M.Tech. / Purpose: Posterior mechanical neck pain is considered a debilitating musculoskeletal problem and is one of the most common reasons for visiting an emergency department (Murphy, 2000). Anti-inflammatory creams and gels are readily available to individuals suffering from musculoskeletal pain. The purpose of this study was to determine the effectiveness of Traumeel®S ointment together with chiropractic spinal manipulative therapy as a treatment form for posterior mechanical neck pain, with regards to pain, disability and cervical spine range of motion. Method: This study was a comparative study and consisted of two groups of fifteen. The participants were between the ages of eighteen and forty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. Group A received chiropractic spinal manipulative therapy followed by the application of aqueous cream over the upper trapezius muscle area of the posterior neck. This was the placebo group. Group B received chiropractic spinal manipulative therapy followed by the application of Traumeel®S ointment over the upper trapezius muscle area of the posterior neck. This was the experimental group. Objective and subjective findings were based on the above treatment protocols. Procedure: Treatment consisted of seven consultations over a three week period. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index as well as from the Visual Analogue Scale (VAS). Objective readings were taken from measurements taken from the Cervical Range of Motion device (CROM). At the first to the sixth consultations participants received spinal manipulative therapy with either the application of aqueous cream or the application of Traumeel®S ointment depending on whether they were in group A or group B. Results: Clinically and statistically significant improvements in both group A and group B were seen over the course of the study with regards to cervical spine range of motion, pain and disability. Conclusion: The results show that both treatment protocols were effective in decreasing cervical spine pain and disability and increasing cervical spine ROM. Group B receiving Traumeel®S ointment did show a greater increase in cervical spine ROM clinically, but statistically there was no significant difference between the two groups.

Background: In recent years, students' screen time has increased, especially during the corona pandemic. As increased prevalence of neck pain and decreased physical activity (PA) have been reported during this period, it is of interest to study the relationship between these variables. Aim: To examine screen time, neck pain and the level of PA and the relationship between these variables in students studying full-time at Uppsala University. Method: A quantitative, descriptive and correlational cross-sectional study. PA was measured with the International Physical Activity Questionnaire, neck pain in days, and intensity with the Numeric Pain Rating Scale (NRS), and screen time in hours, for the past week. The data was collected using a web survey.   Results: Ninety-eight students answered the survey. Fifty-four percent of participants reported neck pain the past week. On average, students spent 18.5 hours on screen studies, and 41.3 hours on total screen time. The PA level averaged 2438 Metabolic Equivalent of Task in minutes. Median neck pain was one day with NRS 1. A low significant correlation was seen between: screen studies and number of days neck pain (r = 0.23; p = 0.028); total screen time and neck pain (r =0.26; p = 0.012); studies at screen and neck pain intensity (r = 0.23; p = 0.024); total screen time and neck pain intensity (r =0.26; p = 0.011). A low, non-significant correlation was seen between screen studies and total screen time and PA (r = 0.04/0.02; p = 0.713/0.881). Conclusion: Students spend a lot of time in front of screens and a majority of students reported low-intensity neck pain the past week. However, there was only a low correlation between screen time and neck pain, and between screen time and FA. / Bakgrund: Under de senaste åren har studenters skärmtid ökat, inte minst under corona-pandemin. Då ökad prevalensen av nacksmärta och minskad fysisk aktivitet (FA) har rapporterats under denna period, är det av intresse att studera sambandet mellan dessa variabler.  Syfte: Undersöka skärmtid, nacksmärta och nivån av FA och samband mellan dessa variabler hos studenter som studerar heltid på Uppsala universitet.  Metod: En kvantitativ, deskriptiv och korrelerande tvärsnittsstudie. FA mättes med International Physical Activity Questionnaire, nacksmärta i dagar, och intensitet med Numeric Pain Rating Scale (NRS), och skärmtid i timmar, för senaste veckan. Datan insamlades med en webenkät. Resultat: Nittioåtta studenter besvarade enkäten. Femtiofyra procent av deltagarna rapporterade nacksmärta senaste veckan. I genomsnitt spenderade studenterna 18,5 timmar på studier vid skärm, och 41,3 timmar på total skärmtid. Nivån FA var i genomsnitt 2438 Metabolic Equivalent of Task i minuter. Medianen för nacksmärta var en dag med NRS 1. Ett lågt signifikant samband sågs mellan: studier vid skärm och nacksmärta i antal dagar (r = 0,23; p = 0,028); total skärmtid och nacksmärta (r =0,26; p = 0,012); studier vid skärm och nacksmärtans intensitet (r = 0,23; p = 0,024); total skärmtid och nacksmärtans intensitet (r =0,26; p = 0,011). Ett lågt icke signifikant samband sågs mellan studier vid skärm respektive total skärmtid och FA (r = 0,04/0,02; p = 0,713/0,881).  Konklusion: Studenter spenderar mycket tid framför skärm och en majoritet av studenter rapporterade lågintensiv nacksmärta under senaste veckan. Dock förelåg enbart ett lågt samband mellan skärmtid och nacksmärta, samt mellan skärmtid och FA.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / BACKGROUND Mechanical neck pain (MNP) has been described as any condition which changes joint mechanics and muscle structure / function. A review of the current literature shows that Muscle Energy Technique (MET) is an effective manual therapy for patients with acute or chronic MNP. The most useful contraction of MET however remains unknown. Some authors advocate the use of a two to seven second MET (Brous, 2005; Greenman, 2003 Mitchell, Moran, and Pruzzo, 1979) whilst other authors have recommended contraction durations of 30 to 60 seconds (Chaitow, 2006; Feland et al., 2001; Bandy and Irion, 1994). This study aimed to establish the most suitable contraction duration of MET in the treatment of chronic MNP by comparing a short duration MET to a long duration MET. OBJECTIVES Objectives included the comparison of a five-second (short duration) MET and a 45-second (long duration) MET in terms of subjective and objective findings in the treatment of chronic MNP. METHOD This randomized clinical trial, with 53 participants utilised a randomization table for group allocation. For the purpose of this study an average of the short contraction durations reported in the literature i.e. five seconds, was used for the short duration MET treatment and an average of the long contraction durations reported in the literature i.e. 45 seconds, was used for the long duration MET. Group A (n=26) received the five-second MET contraction and Group B (n=27) received the 45-second MET contraction treatment. Objective measures included the cervical range of motion (CROM Goniometer) and tenderness levels (algometer). The subjective measures were pain (Numerical Rating Scale-101) and MNP related disability (CMCC Neck Disability Index). Each participant received four treatments over a two week period, with all data collected prior to the first and third consultations and at the final follow up. Data were analysed using the SPSS version 20 (IBM), with a statistically significant p value set at <0.05. Repeated measures ANOVA testing determined the intergroup effects. To assess intergroup effects and effects of the intervention a time x treatment group interaction analysis was conducted. Profile plots assessed direction and trend of the effect of the treatment. RESULTS Intra-group analysis of both groups showed significant improvement in all of the range of motion measures (over time) except for Flexion, Right Lateral Flexion and Left Rotation in Group A and Flexion, Extension, Right Lateral Flexion and Left Lateral Flexion in Group B. The intra-group analysis also showed a significant improvement in the neck disability index scores and the tenderness measurements in both groups. The results of the inter-group analysis revealed that only Left Lateral Flexion showed a significant treatment effect (p=0.011) where increased scores were shown in Group A and not in Group B. There was no treatment effect for the neck disability index scores or the tenderness measurements. CONCLUSION It may be concluded that both treatment protocols were equally effective for all outcomes except for Left Lateral Flexion where the five-second MET seemed to show greater degree of improvement than the 45-second MET. The neck disability index scores and the pain levels of participants in both groups showed an improvement. No treatment was better than the other in terms of these two variables. This therefore seems to support the use of the shorter duration MET in clinical practice.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / It has been noted that in many recent research studies mechanical neck pain is a serious problem in the world today. There are epidemiological and statistical studies documenting the high incidence and prevalence of mechanical neck pain, which effects people’s daily living (Drew, 1995; Ferrari and Russell, 2003; Cote et al., 2000, Venketsamy, 2007 and Haldeman et al., 2008). Background: Treatments for chronic neck pain, which are non-surgical, appear to be the most beneficial for patients (Haldeman, 2008). In brief, the presentation of chronic mechanical neck pain is defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). The muscular dysfunction known as the upper cross syndrome is defined as tightness of the upper trapezius, pectoralis major and levator scapulae and weakness of rhomboids, serratus anterior, middle and lower trapezius and deep neck flexors. These muscles are responsible for stabilizing the scapula and the patient may present with rounded, elevated shoulders and anterior head carriage when diagnosed with this syndrome (Liebenson, 1996). Clinical trials conducted by Cassidy et al., (1992 a, b) concluded that spinal manipulative therapy (SMT) was highly effective in treating mechanical dysfunctions within the cervical spine. However, due to multi systemic involvement of the muscular, neural and passive systems in mechanical neck pain, the treatment may need to target all three of the subsystems of spinal stability to be most effective (Panjabi, 1992 a, b; Lee et al., 1998; Lee 2004 and Richardson et al., 2002). No research has been conducted on the effects and benefits of treatment directed on the cervical spine and upper cross syndromes. This research will compare scapula stabilization training and SMT to SMT in isolation, as a treatment for chronic mechanical neck pain. Objectives: The purpose of this study was to determine the effect that scapula stabilization had on chronic mechanical neck pain. Pilates exercises were used to strengthen and stabilize the scapula muscles (this included stretching out the hypertonic musculature of the upper cross syndrome). The aim was to improve posture as well as to decrease the mechanical stress on the neck. SMT was also concomitantly used to correct any cervical restrictions that were present. These results were then compared to the results of a group that only received spinal manipulative therapy. The null hypothesis was that the intervention group would not respond differently to the treatment protocol in terms of the subjective and objectives measurements. iv Method: This clinical trial was conducted on a sample population of 30 patients with chronic mechanical neck pain. Each patient was assigned to one of two groups (n=15) according to convenience sampling. Both groups received SMT to the cervical spine, while group B (intervention group) also received pilates classes twice weekly for four weeks, which retrained the scapula stabilization muscles to function optimally. The patients each underwent six spinal manipulative treatments over four weeks and a seventh consultation in the fifth week for data collection. Both groups were evaluated in terms of subjective and objective clinical findings. Subjectively the assessment included 2 questionnaires (Numerical Pain Rating Scale and Canadian Memorial Chiropractic College [CMCC] neck disability index). Objective assessment included cervical motion palpation, Cervical Range Of Motion goniometer (CROM) measurements, scapula stabilization tests and a postural analysis with the use of digital photography. The statistics were completed under the guidance of a biostatistician, from the College of Health Science, University of KwaZulu – Natal, (Esterhuizen, 2008) who analyzed the captured data with the use of SPSS version 15. All outcome measures were quantitative. Repeated measures ANOVA testing was used to assess the presence of a different effect for each outcome measure over time between the two treatment groups. A statistically significant time by group effect would indicate a significant treatment effect. The minimum significance level was 0.05. The trends and direction of the effect were assessed via profile plots. Result: According to the statistical analysis, both groups showed improvements - subjectively and objectively - with regards to chronic mechanical neck pain, which is in keeping with the literature. In terms of the inter-group comparison the SMT group (Group A) showed a more constant improvement in range of motion, pain and disability indexes with the SMT only group while the SMT and pilates group (Group B) showed a greater effect in stabilizing the scapula and increasing the functionality of the surrounding musculature. Conclusions and Recommendations: The intervention treatment (Group B) did not have a greater effect on the short-term treatment of chronic mechanical neck pain than the reference group (Group A). It was also evident that the intervention group (Group B) often continued to improve when the SMT (Group A) only group often regressed at the follow up sessions. This improvement was either not significant enough or v the follow up session did not allow for enough time for a true reflection to be noted. It is recommended that more research be carried out to gain conclusive results indicating whether there is a more beneficial long term result to this treatment protocol.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / It has been noted that in many recent research studies mechanical neck pain is a serious problem in the world today. There are epidemiological and statistical studies documenting the high incidence and prevalence of mechanical neck pain, which effects people’s daily living (Drew, 1995; Ferrari and Russell, 2003; Cote et al., 2000, Venketsamy, 2007 and Haldeman et al., 2008). Background: Treatments for chronic neck pain, which are non-surgical, appear to be the most beneficial for patients (Haldeman, 2008). In brief, the presentation of chronic mechanical neck pain is defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). The muscular dysfunction known as the upper cross syndrome is defined as tightness of the upper trapezius, pectoralis major and levator scapulae and weakness of rhomboids, serratus anterior, middle and lower trapezius and deep neck flexors. These muscles are responsible for stabilizing the scapula and the patient may present with rounded, elevated shoulders and anterior head carriage when diagnosed with this syndrome (Liebenson, 1996). Clinical trials conducted by Cassidy et al., (1992 a, b) concluded that spinal manipulative therapy (SMT) was highly effective in treating mechanical dysfunctions within the cervical spine. However, due to multi systemic involvement of the muscular, neural and passive systems in mechanical neck pain, the treatment may need to target all three of the subsystems of spinal stability to be most effective (Panjabi, 1992 a, b; Lee et al., 1998; Lee 2004 and Richardson et al., 2002). No research has been conducted on the effects and benefits of treatment directed on the cervical spine and upper cross syndromes. This research will compare scapula stabilization training and SMT to SMT in isolation, as a treatment for chronic mechanical neck pain. Objectives: The purpose of this study was to determine the effect that scapula stabilization had on chronic mechanical neck pain. Pilates exercises were used to strengthen and stabilize the scapula muscles (this included stretching out the hypertonic musculature of the upper cross syndrome). The aim was to improve posture as well as to decrease the mechanical stress on the neck. SMT was also concomitantly used to correct any cervical restrictions that were present. These results were then compared to the results of a group that only received spinal manipulative therapy. The null hypothesis was that the intervention group would not respond differently to the treatment protocol in terms of the subjective and objectives measurements. iv Method: This clinical trial was conducted on a sample population of 30 patients with chronic mechanical neck pain. Each patient was assigned to one of two groups (n=15) according to convenience sampling. Both groups received SMT to the cervical spine, while group B (intervention group) also received pilates classes twice weekly for four weeks, which retrained the scapula stabilization muscles to function optimally. The patients each underwent six spinal manipulative treatments over four weeks and a seventh consultation in the fifth week for data collection. Both groups were evaluated in terms of subjective and objective clinical findings. Subjectively the assessment included 2 questionnaires (Numerical Pain Rating Scale and Canadian Memorial Chiropractic College [CMCC] neck disability index). Objective assessment included cervical motion palpation, Cervical Range Of Motion goniometer (CROM) measurements, scapula stabilization tests and a postural analysis with the use of digital photography. The statistics were completed under the guidance of a biostatistician, from the College of Health Science, University of KwaZulu – Natal, (Esterhuizen, 2008) who analyzed the captured data with the use of SPSS version 15. All outcome measures were quantitative. Repeated measures ANOVA testing was used to assess the presence of a different effect for each outcome measure over time between the two treatment groups. A statistically significant time by group effect would indicate a significant treatment effect. The minimum significance level was 0.05. The trends and direction of the effect were assessed via profile plots. Result: According to the statistical analysis, both groups showed improvements - subjectively and objectively - with regards to chronic mechanical neck pain, which is in keeping with the literature. In terms of the inter-group comparison the SMT group (Group A) showed a more constant improvement in range of motion, pain and disability indexes with the SMT only group while the SMT and pilates group (Group B) showed a greater effect in stabilizing the scapula and increasing the functionality of the surrounding musculature. Conclusions and Recommendations: The intervention treatment (Group B) did not have a greater effect on the short-term treatment of chronic mechanical neck pain than the reference group (Group A). It was also evident that the intervention group (Group B) often continued to improve when the SMT (Group A) only group often regressed at the follow up sessions. This improvement was either not significant enough or v the follow up session did not allow for enough time for a true reflection to be noted. It is recommended that more research be carried out to gain conclusive results indicating whether there is a more beneficial long term result to this treatment protocol.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / INTRODUCTION: Neck pain is considered to be one of the most disabling conditions, with a universal prevalence among youth, adult and elderly populations. However, despite its disabling nature and its high prevalence there is still much uncertainty surrounding the aetiology of the pain and the extent to which the condition is influenced by the intrinsic and extrinsic characteristics of an individual. While there is growing evidence to support the notion that marked bio-psychosocial associations exist with neck pain, this literature is heavily weighted toward an adult and a developed nation context leaving developing nations and the student population largely under-researched in comparison. Moreover, while a high prevalence of neck pain and its associated risk factors exist in the student population among health sciences and non-health sciences programmes, across many levels of study, the literature is ambivalent about which faculty and level of study is more at risk, if any. The first year of university stands out among the rest in that the students undergo a significant transition and are required to adapt to a new environment and style of learning compared to what they have been used to. Furthermore, students have been observed to exit first year with higher levels of distress than were present in the beginning of the year, suggesting that this unique environment may influence the psychosocial well-being of students. The extent and strength of this relationship is yet to be determined in a South African tertiary educational context and this is even more true of the first year student population at the Durban University of Technology. Research on the unique bio-psychosocial factors of these students would provide a more holistic understanding of the extent to which these factors exist and the role they play in the general well-being of the students and in the development of neck pain. AIMS AND OBJECTIVES: This study aimed, firstly, to determine the prevalence and psychosocial risk factors of neck pain in registered first year Faculty of Health Sciences students at the Durban University of Technology and, secondly, to determine the association between neck pain presentation, demographic characteristics, socio-demographic and psychosocial risk factors. The outcomes of this study could possibly have a threefold benefit (for the student, the institution, and the chiropractic profession at large). RESEARCH DESIGN: A quantitative, descriptive, cross-sectional survey design was adopted in this research. This design was chosen as it was believed to be the best suited to achieving the aims and objectives of the study. RESEARCH METHODOLOGY: Neck pain questionnaires were administered to the first year Faculty of Health Sciences students at the Durban University of Technology towards the end of the academic year in order to determine the prevalence of neck pain and its associated demographic, socio-demographic, and psychosocial risk factors. There was a final sample size of 135 participants achieving a response rate of 54.7% for the study. Data was captured by the researcher and sent to a statistician for statistical analysis. RESULTS: A high prevalence of neck pain was found among the students (72%) with symptoms of depression (59.8%), anxiety (68.1%), and stress (53.6%) also being highly prevalent among this group. However, when neck pain was quantified by its characteristics the related impact was comparatively low. There was a common theme observed in the results highlighting the association between stress and neck pain, with stress furthermore being determined as an independent risk factor for neck pain (p = 0.023) with an odds ratio of 1.1. This result was not surprising, however, considering the stressors which emerged in the results highlighting factors such as transport protests, student protests, upcoming tests and financial aid as stress causing factors among the participants. The results provided valuable insight which enabled recommendations to be made about the direction of future research as well as recommendations for the Institution and the Chiropractic profession in the approach and management of students enrolled in tertiary education and with neck pain. / M

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2003. 104 leaves / 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.