Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 120 leaves / Low back pain has been shown to be associated with inhibition of the lower limb musculature. This inhibition is called arthrogenic muscle inhibition (AMI). Sacroiliac joint dysfunction has been linked with AMI of the ipsilateral and contralateral quadriceps and hamstring muscles. Sacroiliac manipulation has been shown to significantly reduce ipsilateral AMI, however no studies have been conducted to illustrate the effect of sacroiliac manipulation on contralateral AMI. Neither have their been studies to show the presence or extent of spinal dysfunction between the levels of L2-L5 and its significance on muscle inhibition in the quadriceps and hamstring muscles, nor the effect of manipulation of these levels on AMI of the quadriceps and hamstring muscles. The purpose of this study was therefore to determine whether spinal manipulation has an effect on AMI of the contralateral limb as well as that of the ipsilateral limb.

Objective : Low back pain (LBP), and in particular sacroiliac joint syndrome, is a significant health concern for both patient and their chiropractor with regards to quality of life and work related musculoskeletal disorders. Therefore, chiropractors often utilise mechanical aids to reduce the impact on the chiropractor’s health. It is, however, important to establish whether these mechanical aids are indeed clinically effective, therefore, this study evaluated the Activator Adjusting Instrument (AAI) against an AAI placebo to determine whether this adjusting instrument is an effective aid for both the chiropractor and the patient. Method : This randomised, placebo controlled clinical trial consisted of 40 patients (20 per group), screened by stringent inclusion criteria assessed through a telephonic and clinical assessment screen. Post receipt of informed consent from the patients, measurements (NRS, Revised Oswestry Disability Questionnaire, algometer) were taken at baseline, prior to consultation three and at the follow consultation. This procedure occurred with four interventions over a two week period. Results: The AAI group showed clinical significance for all clinical measures as compared to the AAI placebo group which attained clinical significance only for the Revised Oswestry Disability Questionnaire. By comparison there was only a statistically significant difference between the groups in terms of the algometer readings (p= 0.037). Conclusion : Therefore, it is evident that the AAI seems to have clinical benefit beyond a placebo. However this is not reflected in the statistical analysis. It is, therefore, suggested that this study be repeated with a larger sample size in order to verify the effect on the statistical analysis outcomes.

Submitted in partial compliance with the requirements for the Masters’ Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2014. / Background: Spinal manipulation has been shown to result in neurophysiological changes, most often noted in the paraspinal muscles. These effects have been associated with an increase in paraspinal muscle contractibility; it is unclear if this leads to an increase in paraspinal muscle endurance. Objectives: To determine the effect of sacroiliac joint (SIJ) manipulation compared to a placebo treatment of the SIJ on lumbar extensor muscle endurance time. Method: A randomised, placebo-controlled pre-test post-test experimental trial, involving 40 asymptomatic male participants divided into an intervention group receiving SIJ manipulation using an impulse adjusting instrument and a placebo group receiving a pre-load force without the delivery of an impulse thrust. Outcome measures were lumbar extensor muscle endurance time, surface electromyographic (SEMG) readings, lumbar spinal range of motion, paraspinal muscle length assessment and a subjective pain measurement. Results: There was a significant difference between the groups (p=0.004) with the SIJ manipulation group showing an increase in endurance time compared to the placebo group which showed a decrease. SEMG readings increased for both groups with no statistically significant difference between the groups (p>0.05). Only extension lumbar spinal range of motion significantly improved in both groups (p=˂0.001) with no significant differences between groups (p=0.876). Only one participant reported pain during the research procedure. Conclusions: SIJ manipulation may enhance the endurance of the paraspinal muscles. This study should be conducted in a larger sample to validate the findings.

The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application.

As dores lombares acometem a maioria dos atletas, inclusive os equinos. Somente o exame clínico não é suficiente para identificar a localização exata do foco doloroso. O diagnóstico definitivo só é atingido através da utilização dos meios diagnósticos complementares, neste caso, a ultrassonografia. Caso sejam constatadas anomalias discal lombossacras e/ou artropatias ITLS e/ou SI, o veterinário ainda não é capaz de quantificar a influência destas sobre o desempenho atlético do cavalo de esporte. Face a esta dúvida, objetivou-se estabelecer uma relação entre os achados dos exames físicos e ultrassonográficos, executados em 200 cavalos atletas, de quatro raças diferentes (Trote Francês, Quarto de Milha, Puro Sangue Inglês e Cavalos de Sela Francesa e Brasileiro de Hipismo). Todos os animais estavam em treinamento, participando de provas, e não apresentavam claudicação. Após exame físico, os animais foram avaliados ultrassonograficamente, por via transretal, para visualização do aspecto ventral do disco LS (L6-S1), das articulações intertransversas (ITLS) e sacroilíacas (SI), direitas e esquerdas. Para a avaliação transretal os animais foram colocados em tronco de contenção, não tendo sido observada necessidade de sedação ou emprego de outros métodos físicos. Ato contínuo foi introduzido um transdutor linear de 5-7,5 MHz e imagens do disco lombossacro, das articulações intertransversas lombossacras e sacroilíacas foram obtidas. A determinação do número de animais que apresentavam alterações durante os exames de inspeção, palpação, mobilização e avaliação dinâmica assim como a caracterização dos tipos de anomalias discais (T1, T2, T3 e T4) e artropatias ITLS e SI, sugere que durante a execução do exame físico, cavalos que não apresentem sinais clínicos não devem ser descartados de possuírem algum tipo de anomalia discal lombossacra e/ou atropatias ITLS e/ou SI. Observou-se também que as artropatias SI podem afetar o desempenho dos cavalos de trote atrelado, já para as artropatias ITLS e anomalias LS não houve significância quanto às suas influências aos achados no desempenho. / Back pain affects most athletes, including horses. The clinical examination alone is not sufficient to identify the exact location of the painful focus. The definitive diagnosis is only achieved by using complementary diagnostic tools, in the case of this study the ultrasonography. Lumbosacral anomalies and intertransverse lumbosacral and sacroiliac arthropathies, if detected ultrasonographicaly, do not directly input in loss of performance or locomotor impairment. In order to assess this issue, this study aimed to establish a relationship between the findings of physical and ultrasound examinations, performed on 200 horses athletes, from 4 different breeds, French Trotters, Quarter Horse, Thoroughbred Horses and Show Jumpers. After physical examination, the animals were evaluated by a transrectal approach with ultrasonography and the images collected were, ventral aspect of the disc LS (L6-S1), intertransverse joints (ITLS) and sacroiliac (SI), right and left. To perform this evaluation, the animals were placed in the containment trunk with any sedation methods. Immediately thereafter introduced a 5 - 7.5 MHz linear transducer, images of lumbosacral, intertransverse lombossacral and sacroiliac joints were obtained. The determination of number of animals showing abnormalities during clinical examination of inspection, palpation, mobilization and dynamic examination as well as the characterization of the types of disc anomalies (T1, T2, T3 and T4) and arthropathies ITLS and SI, enabled the realization of the following framework, where even the patient, during the execution of the clinical examination, will not provide a positive signals for certain tests, this does not rule out the possibility it has some kind of anomaly in LS joint and/or arthropathy ITLS and/or SI. It was also observed that the arthropathy of SI can affect the performance of French Trotters, and anomalies of ITLS and LS have no significance or influence on athletic performance.

As dores lombares acometem a maioria dos atletas, inclusive os equinos. Somente o exame clínico não é suficiente para identificar a localização exata do foco doloroso. O diagnóstico definitivo só é atingido através da utilização dos meios diagnósticos complementares, neste caso, a ultrassonografia. Caso sejam constatadas anomalias discal lombossacras e/ou artropatias ITLS e/ou SI, o veterinário ainda não é capaz de quantificar a influência destas sobre o desempenho atlético do cavalo de esporte. Face a esta dúvida, objetivou-se estabelecer uma relação entre os achados dos exames físicos e ultrassonográficos, executados em 200 cavalos atletas, de quatro raças diferentes (Trote Francês, Quarto de Milha, Puro Sangue Inglês e Cavalos de Sela Francesa e Brasileiro de Hipismo). Todos os animais estavam em treinamento, participando de provas, e não apresentavam claudicação. Após exame físico, os animais foram avaliados ultrassonograficamente, por via transretal, para visualização do aspecto ventral do disco LS (L6-S1), das articulações intertransversas (ITLS) e sacroilíacas (SI), direitas e esquerdas. Para a avaliação transretal os animais foram colocados em tronco de contenção, não tendo sido observada necessidade de sedação ou emprego de outros métodos físicos. Ato contínuo foi introduzido um transdutor linear de 5-7,5 MHz e imagens do disco lombossacro, das articulações intertransversas lombossacras e sacroilíacas foram obtidas. A determinação do número de animais que apresentavam alterações durante os exames de inspeção, palpação, mobilização e avaliação dinâmica assim como a caracterização dos tipos de anomalias discais (T1, T2, T3 e T4) e artropatias ITLS e SI, sugere que durante a execução do exame físico, cavalos que não apresentem sinais clínicos não devem ser descartados de possuírem algum tipo de anomalia discal lombossacra e/ou atropatias ITLS e/ou SI. Observou-se também que as artropatias SI podem afetar o desempenho dos cavalos de trote atrelado, já para as artropatias ITLS e anomalias LS não houve significância quanto às suas influências aos achados no desempenho. / Back pain affects most athletes, including horses. The clinical examination alone is not sufficient to identify the exact location of the painful focus. The definitive diagnosis is only achieved by using complementary diagnostic tools, in the case of this study the ultrasonography. Lumbosacral anomalies and intertransverse lumbosacral and sacroiliac arthropathies, if detected ultrasonographicaly, do not directly input in loss of performance or locomotor impairment. In order to assess this issue, this study aimed to establish a relationship between the findings of physical and ultrasound examinations, performed on 200 horses athletes, from 4 different breeds, French Trotters, Quarter Horse, Thoroughbred Horses and Show Jumpers. After physical examination, the animals were evaluated by a transrectal approach with ultrasonography and the images collected were, ventral aspect of the disc LS (L6-S1), intertransverse joints (ITLS) and sacroiliac (SI), right and left. To perform this evaluation, the animals were placed in the containment trunk with any sedation methods. Immediately thereafter introduced a 5 - 7.5 MHz linear transducer, images of lumbosacral, intertransverse lombossacral and sacroiliac joints were obtained. The determination of number of animals showing abnormalities during clinical examination of inspection, palpation, mobilization and dynamic examination as well as the characterization of the types of disc anomalies (T1, T2, T3 and T4) and arthropathies ITLS and SI, enabled the realization of the following framework, where even the patient, during the execution of the clinical examination, will not provide a positive signals for certain tests, this does not rule out the possibility it has some kind of anomaly in LS joint and/or arthropathy ITLS and/or SI. It was also observed that the arthropathy of SI can affect the performance of French Trotters, and anomalies of ITLS and LS have no significance or influence on athletic performance.

Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle.We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormonedependent Cushing’s disease. The combination of adrenocorticotropic hormone-dependent Cushing’s disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors’ knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application.