Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves / Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings. / M

Tibial stress fractures are common in runners. However, it is unclear what factors are associated with tibial stress fractures. This study aimed to investigate 1) magnitudes of bone contact forces occurring while running 2) whether or not repeated application of running loads is sufficient to explain tibial stress fractures and 3) whether or not muscle fatigue alters the potential of tibial stress fractures. Tibial stress fractures were predicted through an estimation of the minimum number of cycles to failure (Nfail) using an integrated experimental and mathematical modeling approach. Short running trials within a speed range of 3.5-4 m/s of ten male runners were evaluated with a coupled force plate and 3 dimensional motion analysis system. The collected data were used to estimate joint reaction forces (JRF) and joint moments. Using these JRF and muscle forces predicted from optimization, 2-D bone contact forces at the distal end of the tibia were determined. Next, tibial stresses were estimated by applying these bone contact forces to a tibial model, which were then used to predict the Nfail. All procedures were repeated after plantarflexors fatigued from prolonged running. This study found that peaks of compressive and posterior shear forces occurred during mid stance, and these peaks equaled 8.91 ± 1.14 BW and -0.53 ± 0.16 BW, respectively. These bone contact forces led to a backward bending of the tibia during most of the stance phase and resulted in the maximum stresses of - 43.4 ± 10.3 MPa on the posterior face of the tibia. These maximum stresses predicted the group mean of Nfail as being 5.28*10⁶ cycles. However, 2.5% to 56% of population of runners have a chance of getting tibial stress fractures within 1 million cycles of a repeated foot impact. Within the context of muscle force and stress estimation procedures used in this study, Nfail appeared to increase after fatigue, not decrease as we hypothesized. / Graduation date: 2005

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 xiv, 61 leaves, Annexures 1-12, 20 leaves / It is well known that the lifetime incidence of lower back pain (LBP) is particularly high (Richardson et al., 1999). Most cases of LBP are self-limiting, however certain regional biomechanical deficits may be overlooked, such as core stability. As a result of this, LBP may become a chronic condition in the athletic and general population. This principle can be applied to road running, as the forces that pass through the muscles of the lower limbs and trunk cannot be properly absorbed if the trunk musculature is not properly trained. This may lead to lower back pain as a result of inadequate functioning and strength of stabilizing structures (Hedrick, 2000). The purpose of this exploratory cross-sectional study was to determine the relationship between core muscle strength and chronic lower back pain in amateur female road runners and non-runners. The focus was to determine the core stability values in mmHg between amateur female runners with and without chronic LBP, and female non-runners with and without chronic LBP; as well as to compare female runners and non-runners with regard to core muscle strength.

Ground contact results in the generation of a heel-strike transient that propagates through the musculoskeletal system. The inability to attenuate the heel-strike-induced shock wave is a possible factor in the development of various gait pathologies and overuse-type injuries, such as knee osteoarthrosis, stress fractures, and low back pain. It is hypothesized that prolonged running will result in increased shock transmission at the tibia and sacroiliac joint during conditions of controlled velocity/stride mechanics. Subjects performed an extended running trial for 25-minutes at 75% HRReserve. EMG data of the vastus medialis, vastus lateralis, and tibialis anterior and accelerometer data from the tibial tuberosity and sacrum were recorded at one-minute intervals. Accelerometer data at the tibial tuberosity did show a significant increase during the run protocol. Linear regression of EMG frequency and tibial shock also demonstrated a significant relationship. An extended running protocol will lead to increases in tibia shock acceleration independent of stride mechanics. / School of Physical Education

Thesis (D.Phil.(Biokinetics, Sport and Leisure Sciences))--University of Pretoria, 2008. / Summary in English and Afrikaans. Includes bibliographical references.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 12, xiii, 84 leaves / Plantar Fasciitis (PF) or “painful heel syndrome” is an inflammation of the plantar fascia at its insertion on the medial calcaneal tubercle. Accounting for 7-9% of total sports injuries, this condition is predominantly due to overuse and is notoriously difficult to treat. Traditionally treatment focused on the resolution of the inflammation with the application of such modalities cross frictions / transverse frictions being the modality of choice. With such modalities there are however limitations which include the detection of the appropriate areas in which treatment should be given as well as the treatment depth achieved. The GISTM, however is an advanced form of soft tissue mobilisation that employs the use of specifically designed stainless steel instruments that, when manually brushed over the skin of the affected area, are thought to detect and release scar tissue, adhesions and fascial restrictions. This complementary technique is hypothesized to work in the same manner as cross friction massage, and is thought to achieve quicker and improved outcomes by its detection of the treatment area(s) as well as improving the depth of treatment application. This assertion was however untested. Therefore the purpose of this study was to determine the efficacy of the Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM) in the treatment of Plantar Fasciitis in runners.

M.Tech. / OBJECTIVE: To determine the most effective treatment protocol in the treatment of Lower-Crossed Syndrome by comparing objective results gained from a Rehabilitation program (group one), Spinal Manipulative Therapy (group two) and a combination of these therapies (group three) directed at the sacroiliac joints and lumbar spine. DESIGN: The study was a clinical trial in which three experimental groups of sixteen participants each were compared to each other. These participants were recruited from the local general population and were selected on the basis of inclusion and exclusion criteria, presenting with Lower-Crossed Syndrome and demonstrating unremarkable clinical and radiological findings. INTERVENTION AND DURATION: After randomisation, group one received a Rehabilitation program which consisted of a stretching and strengthening program only, group two received Spinal Manipulative Therapy only whereas group three received a combination of Spinal Manipulative Therapy and a Rehabilitation program. The frequency of the follow up consultations for this study was two consultations over the first two weeks of the trial and once a week for the following four weeks of the trial. MEASUREMENTS: Objective measurements included lumbar spine flexion and extension ranges of motion, hip flexor flexibility (hip extension), active and passive hamstring flexibility, gluteus maximus and abdominal strength tests and Sorenson’s Test (static back extensor strength test). Subjective measurements were the Oswestry Low Back Pain and Disability Index and McGill’s Questionnaire. Measurements were taken before (pre-) and after (post-) the first (initial), third, fifth and eighth (last) consultations. CONCLUSIONS: The aim of the study was to determine the most effective treatment protocol in the management of Lower Back Pain in athletes presenting with Lower-Crossed Syndrome. Although the combined group (group three) showed the greatest improvement these findings were statistically no greater than the statistical findings in group one and group two. All groups showed a statistically significant improvement over the trial period. This illustrates that both Spinal Manipulative Therapy and a Rehabilitation program (including stretching and strengthening) was effective in the management of Lower-Crossed Syndrome. From this study it can therefore be concluded that one treatment protocol did not prove to be more effective than that of the others.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves / Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings.

<p>Across the world, physical inactivity was found to be associated with cardiovascular and chronic diseases of lifestyle which often leads to an increased rate of various physical disabilities andpremature death. To combat these high incidences of chronic diseases of lifestyle, WHO strongly encourages people to become physically active on a daily basis to reduce the risk of&nbsp / premature death. Running has thus become the preferred choice of physical activity by thousands of people to help improve their overall health and wellbeing. Apart from the health benefits&nbsp / that running provides, it can also predispose the runner to potential injury especially when runners follow an inappropriate training programme and have inadequate knowledge about factors causing injury. Therefore, baseline data about the prevalence, incidence of injury and the identification of the aetiological factors associated with running injuries are needed to develop and&nbsp / implement preventative programmes to allow runners to optimally perform in training and races without injury. In South Africa, there is limited research available on the incidence of injury in runners yet there is an annual increase in participation in races such as Two Oceans and Comrades marathon which could lead to an increase in the number of running injuries.Thus, the purpose of this study was to determine the incidence of injuries and identify the various risk factors that are associated with injuries in road runners at a local athletic club. Methods: A prospective cohort study design over a 16 week period using quantitative research methods was used. A sample of 50 runners had consented to participate in the study. The participants had to complete a self-administered questionnaire and clinical measurements of BMI, Q-angle, leglength, muscle strength of lower leg and ROM of hip and knee were recorded. The participants had&nbsp / to complete an injury report form to record any new injuries sustained over the 16 week period of the study. Statistical Package for Social Sciences (SPSS) version 18 and software SAS v9 (SAS Institute Inc., Cary, NC, USA) was used for data capturing and analysis. Descriptive and inferential statistics were done to summarize the data and was expressed as frequencies, percentages, means and standard deviations. Injury prevalence and cumulative incidence was calculated as a proportion rate along with 95% confidence interval. The Poisson regression model was used to analyse the association between running injury and the independent variables of interest such as demographics, anthropometric measurements, training methods, running experience and&nbsp / previous injury. The alpha level was set as p&lt / 0.05. Results: The study found that the majority (92%) of the participants (n=46) sustained running injuries in the past prior to the study. A total of 16 participants sustained a number of 50 new injuries over the 16 week study period. Thus the prevalence rate of injuries was 32%. The incidence rate of injuries for this study was 0.67 per&nbsp / 1000km run at a 95% confidence interval of 0.41, 1.08. Furthermore, the most common location of new injuries reported were the calf (20%) and the second most common location was the&nbsp / knee (18%). PFPS was the most common type of knee injury diagnosed, followed by lumbar joint sprain. The results showed that none of the identified factors (running distance, stretching, age, Q-angle, BMI, running experience, leg-length discrepancy and previous running injuries) were directly associated with running injuries. However, a marginal significance was found for&nbsp / running distance (p = 0.08) and leg length discrepancy (p = 0.06). Conclusions: The study found a high prevalence and incidence rate of injury thus the need for preventative programmes have been highlighted. There was no statistical significance found between the identified factors and risk of injury however, there was clinical relevance found between factors identified. One major&nbsp / limitation was the small sample of participants and the short duration of study period. Thus, future research is needed to further determine possible factors associated with running injuries over a longer period and including a larger sample. The results of the study will be made available to all the stakeholders (runners, coaches and medical team) to implement in athletic club. </p>

<p>Across the world, physical inactivity was found to be associated with cardiovascular and chronic diseases of lifestyle which often leads to an increased rate of various physical disabilities andpremature death. To combat these high incidences of chronic diseases of lifestyle, WHO strongly encourages people to become physically active on a daily basis to reduce the risk of&nbsp / premature death. Running has thus become the preferred choice of physical activity by thousands of people to help improve their overall health and wellbeing. Apart from the health benefits&nbsp / that running provides, it can also predispose the runner to potential injury especially when runners follow an inappropriate training programme and have inadequate knowledge about factors causing injury. Therefore, baseline data about the prevalence, incidence of injury and the identification of the aetiological factors associated with running injuries are needed to develop and&nbsp / implement preventative programmes to allow runners to optimally perform in training and races without injury. In South Africa, there is limited research available on the incidence of injury in runners yet there is an annual increase in participation in races such as Two Oceans and Comrades marathon which could lead to an increase in the number of running injuries.Thus, the purpose of this study was to determine the incidence of injuries and identify the various risk factors that are associated with injuries in road runners at a local athletic club. Methods: A prospective cohort study design over a 16 week period using quantitative research methods was used. A sample of 50 runners had consented to participate in the study. The participants had to complete a self-administered questionnaire and clinical measurements of BMI, Q-angle, leglength, muscle strength of lower leg and ROM of hip and knee were recorded. The participants had&nbsp / to complete an injury report form to record any new injuries sustained over the 16 week period of the study. Statistical Package for Social Sciences (SPSS) version 18 and software SAS v9 (SAS Institute Inc., Cary, NC, USA) was used for data capturing and analysis. Descriptive and inferential statistics were done to summarize the data and was expressed as frequencies, percentages, means and standard deviations. Injury prevalence and cumulative incidence was calculated as a proportion rate along with 95% confidence interval. The Poisson regression model was used to analyse the association between running injury and the independent variables of interest such as demographics, anthropometric measurements, training methods, running experience and&nbsp / previous injury. The alpha level was set as p&lt / 0.05. Results: The study found that the majority (92%) of the participants (n=46) sustained running injuries in the past prior to the study. A total of 16 participants sustained a number of 50 new injuries over the 16 week study period. Thus the prevalence rate of injuries was 32%. The incidence rate of injuries for this study was 0.67 per&nbsp / 1000km run at a 95% confidence interval of 0.41, 1.08. Furthermore, the most common location of new injuries reported were the calf (20%) and the second most common location was the&nbsp / knee (18%). PFPS was the most common type of knee injury diagnosed, followed by lumbar joint sprain. The results showed that none of the identified factors (running distance, stretching, age, Q-angle, BMI, running experience, leg-length discrepancy and previous running injuries) were directly associated with running injuries. However, a marginal significance was found for&nbsp / running distance (p = 0.08) and leg length discrepancy (p = 0.06). Conclusions: The study found a high prevalence and incidence rate of injury thus the need for preventative programmes have been highlighted. There was no statistical significance found between the identified factors and risk of injury however, there was clinical relevance found between factors identified. One major&nbsp / limitation was the small sample of participants and the short duration of study period. Thus, future research is needed to further determine possible factors associated with running injuries over a longer period and including a larger sample. The results of the study will be made available to all the stakeholders (runners, coaches and medical team) to implement in athletic club. </p>