceived performance of runners with low back pain. More specifically, the objective was to determine whether any relationships existed between spinal manipulation, a runner’s perceived performance and their low back pain. Method: Twenty subjects who ran thirty kilometers a week and had LBP were selected for a pre- post- cohort study according to criteria set out beforehand. The subjects received spinal manipulation applied to their lower back twice a week for a period of two weeks. At each consultation, they were requested to fill out a “Perception of Running Performance” questionnaire prior to each treatment, and one week following the final consultation.

Thesis (M.Tech.: Chiropractic)--Durban University of Technology, 2009 / Objective: The efficacy of manipulation as compared to placebo in the treatment of two groups of weight trainers with Acromioclavicular (AC) Joint Dysfunction. Methods: Twenty patients (n=20), using randomised sampling were allocated to two intervention groups. Patients in each group received four treatments each over a two-week period and assessed at initial, one week, two weeks and one month follow ups. Objective measures included Algometer and Inclinometer readings. Numerical Pain Rating Scales (NRS), Shoulder Rating Questionnaire (SRQ) and the Shoulder Pain and Disability Index (SPADI) measured subjective outcomes. Results: Manipulation demonstrated significant improvement in objective findings. Subjective outcomes did not show significant difference between the manipulation and placebo groups. Conclusion: Manipulation, when compared to placebo, can be considered as an effective treatment intervention for the treatment of AC joint dysfunction with particular reference to objective outcomes. Although, caution needs to be utilised in accepting this outcome due to limitations in sample size, subjective measure sensitivity and specificity as well as the stringency of the inclusion and exclusion criteria.

Submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / Aim: The aim of the study was to assess the effect of a single versus multiple cervical spine manipulations, over a two week period, on peak torque of the rotator cuff muscles utilizing the Cybex Orthotron II Isokinetic Rehabilitation System. This study was a pre and post experimental investigation. Method: Forty asymptomatic (in terms of neck and shoulder pain) male chiropractic students were stratified into two equal groups of twenty subjects to ensure that each group consisted of an equal number of subjects from each year of study. All subjects underwent a familiarisation session on the Cybex Orthotron II Isokinetic Rehabilitation System. Group One received a single manipulation. Rotator cuff peak torque was measured pre-manipulation, immediately post manipulation and at a two-week follow up. Group Two received four manipulations over a two week period. Rotator cuff peak torque was measured pre and immediately post the first manipulation. A third rotator cuff peak torque measurement was taken two weeks after the first manipulation. Results: There was no statistically significant effect of a single or multiple manipulations on rotator cuff peak torque (abduction, adduction, internal rotation and external rotation). Inter-group analysis revealed a trend of an effect for abduction as the single manipulation increased at the two-week follow up and the multiple manipulation group decreased; however, this was not statistically significant. Conclusion: No statistically significant results were found possibly due to small sample size and the fact that objective measurements were only taken at the beginning and the end of the research processes and not at regular intervals throughout the study.Further studies are needed to determine the effects of multiple manipulations on peripheral muscle activity, including the treatment of symptomatic patients with rotator cuff pathology. It is also recommended that EMG readings be done in conjunction with peak torque measures to determine muscle activity.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / The low back and the lower limb are generally viewed as two isolated regions, however, there are many authors who believe that these two regions are functionally related. This is due to the two regions being connected to each other through the kinematic chain of the lower extremity. The lumbar spine is the link between the lower extremities and the trunk, and plays a significant role in the transfer of forces through the body via the kinematic chain. The physical link between the low back and the lower limb is supplied by the thoracolumbar fascia, which plays an important role in the transfer of forces between the spine, pelvis and legs. Although a relationship between the lower extremity and low back pain is often assumed, little research has been published to demonstrate the association. Most of the evidence so far has been anecdotal, without scientific research to support it. This study was designed to compare the relative effectiveness of lumbar spine manipulation, compared to combined lumbar spine and subtalar manipulation for the treatment of chronic mechanical low back pain, using subjective and objective measures, for the management of chronic mechanical low back pain. The study design was a quantitative clinical trial, using purposive sampling. It consisted of forty voluntary participants with chronic mechanical low back pain. There were two groups of twenty participants each, each of whom received six treatments within a three week period. Group A received manipulation of the lumbar spine only, whilst Group B received manipulation of both the lumbar spine and subtalar joint. The outcome measures included the response of the participants to the Numerical Pain Rating Scale-101 and the Quebec Low Back Pain and Disability Questionnaire. Objective data was obtained from three digital Algometer measures. Data was collected prior to the initial, third and sixth treatment. iv Statistically both groups showed improvements, subjectively and objectively, with regards to chronic mechanical low back pain. Inter-group testing for NRS over time showed no significant effect for both treatment groups. There was a significant treatment effect for Algometer Average TP1 while the treatment effect for Algometer Average TP2 was not significant. However, inter-group testing for the Quebec LBP over time showed no significant effect for both treatment groups. Inter-group analysis demonstrated no statistical significance between the two groups for subjective and objective measurements, thus suggesting that there is no additional benefit in treating the subtalar joint in the management of mechanical low back pain. Further studies will also benefit greatly from the use of larger sample sizes to improve statistical relevance of data.