Partial Dissertation in compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / 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. / M

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. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / There are many non-surgical treatments that are available to patients with low back pain but few have been proven effective in controlled clinical trials. Arguably, the treatments with the greatest evidence for efficacy are nonsteroidal anti-inflammatory drugs (NSAIDs), some muscle relaxants and spinal manipulation (Deyo et al.(1983) and Shekelle et al.(1992). Non-steroidal antiinflammatory drugs are the most widely used agents for musculoskeletal pain and inflammation. The widespread use of NSAIDs augments the impact not only of their benefits but also the risk of their adverse effects. The effectiveness of chiropractic management is now firmly established for most patients with acute and chronic low-back pain (Koes et aI.1996). The purpose of this study was to determine the relative efficacy of combined diclofenac sodium therapy and spinal manipulation compared to combined placebo therapy and spinal manipulation in the treatment of mechanical low back pain. Sixty subjects were selected and randomly divided into two groups of thirty subjects. Subjects were treated four times over a two-week period, including a diclofenac or placebo medication course, taken three times daily for five days, starting from the first consultation. The results of the Numerical Pain Rating Scale-101, Revised Oswestry Low Back Pain Disability Questionnaire, Orthopaedic Rating Scale and Algometer readings were taken before the first, third and fourth consultations. The statistical tests used were the parametric two-sample unpaired t-tests and the paired t-tests, and the nonparametric intra-group Friedman test, multiple comparison procedure, Wilcoxon Signed Ranks test and the inter-group Mann Whitney U-test at the 95% level of significance using the SPSS statistical package. There was a statistically significant improvement in both treatment groups for both subjective and objective clinical findings, suggesting that spinal manipulation combined with either an NSAID or placebo medication will ultimately give relief to a patient suffering from lower back pain. The conclusions / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Technikon Natal, 2002. / Carpal Tunnel Syndrome is defined as a median nerve entrapment beneath the flexor retinaculum in the carpal canal such that it produces symptoms in the hand, wrist and upper extremity. A review of related literature suggests that statistics on the incidence of Carpal Tunnel Syndrome in South Africa are unavailable. In the U. s. A, Carpal Tunnel Syndrome occurs in 1% of the population and is the most frequently diagnosed peripheral neuropathy. Several studies investigating the use of conservative care in managing Carpal Tunnel Syndrome have been performed, but none have compared the effect of wrist joint manipulation and ultrasound in the management of Carpal Tunnel Syndrome, The purpose of this study was to investigate the effectiveness of wrist joint manipulation compared to ultrasound in the management of Carpal Tunnel Syndrome. This randomized controlled clinical trial consisted of a study population offorty patients. The patients were randomly allocated to two groups of twenty each. One group received wrist joint manipulation while the other received ultrasound application to the palmar-radial aspect of the wrist. Both groups received four treatments over a two week period. Subjective measures included the Numerical Rating Scale-I 0 1 Questionnaire and the Carpal Tunnel Pain and Disability Form and objective measures consisted of the grip strength reading and goniometer readings for wrist flexion and extension. Both the subjective and objective measures were taken before the first and third visit and at the fifth follow- up consultation which took place during the following week. Inter-group analysis was done using the Mann- Whitney U test. Friedman's T test was used for intra-group analysis. ct was set at the 0.05 level of significance. The results were illustrated by means of tables and bar- charts. The results indicated that for intragroup analysis, a statistically significant difference existed for both groups, warranting the use of a multiple comparison procedure (Dunn' s procedure) to determine at which stage the treatment made a significant difference. For all the measures except the wrist extension reading in the ultrasound group, most improvement occurred between the first and fifth consultations. For inter-group analysis, no significant difference for any of the measures, except the wrist extension readings, was present between the two groups indicating that both wrist joint manipulation and ultrasound were equally effective in treating Carpal Tunnel Syndrome. The improvement in wrist extension, in the wrist joint manipulation group was significantly better than that in the ultrasound group. Although this study was limited by its single researcher design and could not clarify which treatment protocol was more effective, it supports the existing body of evidence in favour of both wrist joint manipulation and therapeutic ultrasound application in the management of Carpal Tunnel Syndrome / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 2001. / For neck pain, the first-line treatment of allopathic physicians is usually the prescription on non-steroidal ant-inflammatory drugs (NSAIDs), whereas the firstline treatment of chiropractic physicians is usually cervical manipulation. The literature shows that both chiropractic manipulation alone and NSAIDs alone are effective for the treatment of cervical facet syndrome, with chiropractic manipulation being much safer than the use of NSAIDs. Furthermore, patients that receive chiropractic care have been shown to generally be much more satisfied than those that receive conventional medical care. The aim of this study was to determine the short-term effectiveness of cervical spine manipulation as compared to Piroxicam administration in the treatment of chronic cervical facet syndrome. The study design that was chosen was that of a comparative clinical trial. Forty consecutive patients diagnosed with chronic facet syndrome of the cervical spine were randomly assigned to either the manipulation group or the NSAID group (twenty patients in each group). Each patient in group A received manipulative therapy of the cervical spine on three consecutive days. Each patient in group B received 40 mg of Adco Piroxicam on the first two days of treatment, and 20 mg daily for the remainder of the seven day treatment period. The patients were assessed by means of objective and subjective data obtained before each consultation on days 1, 3 and 7. The objective data was gathered from algometric pressure-pain threshold readings over the involved facet joint. The subjective information was obtained from the Short-Form McGill Pain Questionnaire, the Numerical Pain Rating Scale - 101 and the CMCC Neck Disability Index, as well as the patients perceived improvement which was recorded as a percentage on days 3 and 7. / 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 The electromyographic response post-spinal manipulation may support the elucidation of the underlying neurophysiological mechanism of spinal manipulation on motor activity as well as on arthrogenic muscle inhibition. The literature shows conflicting evidence regarding the excitatory or inhibitory nature of the reflexive electromyographic response and the excitability of the homonymous motor neuron pool post-spinal manipulation. The current study investigated whether the electromyographic response post-spinal manipulation is affected by a facilitated golgi tendon organ Ib inhibitory di-synaptic spinal reflex as part of the convergent input on the homonymous motor neuron pool excitability. Objectives The objectives of this placebo-controlled, single-blinded, repeated measures design were: 1) to determine electrical activity and muscle force of the biceps brachii muscle immediately before and after an Activator Adjusting II Instrument placebo spinal manipulation, 2) to determine electrical activity and muscle force of the biceps brachii muscle immediately before and after a C5/C6 spinal manipulation, 3) to compare the electrical activity and muscle force of the biceps brachii muscle between the control and intervention groups pre- and post-test. Method Each participant performed three sets of modified stretching of the biceps brachii muscle with two minute rest intervals between each set in a single appointment, of which at a standardized fourth second during each set an intervention was applied to the ipsilateral C5/C6 segment. The first intervention (AAI 1) entailed the application of an Activator II Adjustment Instrument placebo spinal manipulation; the second intervention (AAI 2) entailed the application of an Activator II Adjustment Instrument placebo spinal manipulation; and the third intervention (SMT) entailed the application of spinal manipulation. One-second electromyography (EMG) segments were taken during the force plateau of each set; the EMG signal was processed through Root Mean Square (RMS) analysis and the muscle force data were obtained by using the Biopac - MP 150 Data Acquisition system and AcqKnowledge analysis software. Results The objective data analysis revealed a noteworthy scientific finding of a medical anomalous inverse relationship between the muscle force and EMG RMS immediately post-spinal manipulation. The immediate post-SMT intervention revealed an increase in the biceps brachii muscle force by 4.76 % and a decrease in the biceps EMG RMS by 9.03 % with a summation of percentage difference between the muscle force and EMG RMS of 13.79 %. The immediate post-placebo AAI 1 intervention showed a decrease in the biceps EMG RMS by 1.86 % and a decrease in the biceps brachii muscle force by 0.85 % with a summation of percentage difference between the muscle force and EMG RMS of 1.01 %. The immediate post-placebo AAI 2 intervention showed a decrease in the biceps EMG RMS by 0.05 % and a decrease in the biceps brachii muscle force by 1.97 % with a summation of percentage difference between the muscle force and EMG RMS of 1.92 %. Conclusion Further research is warranted to add statistical significance to the inverse relationship between muscle force and EMG RMS observed immediately post-spinal manipulation. This knowledge obtained, may have clinical relevance for rehabilitation practitioners and physical therapists by providing evidence based support for the suggestion that optimal management of patients with muscle weakness suspected to be of arthrogenic nature could include the application of spinal manipulation to the segmentally innervated facet joints before traditional strength training is initiated. / M

Submitted in partial compliance with the requirements for the Masters’ Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Kayaking performance can be improved either through reducing drag of the boat or increasing propulsion (Michael et al., 2009). In order to increase propulsion, biomechanical efficiency is required. The trunk muscles have been highlighted as having an important role in the paddler’s stroke. Due to their relationship with the thoracic spine, dysfunction of the movement of the thoracic vertebrae could negatively impact the ability of the trunk muscles to work effectively. Spinal manipulation is used to restore joint range of motion and this has been shown to have a positive effect on the surrounding muscles. Limited studies have investigated the effect of spinal manipulation on performance outcomes, specifically in paddlers. Objective: To determine the effect of lower thoracic spine manipulation, of T7 - T12 vertebrae, compared to sham laser, on the mean power (watts) of a paddler’s stroke, the time taken (seconds) to paddle a 200m distance and stroke rate (strokes/min). Method: This study was designed as a pre-test, post-test experiment, involving 30 asymptomatic, male paddlers from Durban. Participants were divided into an intervention group, receiving spinal manipulation to the lower thoracic spine between T7 - T12 or a control group receiving sham laser. Participants performed a 200m sprint on a kayak ergometer followed by a timed five minute break, during which, the interventions were administered. This was followed by a second 200m sprint on the kayak ergometer post-intervention. Outcome measures were average power (watts), time taken to paddle a 200m sprint on a kayak ergometer (seconds) and stroke rate (strokes per minute). Conclusion: Lower thoracic spine manipulation did not result in a significant change in average power, time taken to paddle 200m on a kayak ergometer or stroke rate. Future studies are necessary to investigate the trends observed. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / Whiplash injuries are thought to occur in as many as one-fifth of all MVA’s in the United States and Canada. South Africa may have a higher incidence of whiplash injuries due to the exceptionally high road accident rate when compared with international norms (Burger 1996:478). The incidence rate is higher among female subjects and people aged 20-24 years (Teasell and Shapiro 1998: 72, Spitzer et al. 1995). Whiplash injuries or whiplash-associated disorders (WAD) often result in chronic pain with a poor response to conventional therapeutics. Manipulation, exercise and anti-inflammatories have been identified as the options with scientifically established validity in the management of WAD (Spitzer et al. 1995) Patients with WAD have a distortion of the posture control system as a result of disorganised neck proprioceptive activity. It would therefore appear that proprioceptive rehabilitative exercises would benefit WAD sufferers (Revel et al. 1994, Gimse et al. 1996). Spinal manipulation has also been shown to have a significant effect on proprioceptive-dependent abilities in subjects with chronic neck pain (Rogers 1997). This suggests that a combination of manipulation and proprioceptive rehabilitation may offer an improved treatment protocol for WAD (Fitz-Ritson 1995). The purpose of this investigation is to evaluate the relative effectiveness of proprioceptive exercises and cervical spine manipulation compared to manipulation alone, in terms of subjective and objective measures, in the treatment of whiplash-associated disorders. / M

Inventées au milieu des années 1980, nous assistons actuellement au développement à grande échelle des interfaces tactiles multipoints. Par comparaison avec la souris, les écrans multipoints nécessitent un nouveau processus d'étude afin de comprendre les changements apportés par cette technologie. Le travail déjà effectué avec d'autres périphériques d'entrée doit être repris à zéro afin de formuler de nouvelles théories pour la création d'interfaces tactiles multipoints. La manipulation à trois dimensions (3-D) d'un objet nécessite le contrôle de six degrés de liberté. Trois sont responsables de la position de l'objet et trois contrôlent son orientation. Dans ce mémoire, nous nous focalisons sur la manipulation 3-D d'un objet à l'aide de surfaces tactiles multipoints. Plus précisément, nous avons étudié le lien entre le périphérique d'entrée (ici la surface multipoint) et la tâche à effectuer (ici la manipulation 3-D). En premier lieu, nous avons introduit une taxonomie pour la représentation des techniques d'interaction 3-D spécifiques aux écrans multipoints. Cette taxonomie nous a permis de mettre en avant l'influence des stratégies de conception des techniques en termes d'intégration de degrés de liberté. Par la suite, nous avons mené une étude concernant les techniques d'interactions permettant le positionnement 3-D d'un objet. Nous avons présenté deux nouvelles techniques, tirant profit des capacités offertes par les écrans multipoints. L'évaluation de ces techniques nous révéla des conclusions quant à la coordination de l'utilisateur dans la réalisation de la tâche. Enfin, nous avons introduit une nouvelle technique d'interaction de manipulation 3-D. Cette technique a été évaluée plus rapide que les techniques existantes et nous avons pu déterminer les raisons expliquant cette performance accrue. Ces travaux, qui s'intéressent à la coordination de l'utilisateur lors de la réalisation de tâches 3-D à l'aide de surfaces multipoints, recommandent une approche favorisant la séparation des degrés de liberté, dans le but de pouvoir paralléliser les actions de l'utilisateur afin de tirer profit de la bande passante d'entrée plus importante offerte par les écrans multipoints. / Invented in the mid-1980s, we are currently witnessing large-scale development of multitouch interfaces. Compared with the traditional mouse, multitouch displays require rethinking from scratch interaction techniques in order to understand the changes brought by this technology and formulate new theories. Manipulating three-dimensional (3-D) objects require the control of six degrees of freedom. Three are responsible for the object's position and three control the orientation. In this work, we focused on 3-D manipulation of an object using multitouch displays. Specifically, we studied the relationship between the input device (the multitouch display) and the task (3-D manipulation). First, we introduced a taxonomy for the representation of 3-D interaction techniques specific to multitouch displays. This taxonomy allowed us to highlight the influence of design strategies in terms of integration of degrees of freedom.Subsequently, we conducted a study of interaction techniques for 3-D positioning of an object. We presented two new techniques, which take advantage of capabilities offered by multitouch displays. The evaluation of these techniques revealed us results regarding the user coordination in realizing the task. Finally, we introduced a new interaction technique to handle 3-D manipulation. This technique was evaluated faster than existing techniques and we were able to determine the reasons for the improved performance.This work, which focus on the user coordination when using multitouch displays to perform 3-D tasks, recommend an approach that favors the separation of degrees of freedom, in order to parallelize the user actions so as to take advantage of the extra input bandwidth offered by this type of input devices.

M.Tech. (Chiropractic) / Background: In sporting activity, especially rugby, soccer, cricket and hockey, re-occurring hamstring injuries are a common sight that suggests that there is an opening for an improvement in the treatment and management of these injuries. This can be debilitating to any sportsman as it results in recurrent time away from his/her sporting activity. A study by Fyfer, Yelverton and Sher (2005), found that sacroiliac manipulation alone had a positive effect in the treatment of recurrent hamstring injuries. Cibuklka, Rose, Delitto and Sinacore (1986), proposed a possible link between hamstring muscle injuries and sacroiliac joint dysfunction. A study conducted by Donahue, Docherty and Schrader (2010), on the effects of Graston technique on pressure pain threshold, revealed a significant improvement in the patient’s pain threshold due to the fact that the instrument assisted technique effectively broke down scar tissue and correct fascial restrictions. The FAKTR approach to soft tissue dysfunction combines instrument-assisted soft tissue mobilization (Graston Technique) with proprioceptive (functional) techniques to reduce pain and return to function (Hyde and Doerr, 2012). Objective: This blinded, randomised pilot study was done to investigate the effects of sacroiliac joint manipulative therapy versus functional and kinetic treatment with rehabilitation on hamstring flexibility in previously injured hamstring muscle. Design: The study consisted of 30 participants recruited from the University of Johannesburg by word of mouth and posters, which met the inclusion criteria. They were equally and randomly divided into 2 groups. Group 1 received chiropractic therapy of the sacroiliac joint. Group 2 received functional and kinetic treatment with rehabilitation. Objective measurements consisted of digital inclinometer which measured the flexibility and range of motion of the hamstring muscle. The pressure algometry was used to measure pain pressure threshold. Procedure: Both group participants hamstring flexibility and ranges of motion were tested. Group 1 participants were motion palpated to determine sacroiliac joint dysfunction and treated with a high velocity, low amplitude trust to restricted segment, group 2 received functional and kinetic treatment with rehabilitation. Results: The statistical results should be viewed with regards that this study only represent a small group of thirty participants and therefore no assumption can be made with respect to whole population. The p-value was set at 0.05 and represents the level of significance of the results. If the p-value was less or equal to 0.05 (p≤0.05) there was a statistical significance finding. If the p-value is greater than 0.05 (p>0.05) vi there was no statistical finding. Statistical significance only means that a given result is unlikely to have occurred by chance. Analysis included demographic data analysis of age and gender. Objective data were collected using Digital Inclinometer and Pressure Algometry. Intra-group and inter-group analysis was done on straight leg raise, passive knee extension, hip extension, lateral rotation of the hip and medial rotation of the hip. The Shapiro-Wilk test was performed to determine normality. As normality could not be assumed, non-parametric testing were used to do intra-group analysis. The Non-parametric Friedman test was used to determine if a change occurred over time. As change did occur over time the Wilcoxon Signed Rank Test was use to determined where the change within each group occurred. The Mann-Whitney U test was also used to determine if any difference between the groups were present at any given time. At the end of the study both test groups showed significant clinical as well as statistical improvement over the three week course of the study. Conclusion: The FAKTR treatment did clinically have the greatest improvement, however the changes seen was not statistically superior to those seen with the sacroiliac joint manipulation treatment. A statistical significant improvement was seen in both treatment protocols, concluding that both the spinal manipulative therapy and the functional and kinetic treatment with rehabilitation could be proficient protocols in treating hamstring flexibility.