Thesis (D.PT.)--Sage Colleges, 2010. / "May 2010." "A Capstone project for PTY 768 presented to the faculty of The Department of Physical Therapy Sage Graduate School in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy." Includes bibliographical references.

The sacroiliac joints are a source of low back pain (1) and sacroiliac joint disorders are a common occurrence in clinical practice (2). Sacroiliac dysfunction is considered to be the most common cause of sacroiliac joint pain and subsequent lower back pain (3). However, the anatomical location of these joints and the lack of a satisfactory criterion standard (the “gold standard”) make the diagnosis of sacroiliac joint dysfunction difficult (4). Nevertheless, many different sacroiliac joint tests have been described to detect the sacroiliac dysfunction however none have been validated against any independent criterion standard (5). Furthermore, numerous invalidated tests attempt to diagnose the type of sacroiliac joint dysfunction although they also lack that satisfactory criterion standard (4, 5). The Sacral Base Pressure Test has been shown in a previous study to have good validity as an indicator of sacroiliac dysfunction (6). This study aimed to reconfirm the validity of the Sacral Base Pressure Test in diagnosing sacroiliac joint dysfunction. It also determined the predictive powers of the test in determining which type of sacroiliac joint dysfunction was present. Sixty-two participants underwent a double-blind experimental study where the results from the Sacral Base Pressure Test were compared against a cluster of previously validated tests of sacroiliac joint dysfunction. The cluster of tests gave the diagnosis against which the Sacral Base Pressure Test’s validity and predictive powers were determined. The cluster of tests included Standing Flexion Test, the Iliac Springing Test, Spine Test and Supine Long-Sitting Test. The former two tests only determined the presence of the sacroiliac joint dysfunction, whilst the latter tests also determined the type of dysfunction present. The results occurring in the Sacral Base Pressure Test, namely the external rotation of the feet, were measured using a digital inclinometer. There was no statistically significant difference in the results of the Sacral Base Pressure Test between the types of sacroiliac joint dysfunction. Only when the Sacral Base Pressure Test was performed on the right of the patient and when it analysed right-sided dysfunction types, was there a slight statistically significant difference (P = 0.0529) evident in the results. In terms of the results of validity, the Sacral Base Pressure Test was useful in identifying positive values of sacroiliac joint dysfunction but was not useful in identifying the negative values. The Sacral Base Pressure Test did not accurately diagnose patients with positive test results, however it was fairly helpful in correctly diagnosing patients with negative test results. The Sacral Base Pressure Test had only a “slight” agreement with the diagnosis according to the Landis and Koch Guidelines for Kappa interpretation. At this stage of research into the Sacral Base Pressure Test, the results are varied. In this study, the test was not a clinically useful test for determining the presence of sacroiliac joint dysfunction or the type of dysfunction present. Further research comparing the agreement of the Sacral Base Pressure Test or other sacroiliac joint dysfunction tests with a gold standard of diagnosis is necessary. / Dr. E.K. Urli Dr. J. Breitenbach Dr. C. Yelverton

Dissertation submitted to the Faculty of Health Services in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, at Technikon Natal, 2001. / This study aims to provide insight into the relative effectiveness of two different approaches in the treatment of sacro - iliac syndrome. Until recently, the sacro - iliac joints were not commonly considered to be mobile enough to suffer from detectable restriction of motion (Panzer and Gatterman 1995:453). Kirkaldy - Willis et al. (1992:126) however, states that sacro - iliac syndrome is a well defined and common type of dysfunction. Frymoyer et al. (1991 :2114) also reports sacro - iliac syndrome to be common, although it is frequently overlooked as a source of low back pain. This study will attempt to determine whether manipulation of the sacro - iliac joints together with Proprioceptive Neuromuscular Facilitation (P.N.F.) stretching of the piriformis muscles is a more effective treatment for sacro - iliac syndrome, than manipulation alone. This will be accomplished by determining which approach yields the best patient response in terms of subjective and objective clinical findings. The study conducted was a randomised clinical trial consisting of two groups of 30 patients each. The patients were randomly allocated into the two groups. All patients received four treatments over a two - week period. Group one received manipulation of the sacro - iliac joints alone, while Group two received manipulation of the sacro - iliac joints together with P.N.F. stretching of the piriformis muscles. Only the sacro - iliac joint on the side of the sacro - iliac syndrome was manipulated, and only the piriformis muscle on the side of the sacro - iliac syndrome was stretched. If any patients became asymptomatic within the treatment period, then the treatment was terminated. The patients were however required to return for all the remaining consultations for observational purposes. The results of the Numerical Pain Rating Scale, Oswestry Low Back Disability Index questionnaire, inclinometer and algometer readings, as well as the sacro - iliac orthopaedic tests, were recorded before the first and second treatments, and immediately following the fourth (final) treatment. / M

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropratic, Technikon Natal, 2002. / McGregor et al ( 1998) stated that approximately 50 – 80 % of the population in Western society will experience low back pain at some point. According to Cibulka and Koldehoff (1999), the sacroiliac joint is a common cause of low back pain that is overlooked. This study aimed to provide insight into the relative effectiveness of three different approaches in the management of sacroiliac syndrome. Giles and Muller (1999) concluded that spinal manipulative therapy was an effective form of treatment for spinal pain syndromes whilst Burgos et al (2001) states that the use of transcutaneous non-steroidal anti-inflammatories in the management of musculoskeletal conditions is a common therapeutic strategy. This investigation aimed to determine the relative effectiveness of spinal manipulative therapy combined with transcutaneous flurbiprofen (TransAct® patches ) versus spinal manipulative therapy combined with either menthol or non-medicated placebo patches in the management of sacroiliac syndrome, in terms of objective and subjective measures. / M

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Technikon Natal, 2002. 1 v. (various pagings) / McGregor et al ( 1998) stated that approximately 50 – 80 % of the population in Western society will experience low back pain at some point. According to Cibulka and Koldehoff (1999), the sacroiliac joint is a common cause of low back pain that is overlooked. This study aimed to provide insight into the relative effectiveness of three different approaches in the management of sacroiliac syndrome. Giles and Muller (1999) concluded that spinal manipulative therapy was an effective form of treatment for spinal pain syndromes whilst Burgos et al (2001) states that the use of transcutaneous non-steroidal anti-inflammatories in the management of musculoskeletal conditions is a common therapeutic strategy. This investigation aimed to determine the relative effectiveness of spinal manipulative therapy combined with transcutaneous flurbiprofen (TransAct® patches ) versus spinal manipulative therapy combined with either menthol or non-medicated placebo patches in the management of sacroiliac syndrome, in terms of objective and subjective measures.

M.Tech. (Chiropractic) / This study was conducted in order to determine if Chiropractic Spinal Manipulative Therapy (SMT) to the lumbar spine and Sacroiliac joints can accelerate the recovery process of the Hamstring and Quadriceps femoris muscle and thus enabling the athlete to sustain endurance levels for a longer period of time. Participants used were recruited from the cycling community by means of word of mouth. Thirty participants that matched the inclusion criteria were included in the study. The participants were then randomly divided into two groups, a Test Group and a Control Group, of fifteen participants each. Motion and static palpation was used to detect spinal restrictions. The Test Group received Chiropractic SMT to the restricted lumbar vertebral segments and the Sacroiliac joints after the first test was completed. The participants then underwent a 30 minute recovery period after which they were re-tested. The Control Group received no treatment after the first test, but still had a 30 minute recovery period after which they were re-tested. Objective measurements were taken by making use of Cybex Isokinetic Dynamometer. The objective measurement indicated that there was an increase in muscle endurance of the Quadriceps femoris and Hamstring muscle groups for both the test and the Control Group. When the increase in Hamstring and Quadriceps femoris muscle endurance was compared between the Test and Control Group, it was the Control Group that showed a more significant increase in Quadriceps femoris muscle endurance which was greater than the increase of the Quadriceps femoris muscle endurance in the Test Group. The Control Group also showed a greater increase mean endurance of the Quadriceps femoris and Hamstring muscle. In conclusion to the study, muscle endurance in cyclists can be increased by rest alone and does not require Chiropractic SMT to restricted spinal segments.

Dr. C. Yelverton

This unblinded, non-randomised pilot study was conducted in order to determine if diversified chiropractic manipulation and/or sacro occipital technic adjustments of the sacroiliac (SI) joint could increase the short-term strength of the gastrocnemius muscle. Ninety asymptomatic male patients between the ages of 20 and 30 years participated in the investigation. These patients were recruited by the use of posters that were placed in strategic areas around the Technikon Witwatersrand campus. The patients were randomly placed into one of three groups of thirty. Group FA (force adjustment) received force, side-lying, diversified sacroiliac adjustments to the sacroiliac joint. Group NA (non-force adjustment) received non-force sacro occipital technic (SOT) adjustments to the same area by means of SOT blocking technique. The third group. Group C (control) received detuned ultrasound over the SI joint. Each patient received only one treatment. The inclusion criteria required that the patient had to be male, fall inside the above age range, and presented with asymptomatic sacroiliac joint dysfunction. This was determined either by diversified chiropractic motion palpation or SOT category analysis. Only category one patients were used in this study. The objective data was collected using an isometric dynamometer. The gastrocnemius muscle strength was measured with the dynamometer before and after the treatment. The objective results indicated that there was a statistically significant increase in gastrocnemius muscle strength in both of the experimental groups. In conclusion, it has been shown that both force and non-force adjustments positively effect active muscle strength. In this case it was shown that these types of adjustments to the SI joint caused an increase in active gastrocnemius muscle strength. It is suspected that the inhibition of the motor neuron, via the capsular stretch reflex, plays a major role in the effect seen in this study. This gives further information about the underlying mechanisms of the chiropractic adjustments and may support the role of non-force techniques in treating patients. / Dr. Chris Yelverton Dr. Malany Moodley

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2003. xvi, 138 leaves / Knee joint pathologies, in general, are associated with a loss of knee-extensor muscle strength. This weakness has been attributed to arthrogenic muscle inhibition (AMI). Manipulation of the sacroiliac (SI) has been shown to significantly reduce AMI and increase the strength in the quadriceps muscle group. Although both the knee and SI joints have been linked to AMI of the quadriceps muscle group, no studies have been conducted showing that manipulating the tibio-femoral (knee) joint has any effect on quadriceps muscle strength or AMI. The purpose of this study was therefore to verify whether manipulation of the knee (tibio-femoral) joint is as effective as SI joint manipulation in increasing quadriceps muscle strength in PFPS patients. This study also investigated the effect of combining manipulative therapy of the tibio-femoral and SI joints on quadriceps muscle strength in PFPS patients.

Thesis (M.Tech.: Chiropractic)- Dept of Chiropractic, Durban Institute of Technology, 2005. xiii, 129 leaves :|bill. (some col.) ;|c30 cm / Research indicates the sacroiliac joint (prevalence of sacroiliac syndrome ranges from 19.3% and 47.9% (Toussaint et al., 1999)) as being the primary source of low-back pain in 22.5% of patients with back pain (Bernard et al., 1987:2107-2130). Treatment options that are available for the treatment of low-back pain include allopathic (Hellman and Stone, 2000), and manual therapies such as hydrotherapy and traction (Cull and Will, 1995). It has been found that allopathic interventions have been less effective than spinal manipulative therapy, even with spinal manipulative therapy having various modes of application (e.g. side posture and drop piece manipulations) (Gatterman et al., 2001). Drop table thrusting techniques were found to be effective for patients with neuromuskuloskeletal problems such as facet syndrome (Haldeman et al., 1993), however, it is still not known which specific drop piece technique is the most appropriate for sacroiliac syndrome. Thus it is important to ascertain the clinical effectiveness of the technique as certain conditions prevent the patient from being positioned in the conventional side posture for treatment of sacroiliac syndrome (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Therefore this study aims at determining the efficacy of a maintained contact drop piece manipulation technique.