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.

Dissertation submitted to the Faculty of Health at the Durban University of Technology in partial compliance with the requirements for the Master‟s Degree in Technology: Chiropractic, 2009. / The prevalence of neck pain in musculoskeletal practice is second only to that of low back pain (Vernon et al., 2007). There is a growing interest in neck pain research due to the escalating disability burden and compensation costs associated with neck pain (Côte et al., 2003). Manual therapies are commonly used in the treatment of neck pain (Côte et al., 2003). After an extensive literature review by Haldeman et al. (2008) they found that manual therapy techniques have some benefit but no one technique was clearly superior to the next. Therefore, the purpose of this study is to compare three commonly used manual therapy techniques in the treatment of chronic mechanical neck pain. OBJECTIVES The purpose of this study was to compare three different manual therapy techniques (SMT, MET and PNF) which are commonly used in the treatment of chronic MNP in terms of range of motion, pain and disability. METHOD Forty-five patients with chronic mechanical neck pain were obtained through non-probability convenience sampling and assigned into one of three treatment groups (15 per group) using a computer generated randomized table. The three different treatment groups were: Spinal Manipulative Therapy (SMT), Muscle Energy Technique (MET) and Proprioceptive Neuromuscular Facilitation (PNF). Each group received six treatments over a period of three weeks with a follow-up consultation. Measurements were taken at the first, third and sixth treatment and at the follow-up consultation. SPSS version 15.0 was used to analyse the data. A p value of <0.05 was considered as statistically significant. An intra-group analysis was done using repeated measures ANOVA testing to assess the time effect for each outcome separately. For inter-group analyses the time x group interaction effect was assessed using repeated measures ANOVA testing, and profile plots were used to assess the trend and direction of the effects. RESULTS Intra-group analysis of the results revealed that all three groups improved significantly between the first and the final consultation, for all measures. Inter-group analysis of the data did not show any difference between the three groups by the end of the final consultation. However, extension range of motion appeared to improve slightly faster in the PNF group iv but it was not significant when compared to the other two groups. Therefore, there was no statistical significance between the three groups. CONCLUSION It was concluded that all three treatment groups responded equally to the treatment, thus, suggesting that MET or PNF techniques can be used if SMT is contra-indicated.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The aim of this research was to investigate the relative effectiveness of manipulation versus core rehabilitation in the treatment of acute mechanical low back pain in sedentary patients. Recent research has found that dysfunction of the primary core stabiliser muscles is linked with an increasing number of the general population suffering from low back pain; this is thought to be due to the fact that people in general are living more sedentary lifestyles. The Aims and Objectives of this study were to determine the relative effect of manipulation and core rehabilitation in sedentary patients suffering from acute mechanical low back pain in terms of subjective findings, objective findings and to determine any correlations between these findings Thirty-two participants, with acute low back pain participated in the study. They received treatment over a period of three weeks, two treatments in the first week, two treatments in the second week and a follow up seven days later. Group A received a spinal manipulation while Group B received core rehabilitation exercises. Readings were taken at three time points, namely visit one, three and five before the treatment, they included the following readings: Numerical Pain Rating Scale, Algometer, Roland Morris Low Back Pain and Disability Questionnaire, Biofeedback Stabiliser and the Surface EMG. The results showed that there was no differential (p<0.05) treatment effect between the two Groups, and that both Groups showed a clinical improvement in their low back pain. In conclusion, it appears that even though both these treatment protocols have very different mechanisms of action, both can be effective treatment protocols and that core rehabilitation exercises when properly performed are as effective as manipulation in the treatment of acute low back pain.

Mini-dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury induced by friction of the iliotibial band (ITB) over the lateral epicondyle of the femur (LFE) with secondary inflammation. ITBFS is a prevalent condition and is the most common cause of lateral knee pain in long distance runners and cyclists. There are a significant number of aetiological factors related to ITBFS. As a result of this the general chiropractic approach to the treatment of ITBFS is multimodal and include interventions such as joint manipulation, cryotherapy, orthotics, massage, electrical stimulation, acupuncture type procedures and therapeutic exercise. Dry-needling is an effective therapy in the treatment of active Myofascial Trigger Points (MFTP’s) that are associated with ITBFS. However, the available literature suggests that to determine its efficacy, it should be performed in isolation. The association of sacroiliac joint dysfunction in ITBFS has also been addressed and are thought to co-exist and perpetuate one another. It is recommended that chiropractors include pelvic manipulation in their treatment protocol for ITBFS however there is a paucity of literature showing its effectiveness in the treatment of this condition. There appears to be a need for further research in the form of randomized controlled clinical trials with regard to chiropractic specific procedures, performed in isolation, in the treatment of ITBFS. Therefore this study aimed to add to the literature by assessing the effect of the sacroiliac joint manipulation and dry needling in the treatment of ITBFS. Objectives The study aimed to determine the comparative effectiveness of dry needling alone versus manipulation alone, as well as a combination of the two interventions in the treatment of ITBFS. Methods This study was a randomised, open label trial. 47 participants with ITBFS were divided into three groups, each group receiving a different intervention i.e.: group one received dry needling of the active MFTP’s in the Tensor Fascia Lata (TFL) and ITB, group two received sacroiliac joint manipulation, group three received a combination of the two interventions. Subjective measurements, in the form of the Numerical Pain Rating Scale-101 (NRS-101), and objective measurements, in the form of algometer readings in the TFL, ITB and Nobles Compression test as well as digital inclinometer readings of Modified Obers test, were utilised to determine the effects of the respective interventions. These measurements were recorded twice, once prior to commencing the treatment programme. These values were then evaluated to compare the efficacy of the different treatment interventions. Each participant received four treatments over a two week period. Results There were no statistically significant differences between the three treatment groups as they all seemed to parallel one another with regards to overall improvement in subjective and objective measurements (P<0.5). However on closer examination subtle differences between the groups were noted. An interesting endpoint is that the combination group did not fair the best throughout the study, which was contrary to the original hypothesis. The groups receiving only the single intervention appeared to fair marginally better over the combination group. A secondary endpoint that became evident during the study and on analysis of the data, was that hip joint instability must also be considered when treating ITBFS when there is concomitant sacroiliac joint dysfunction. Conclusion A decision needs to be made with regard to which intervention best suits the individual at the time. A combination therapy, which originally was thought to be the best treatment option, should possibly be reconsidered. Perhaps a single intervention of manipulation or dry needling should be decided upon. In totality, all intervention proved to be effective in the treatment of ITBFS.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology, Durban University of Technology, 2010. / Episodic Tension–type headache (ETTH), which has a high prevalence, is the most common headache. Manual therapeutic approaches towards Episodic Tension-Type Headaches (ETTHs) have not been fully explored. However, cervical spine manipulation (CSM) and dry needling are found to be successful modalities for the treatment of tension-type headache (TTH). Therefore, this study aims to determine the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in the treatment of ETTHs. Objectives The objectives of this study include: determining the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in terms of objective and subjective data for the treatment of ETTHs. Method Forty five participants suffering from ETTHs, between the ages of eighteen and fifty, were recruited through convenience sampling and were randomly allocated to one of three equal groups (15 per group). The three different groups were: (A); CSM alone, (B); dry needling alone and (C); CSM in addition to dry needling. The study took place over a period of four weeks involving six consultations. Each participant received a headache diary for the duration of the study. At the first consultation the participant received the headache diary and was monitored for one week before the treatments commenced. Thereafter, four treatments were administered over the next two weeks, depending on group allocation. Participants were also monitored with the headache diary for one week after the last treatment. The objective data for each participant consisted of cervical range of motion (CROM) and pressure–pain threshold readings, measured using a CROM goniometer and an algometer respectively. The subjective data for each participant was collected using a headache diary and a headache questionnaire/disability index. SAS version 9.1.3 was used to analyse the data. A p value of <0.05 was considered as statistically significant. Results A decrease in headache duration, frequency, intensity and severity and increases in CROM and algometer measurements were observed in all groups. However, no statistically significant differences were found between the three groups in terms of objective and subjective measurements although, a statistically significant improvement from consultation five to six was found in Group C in terms of headache disability. Conclusion CSM and dry needling, used in isolation or in combination are effective in the treatment of ETTHs although Group C did show superiority over the other groups in the long term with respect to the disability index.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / The lifetime incidence of low back pain is between 48% to 79% in South Africa. Globally, chronic Sacroiliac Joint Syndrome occurs in 13% to 63% of the world’s population. Therefore, chronic Sacroiliac Joint Syndrome is a significant health problem that has the potential to have a major impact on quality of life. Chronic Sacroiliac Joint Syndrome is described as an alteration in normal motion or mechanics. The Sacroiliac Joint fibrous capsule contributes to proprioceptive and nociceptive output, which may be exacerbated when the joint is in a dysfunctional state. Chronic Sacroiliac Joint Syndrome may be effectively treated by spinal manipulative therapy. Spinal manipulative therapy is professed to have four therapeutic effects – mechanical correction, pain reducing effects, circulatory increase and neurobiologic effects. Similarly, Kinesio Tex® Tape therapy is professed to have comparable therapeutic effects – circulatory increase, pain reduction and stimulation of proprioceptive systems. Spinal manipulative therapy and Kinesio Tex® Tape therapy may, therefore, have similar therapeutic effects which, if used in adjunction, may produce enhanced therapeutic effects and accelerated results regarding reduction of symptoms in patients with chronic Sacroiliac Joint Syndrome. This investigation aimed to determine whether Kinesio ® Taping methods would have any relative effect on the Sacroiliac Joint, and whether it would be appropriate to use as an adjunct to spinal manipulative therapy in the treatment of chronic Sacroiliac Joint Syndrome. The study was a prospective stratified clinical trial with three intervention groups, twenty participants in each (n = 60). All participants were 18-50 years of age and suffering from chronic Sacroiliac Joint Syndrome. Subjective measurements included the Numerical Rating Scale and Oswestry Low Back Pain Disability Index. Objective measurements included the Algometer Scores. Numerical Rating Scale and Algometer measurements were taken before and immediately after treatment at the first consultation and at the second consultation. Oswestry Low Back Pain Disability Index measurements were taken at the first and second consultation. Group One underwent spinal manipulative therapy alone, Group Two underwent Kinesio Tex® Tape therapy alone and Group Three underwent both spinal manipulative therapy and Kinesio Tex® Tape therapy in combination. Comparisons were made using the Unpaired and Paired t-tests. The results for the Inter-group analyses suggested that most comparisons were statistically insignificant (p ≥ 0.05) which indicated that all treatment groups appeared to improve to a similar degree. The results for the Intra-group analyses suggested that most comparisons were statistically significant (p < 0.05) which indicated that Kinesio Tex® Tape therapy was effective as an adjunct to spinal manipulative therapy, however not statistically more or less effective that spinal manipulative therapy or Kinesio Tex® Tape therapy alone. In conclusion, it was found that some differences did occur, however these differences were not sufficient enough to conclude that one treatment was more effective than the other. Further research with a larger sample size, more frequent treatments and follow-ups, a more homogenous stratification of age, ethnic group, gender, side of diagnosis and categorizing participant occupation is needed in order for the power of the study to be amplified and, therefore, any results would carry more weight.

Submitted in partial compliance with the requirements for Master’s degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Functional dyspepsia is a chronic pain/discomfort centred in the upper abdomen in the absence of any known structural cause. Epidemiological studies have shown that functional dyspepsia is a common complaint affecting all population groups that over time places considerable financial strain on public and private resources due to frequent doctors’ visits and expensive diagnostic procedures. The development of non-surgical and non-pharmaceutical treatments of functional dyspepsia would not only make economic sense but would also provide a means to improve patients’ quality of life in the least invasive way possible. Although not traditionally seen to be within the chiropractic scope of practice, anecdotal evidence suggests that chiropractic care and management may have the ability to alleviate visceral symptomatology. Objectives The purpose of this placebo controlled pilot study was to evaluate the preliminary effects of chiropractic manipulation versus inactive laser in the treatment of adult patients suffering from functional dyspepsia. Due to the small sample size, time and budgetary constraints it was hypothesised that the dyspepsia symptoms of participants treated with active chiropractic manipulation would not respond more favourably to the treatment, nor would these patients experience a greater improvement in terms of quality of life, compared to those participants receiving placebo treatment. Method Thirty participants with pre-diagnosed functional dyspepsia were selected after being screened according to the inclusion and exclusion criteria identified by the researcher. These participants were then divided into two groups using consecutive sampling. Data was collected at the Chiropractic Day Clinic at the Durban University of Technology. Group A received an active chiropractic manipulation using diversified technique to pre-identified levels in the cervical, thoracic and lumbar spine. Group B received inactive laser to pre-identified levels in the cervical, thoracic and lumbar spine. Both groups received one treatment a week for three weeks. The fourth and final consultation consisted only of data capturing. At each visit both groups of participants filled in three validated questionnaires: The numerical pain rating scale; PAGI-SYM physical symptom assessment; Results Results were statistically analysed using IBM SPSS version 20 and a p value ≤ 0.05 was considered to be statistically significant. Repeated measures ANOVA testing was used to assess the effect of each of the treatments separately and to assess the comparative effects of the spinal manipulation vs the placebo. Conclusion and Recommendations The gathered results and analysis were statistically insignificant. Clinical improvement in their symptomotology was however noted within both groups over the trial period in terms of treatment received and their perceived quality of life, symptomatology and pain levels. Both groups tended to have reduced pain and discomfort over time, improved: emotional distress, sleep disturbance, food problems, vitality, post-prandial fullness and abdominal pain. This study should be repeated with selected outcome measurements, and perhaps objective outcome measurements, and a larger sample size in order to determine any benefit.

Climate change is expected to have a large impact on northern ecosystems. Increased temperatures and altered precipitation and snow cover patterns will have a great impact on subarctic tundra. Bryophytes form an important component of tundra ecosystems because of their high abundance and their importance in many ecological processes. The effect of elevation and snow cover on freezing damage in shoots of three subarctic bryophytes: Ptilidium ciliare, Hylocomium splendens and Sphagnum fuscum, was studied in a snow manipulation field experiment at different elevations in Abisko, Sweden, during early spring. The treatments included snow addition, snow removal and control. In addition, bryophyte healthiness at the plot scale was determined by image analysis using colour selection, and soil temperature and moisture data were collected. Freezing damage differed significantly among bryophyte species with P. ciliare having the lowest freezing damage. There was a decrease in freezing damage over time due to the increase in temperature as spring progressed. Counter expectation, freezing damage was higher at low elevation although the mean daily minimum temperature was lower at higher elevation, which might be due to adaptation effects. Snow treatment had only a minor effect on freezing damage, but it did have an effect on proportion of undamaged tissue at the plot scale which increased with increasing snow cover at high elevation, but decreased with increasing snow cover at low elevation. Soil moisture content was also affected by snow treatment. The number of freeze-thaw cycles was less for S. fuscum and H. splendens compared to bare soil plots, which indicates insulating capacities of these bryophytes. Freezing damage could not be explained by the measured climate variables alone; therefore, it is likely the result of a complex set of factors, possibly including solar radiation and disturbance by herbivores.