A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / 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. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology. Thesis, 2005. / In symptomatic sacroiliac syndrome, nociceptors located within the capsule and ligaments of the sacroiliac joint are said to be activated which in turn act on inhibitory interneurons that synapse with the motor neuron pool of the muscles of that joint (muscles responsible for hip flexion, extension, abduction and adduction fall within the sacroiliac motor neuron pool). These inhibitory interneurons relay information that decreases the recruitment ability of that motor neuron pool. This is termed Arthrogenic muscle inhibition (AMI) and it has been stated that the number of motor units innervating a muscle relates positively to the strength of that muscle and hence may have an effect on the functional ability of that muscle. However, it has been proposed that spinal manipulation activates mechanoreceptors (Wyke receptors) from structures in and around the manipulated joint causing changes in motor neuron excitability through the altered afferent input and thereby causing an increase in motor neuron recruitment and a decrease in AMI. Furthermore, it has been found that sacroiliac joint problems have often been related to reduced or asymmetric range of motion (ROM) of the hip and / or lack of proprioceptive ability in the ipsilateral limb. In light of the above, manipulation has been found to cause a re-establishment of normal muscle tone and joint kinematics, therefore relaxing the muscles in that area and restoring normal ROM of the involved joint. This study presents the results of sacroiliac manipulation on objective hip measures (including peak torques, ROM and proprioception). / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2004. / Arthrogenic muscle inhibition (AMI) is the reflex inhibition of the muscles that surround an injured joint in consequence to disturbed afferent feedback originating from the receptors of that joint. The resultant altered afferent innervation of the motor neuron pool leads to a decrease in recruitment ability within the motor neuron pool, a decrease in contraction force of the muscles that fall within the motor neuron pool, and hence the clinical manifestation of AMI as a decrease in muscle strength. Spinal manipulation has been proposed to activate mechanoreceptors and proprioceptors within and around the manipulated joint. The altered afferent input arising from their stimulation is thought to cause changes in motor neuron excitability. In this respect, sacroiliac manipulation has been shown to effectively reduce muscle inhibition and increase muscle strength of the quadriceps muscle group in patients with anterior knee pain. The focus of AMI has been aimed primarily at the quadriceps muscle group whereas little information is available on the functional properties of the muscles moving the hip joint. Thus, the purpose of the present cohort study was to determine the short - term effect of sacroiliac manipulation on ipsilateral hip muscle strength and subjective low back pain intensity in thirty male subjects presenting with low back pain, attributable to chronic sacroiliac syndrome. The first objective of the study was to evaluate the short - term effect of sacroiliac manipulation on the strength of the musculature of the ipsilateral hip joint for the actions of flexion, extension, adduction and abduction by means of the Cybex Orthotren II Isokinetic Rehabilitation System, with respect to objective clinical findings. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban institute of Technology, 2003. / Low back pain is a significant health problem that has had a major impact on quality of life and on health care costs (Weiner, et al. 2000:450). Schwarzer, et al. (1995) established the sacroiliac joint to be a significant source of pain in patients with chronic low back pain. Bernard and Kirkaldy-Willis (1987:2107-2130) established the sacroiliac joint to be the primary source of low back pain in 22.5% of 1293 patients presenting with back pain. According to a review article by Hendler, et al. (1995:169), “manipulation provides dramatic relief” in cases of sacroiliac syndrome. Little research, however, has been done regarding instrument manipulation and it’s effect on acute, chronic or acute on chronic sacroiliac syndrome. Osterbauer and De Boer, et al. (1993) found a significant decrease in Visual Analogue Scale and Oswestry scores following treatment using instrument manipulation for sacroiliac joint syndrome. They also noted a reduction in the number of pain provocation tests applied to the research subjects. “Unless reliability and validity of assessments and effectiveness of treatment procedures can be demonstrated, clinicians should temper their claims of measurement of, and direct effects on, the sacroiliac joint” (Walker 1992:914). The study design was a randomised, omparative clinical trial. Sixty voluntary subjects were accepted onto the trial; each diagnosed as having acute on chronic sacroiliac joint syndrome, and divided into two groups of thirty subjects. Each subject received five treatments within a three-week period. The subjects in group one received manipulation using the Diversified Technique of manipulation and those in group two received instrument manipulation using the “Activator Adjusting Instrument”. / M

The burden of non-specific low back pain in the population is substantial. Putative sacroiliac joint pain or 'sacroiliac syndrome' is a significant subset of this condition. Localisable pain over the long posterior sacroiliac ligament (LPSL) is often described as both a clinical sign and symptom of this syndrome. The aim of this qualitative morphological investigation was to investigate a potential basis for a patho-anatomic relationship between the long posterior sacroiliac ligament (LPSL) and the posterior sacrococcygeal plexus (PSP). Twenty-two cadavers were available for study. Three methods were utilised: macro-dissection (n = 22 sides), small wax block histology (n = 3 sides), large wax block histology (n = 1 side), giant wax block histology (n = 4 sides) and a review of E12 sheet plastinated transverse and sagittal sections (n = 4 sides). The LPSL was demonstrated to have a layered structure that was penetrated by the lateral branches of the dorsal sacral rami. A segmental relationship was observed between the lateral branches of the dorsal sacral rami and the LPSL. The posterior layer of the thoracolumbar fascia was not continuous with the superficial layer of the LPSL, deep to the fibres of gluteus maximus. The LPSL was shown to have three morphologically distinct regions, the proximal, mid and distal LPSL. A confluence of three layers was observed at the mid LPSL posterior to the sacroiliac joint (SIJ) namely the erectores spinae aponeurosis (ESA), the gluteal aponeurosis (GA) and the deep fascial layer from the second and third medial dorsal sacral foramina. A region of adipose and loose connective tissue was evident deep to the deep fascial layer in which lateral branches of the dorsal sacral rami were observed. In the region of the mid LPSL between the inferior PSIS and the third sacral transverse tubercle (ST), the attachment of the ESA to sacral bone was absent. This space was occupied by the continuous underlying region of adipose and loose connective tissue. At its greatest extent, this region was observed between the central sacral canal medially and the gluteal aponeurosis laterally. This study suggests that the LPSL may be better described as a retinaculum for the lateral branches of the dorsal sacral rami. These morphological findings provide a basis for the existence of a potential patho-anatomical mechanism that may explain localised pain in the posterior sacroiliac region, usually interpreted as referred pain from the sacroiliac joint. The lateral branches of the dorsal sacral rami may have a potential vulnerability to trauma or ischaemic challenge in this region, which may account for SIJ related 'non-specific' low back pain or for pregnancy related peripartum pelvic pain. Furthermore, a morphological basis for the anatomical confounding of SIJ tests is shown.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xi, 123 leaves ; 30 cm / The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xi, 123 leaves ; 30 cm / The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.

M.Tech. (Chiropractic) / This study aims to compare sacroiliac joint adjustments versus pubic symphysis adjustments in the treatment of sacroiliac joint dysfunction with regards to pain and disability as well as alternative treatment approaches in treating sacroiliac joint dysfunction.This study was a comparative study that consisted of two groups of fifteen participants each. The participants were between the ages of eighteen and forty five with an equal male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria for the study. The method of treatment that was administered was determined by group allocation. Group 1 received Chiropractic manipulative therapy delivered to the restricted sacroiliac joint and Group 2 received Chiropractic manipulative therapy delivered to the pubic symphysis.Treatment consisted of six treatment sessions with an additional follow up consultation over a three week period. Objective and subjective data was measured at the beginning of the 1st, 4th and 7th consultations. Subjective readings were taken from The Oswestry Pain and Disability Questionnaire as well as The Numerical Pain Rating Scale. Objective measurements were taken from The Orthopaedic Rating Scale. Analysis of the data collected throughout the study were performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data collection only.

M.Tech. / Purpose: To compare the efficacy of diversified side posture adjustments and segmental drop piece adjustments in the treatment of sacroiliac joint dysfunction. Method: Thirty-two participants were randomly divided in two equal groups. Group A (n = 16) received diversified side posture adjustments and Group B (n = 16) received segmental drop piece adjustments. The trial consisted of seven sessions over a period of three weeks, of which the first six were treatment sessions, with the final seventh session serving the purpose of obtaining final post-treatment data. Data was obtained only at the first, third, fifth and seventh sessions. Objective data consisted of measuring lumbar spine range of motion using a digital inclinometer and pain pressure tolerance over the middle of the sacroiliac joint line by using a pressure algometer. Subjective data was obtained by having each participant complete a numerical pain rating scale and the Oswestry back pain and disability questionnaire.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Technikon Natal, 2000. / Sacroiliac joint syndrome represents a common cause of lower back pain (Cassidy and Burton 1992:3). However, much controversy exists regarding the most reliable method used to diagnose and determine sacroiliac joint dysfunction (Wiles and Faye 1992). / M