University of Macau / Institute of Chinese Medical Sciences

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: Acute ankle sprains and chronic ankle instability syndrome (CAIS) may be managed effectively through conservative management approaches such as strapping. There are two main types of strapping viz. rigid tape which is used to stabilise the joint and limit joint motion and elastic tape which permits joint motion but provides dynamic support. Kinesio™ tape is becoming increasingly popular in the management of various conditions. It is reportedly beneficial in reducing pain, improving circulation, increasing proprioception and correcting muscle function. Due to claimed benefits of Kinesio™ tape, it should, in theory, be beneficial in the management of individuals with CAIS particularly in terms of reducing pain and improving proprioception. AIM: To investigate the effect of three types of strapping applied in the method described for the application of Kinesio™ tape in the management of CAIS. METHODS This study consisted of three groups of 15 participants (recruited through convenience sampling) with each group receiving a different tape (i.e. rigid, elastic or Kinesio™ tape), all three groups, however, received the same taping method which was the Kinesio™ tape functional correction application. After obtaining informed consent each participant underwent a case history, physical examination and a foot an ankle orthopaedic examination. Thereafter, baseline measurements of subjective pain rating (NRS-101), pain threshold (analogue algometer), ankle dorsiflexion, plantarflexion and inversion (analogue goniometer) and proprioception (Biodex Biosway portable balance system) were documented. Depending on the group, the particular tape was then applied and a follow up consultation was made for two to three days later where the tape was removed, measurements were reassessed and the tape was reapplied. At the final consultation three to four days later, the tape was removed and final measurements were assessed and documented. Statistical intra- (using Wilcoxon Signed Ranks Test) and inter-group (using the Mann-Whitney U-test) analyses of the data were performed due to a skewed distribution of the variables. Data was analysed using SPSS version 21.0 with the level of significance set at 0.05. RESULTS The mean (± SD) age of the participants was 24.8 (4.7) and there were 23 male participants in total. Intra-group analyses of subjective outcome measurements showed significant increases (p < 0.05) in subjective pain rating in all three groups across all consultations. Similarly, intra-group analyses of objective outcome measurements found significant increases (p < 0.05) in pain threshold and dorsiflexion range of motion in all three groups across all consultations. Plantarflexion and inversion range of motion also showed significant increases (p < 0.05) but these were not consistent across all consultations. Intra-group analyses of the sway index showed no significant improvements (p > 0.05) in Groups Two and Three across the three consultations. Only Group One showed significant increases during the eyes open foam surface (EOFoS) (p = 0.013) and eyes closed foam surface (ECFoS) (p = 0.047) test conditions between Consultations One and Two. Inter-group analyses of subjective outcome measurements showed no significant increases (p > 0.05) in subjective pain rating across each of the three consults in all three groups. Inter-group analyses of objective outcome measurements revealed a significant increase in pain threshold (p = 0.040) between Groups Two and Three at Consultation One. There was a significant increase in plantarflexion between Groups One and Three at Consultation Two (p = 0.021) and Consultation Three (p = 0.030). There were no other significant results amongst the three groups. CONCLUSION The results suggest that pain rating, pain threshold and ankle dorsiflexion would improve if taping is applied in the manner described for Kinesio™ tape irrespective of the type of taping used in the management of CAIS. The taping method did not result in a significant difference in proprioception. Further studies, with larger sample sizes are required to confirm the findings of this study and to determine the role of taping in the management of CAIS. / M

M.Tech. (Chiropractic) / Introduction The aim of this study is to determine whether standard leg rubs and reassurance combined with lumbosacral manipulations have an effect on growing pain symptoms by comparing it to standard leg rubs and reassurance only. The study can possibly serve as a platform for further research. Furthermore, this will be one of the first chiropractic studies done in this field and may provide the chiropractic profession with a proven treatment for growing pains. Methodology Thirty participants with growing pains between the ages of 4 and 12 years were recruited. The participants were placed into two groups of fifteen participants each on a first come first serve basis. The two groups received different treatment protocols according to their group allocation. Group One received chiropractic manipulative therapy to the lumbar spine and sacroiliac joint restrictions combined with legs rubs and reassurance administered by the parent(s)/guardian(s). Group Two received only legs rubs and reassurance administered by the parent(s)/guardian(s). The participants completed the study over a period of three weeks. Subjective and objective readings were taken. Subjective readings from each participant were taken using the Oucher self-rating pain scale (OSRPS) and a pain diary completed by the parent(s)/guardian(s). Objective readings were taken using a pressure algometer over the anterior tibial muscles bilaterally. A six-week post study follow up was done via email. Results The statistical data was analyzed using the Friedman test, Mann-Whitney test and the Wilcoxon Signed-Rank test. The results demonstrated that both groups responded favourably to their specific treatment over time. However, Group One proved to show a quicker response to treatment over time; and the post study follow up of Group One proved to be significantly more positive than Group Two. These results highlight the positive effects of the chiropractic manipulation. Discussion The fact that the participants of Group One have improved in subjective and objective measurements and the parent(s)/guardian(s) of the participants have responded very positively to the post study follow up, one has to consider that the anatomical theory proposed by Evans and Scutter (2007), the pain referral theory supported by Cookson (2003) and the activation of pain inhibitory systems supported by Wright (1995) and Sterling et al. (2001) might all be a likely aetiologies for growing pains. However, one has to consider that the participants from Group Two, who received no spinal manipulation, have also improved in subjective and objective readings. Therefore it is possible, and cannot be excluded, that the leg rubs administered to both groups could also have played a role in relieving the growing pains. Conclusion The results of the data collected from this study, the pressure algometer and OSRPS readings, showed that spinal manipulation did not have much of a benefit. However, the pain diaries and feedback from the parent(s)/guardian(s), which are probably more reliable for growing pains, indicates that spinal manipulation does show to be beneficial.

M.Tech. / Since its discovery in 1983, millions of people worldwide have been infected with the human immunodeficiency virus (HIV). HIV is a singlestranded retrovirus belonging to the Lentivirinae subfamily of retroviruses and is responsible for the acquired immune deficiency syndrome (AIDS) (Haslett et al, 2002). The infection results in a wide range of clinical manifestations related to defective cell-mediated immunity (Beers and Berkow, 1999). At the end of the twentieth century, over 21 million individuals worldwide had died from AIDS, over 34 million were living with the HIV infection, and over 95% of HIV-infected persons resided in developing nations (Klatt, 2005). At present, 40 million people worldwide are infected with HIV/AIDS of which more than 26 million reside in Africa (Treatment Access, 2005). Sutherlandia frutescens, a medicinal plant from South Africa has documented anti-cancer and antiviral activity. One of the active compounds of this plant is L-canavanine, a cytokine-inducible nitric oxide synthase (iNOS) inhibitor (Van Wyk and Gericke, 2000). In minute doses, the iNOS inhibitor may stimulate nitric oxide (NO) release to counteract retrovirus replication. This study aimed to ascertain the effect of Sutherlandia frutescens 200CH on CD4 cell counts and symptomatology in persons infected with HIV. Study parameters involved recording of vital signs, symptomatology and CD4 analysis at three separate consultations over a ten-week period. All information was collected and collated for statistical or descriptive analysis. The research study was carried out on a random sample size of twenty-six participants, between the age of seventeen and fifty years over a period of ten weeks. Participants included both genders and had been previously diagnosed HIV-positive. Persons using antiretroviral treatment or falling into Category C as specified in the Centres for Disease Control Classification (Appendix B), were excluded from the sample group. Participants acted as own controls for the study with the use of a CD4 analysis baseline reading at the first consultation. Participants were then assessed at mid-term (week 5) and final consultations (week 10) during the study. Sutherlandia frutescens 200CH, in granule form, was taken sublingually once a day for two weeks, with participants then taking no medication for three weeks until the mid-term consultation. The treatment regimen was repeated in the second half of the study. Physical examinations to assess vital signs and opportunistic infections, completion of a health status questionnaire and report-back sessions were conducted at all consultations to determine a general symptomatic picture of research participants. Blood samples taken at all consultations were analysed for CD45+ white cell count, CD4 percentage of lymphocytes and absolute CD4 cell count. The McNemar test and a One Factor Repeated Measure (ANOVA) test were used to give statistical results and to form a profile analysis. Analysed results show that treatment with Sutherlandia frutescens 200CH significantly improves several common signs and symptoms experienced by HIV positive people, including oral candidiasis, fever and skin rashes; a number of other pathologies showed improvement, but not to a statistically significant level. The analysis of CD4 cell counts demonstrated a significant decrease of absolute CD4 cell counts during the course of the study, even in the presence of a stable CD4 percentage. Statistical analysis also indicated a lack of consistency in change of CD4 percentage and absolute CD4 between participants, as well as a lack of correlation between change of CD4 percentage and absolute CD4 changes. As NO was not tested directly no assumption can be made as to how these results might have been influenced. Further research into the use of Sutherlandia frutescens in the treatment of HIV is none the less to be recommended given its reported large number of medicinal properties and its extensive use as an herbal supplement in HIV treatment in South Africa.

M.A. (Clinical Psychology) / TIle phenomenon of incest has been examined from differing perspectives over the past few decades and continues to be viewed from psychodynamic, sociological and systemic viewpoints. The past decade has seen a substantial increase in the volume of literature relating to child sexual abuse which includes incest, confirming that such abuse is a phenomenon which has become virtually endemic to our society. In its examination of incest, this dissertation attempts to, integrate intrapsychic views such as Erikson's (1950) developmental theory with more systemic orientated views such as the interactional view of Watzlawick, Beavin and Jackson (1967). Having criticised traditional views of incest, this dissertation goes further in attempting to integrate both the individual's particular perspective of the traumatic incident of incest during her childhood and how this incident affected her adult life, subsequent interactions and relationships. In integrating the apparently widely disparate approaches, this dissertation attempts to provide an alternative theoretical perspective around the phenomenon of incest. By integrating both psychodynamic (intrapsychic) and interactional (systemic) approaches, this dissertation seeks to avoid the pitfalls of rcification, distortion and reductionism. This dissertation adopted the methodology of a single case study. A clinical x interview was analysed according to Erikson's (1950) developmental stages and these stages were viewed from a systemic perspective. Erikson's developmental stages which are bipolar in nature, were proposed as double binding paradoxical contexts. As such, Erikson's views were seen as metaphors of systemic and heuristic value to the author. This dissertation hypothesised that the therapeutic system was a subsystem in interaction with the abusive subsystem and as such would reflect within its content and process the secrets and interactions of the incestuous family system. In investigating this hypothesis, the interactions between the secret incestuous subsystems and other family subsystems were examined. The findings of this work confirm the hypothesis. It is hoped that the application of this knowledge shall enable therapists and investigators to identify the possibility of incest in the narrative of adults and thereby avoid reports of incest being dismissed, avoided or clouded by scientific discussion. As such, the occurrence of incest, which is often an unmentionable secret, may be addressed and the patterns of incest identified in the initial conversation with the victim.

M.Tech. (Chiropractic) / PURPOSE: Shoulder pain has been identified to be one of the most common musculoskeletal problems found in a variety of different countries, showing characteristics of chronicity and recurrence. It is considered to be a main contributor towards nontraumatic upper limb pain. One of the identifiable causes of chronic or reoccuring shoulder pain may be attributed to myofascial pain syndrome which is caused by MTrP’s and produces symptoms that are similar to that of other shoulder pain syndromes. The infraspinatus muscle as an integral component of the rotator cuff complex is subject to high tension biomechanical strain as well as neuromuscular tension. While therapeutic interventions have been devised to treat varying degrees of biomechanical and neuomuscular tension, little evidence exists establishing which of these treatment regimes is most effective in treating myofascial trigger points. The purpose of this study was to compare different regional chiropractic adjustments relative to the attachment site and the innervation segment of the infraspinatus muscle and to identify the most effective treatment protocol with regard to chronic, active infraspinatus myofascial trigger point dysfunction. DESIGN: A selection of thirty participants were recruited for this study. The participants were divided into two groups of fifteen participants each. Group A received a chiropractic adjustment to the glenohumeral joint, the attachment site for infraspinatus muscle. Group B received a chiropractic adjustment to the cervical spine segments associated with the innervation to the infraspinatus muscle. Cervical spine restrictions specific to levels C4/C5 and/or C5/C6, and glenohumeral joint restrictions were determined using motion palpation techniques. All participants received a total of six treatments over a three-four week period. MEASUREMENTS: Subjective measurements were obtained by the Functional Rating Index Questionnaire and the Numerical Pain Rating Scale. Objective measurements were obtained using the hand-held pressure algometer and counting the number of active infrapsinatus myofascial trigger points. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the Functional Rating Index Questionnaire for the intragroup analysis indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (15.5%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (68.8%). The intergroup analysis indicated that there were no statistically significant differences. vii With regard to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (21.7%). There were no statistically significant differences with the intergroup analysis. The intragroup and intergroup analysis of the number of active infraspinatus myofascial trigger point dysfunction showed no statistically significant differences between the groups or within each of the groups over time. CONCLUSION: The results showed that both treatment groups protocols were effective in reducing chronic, active infraspinatus myofascial trigger point dysfunction. Small differences were noted between the two treatment groups with regards to the subjective and objective findings. The glenohumeral joint adjustment group showed the greatest clinical and statistical improvements over the three-four week trial period.

M.Tech. / This research study was conducted as an unblinded controlled pilot study. The aim of this research was to investigate the effects of Chiropractic adjustive therapy on lower back pain in South African Police Service (SAPS) operational mounted policemen in Gauteng. The participants for this research where obtained from the Johannesburg, East Rand, Vaal Rand and Pretoria SAPS Mounted units. Only male participants were recruited and placed into one group where they received Chiropractic adjustive therapy to the restricted Lumbar and Sacroiliac joints. Thirty participants were treated 6 times over a 3-week period, which translated to 2 treatments per week. A two day follow-up visit (visit 7) was conducted to obtain only subjective and objective data, no treatment was administered. An important part of this study was that the duties of the participants continued as usual and were not stopped during this trial. Subjective data was collected using the Oswestry Pain and Disability Questionnaire. Objective data was collected using lumbar range of motion (with a Digital Inclinometer) in flexion, extension, lateral flexion and rotation. All data was collected during the 1st, 4th and 7th visits. Additional data was collected by enquiring about the saddle type and stirrup length that the participants used. The data collected was analysed using Maunchly and Greenhouse Tests for parametric tests and the Friedman and Wilcoxon Signed Rank Tests for the non-parametric tests. The results of this study concluded that Chiropractic adjustive therapy was effective in relieving or completely eliminating the lower back pain of the participants as well as increasing there lumbar spine range of motion.

M.Tech.

M.Tech. / The aim of this study was to compare the effectiveness of cervical adjustment therapy, dry needling of the levator scapulae muscle and a combination of the two in the treatment of chronic mechanical neck pain. Forty-five patients were recruited via posters and advertisements from in and around the University of Johannesburg. The participants had to present with bilateral neck pain, decreased range of motion and an active levator scapulae muscles trigger point, which was diagnosed using range of motion and trigger point examination. The participants were randomly allocated into three groups of fifteen participants each. Prior to treatment a full case history, physical examination and cervical regional examination were performed to ensure that the patients were eligible to partake in the clinical trial. Group 1 was the adjusting group; group 2 was the combination group while group 3 was the needling group. Participants were treated five times over a period of three weeks. The objective measurements used in this clinical trial involved a cervical range of motion instrument (C.R.O.M., Performance Attainment Associates) and an algometer (Wagner Instruments). Subjective measurements were achieved using the Neck Pain and Disability Index (Appendix G) and the Numerical Pain Rating Scale (Appendix H). Each measurement was taken prior to treatment on the first and third visits and after treatment on the fifth visit with three measurements per participant overall. The statistical analysis was conducted using the Kruskal-Wallis, Friedman and Wilcoxon tests to compare data. The results indicated that the three groups responded favourably to their respective treatments. Overall, this study has indicated that dry needling of the Levator scapulae muscle provides no statistically significant contribution to the conservative treatment of mechanical neck pain caused by levator scapulae trigger points.

M. Tech. / It is well known internationally that the high prevalence of back pain costs the economies of the world many billions of dollars annually. This has prompted a great deal of research abroad into means of reducing the deleterious economic effects of back pain. One of the results of this research is the realisation that Chiropractic treatment of back pain offers an efficacious and cost effective alternative to the conventional medical treatments currently employed in most countries. To this end there has been a move, by health management organisations in the USA and Canada, toward the integration of Chiropractic into their health care systems in a gatekeeper role with notable success in terms of cost reduction. Similar research has not been conducted in the Republic of South Africa and, notwithstanding the evidence emerging from abroad, Chiropractic, although integrated into many health care systems, remains inaccessible to most back pain sufferers, particularly those employed in the lower ranks of industry. This is in large part due to the unavailability of Chiropractic services in the more remote areas of the country where many mines are situated, but also partly due to the lack of incentive for mining companies to make use of Chiropractic services. The data used in this study was obtained from the in-house medical aid of a reputable South African mining company. The data was used to summarise the cost of treatment of selected categories of back pain by the various service providers within the medical fraternity. The medical costs were then compared to the similarly summarised Chiropractic cost of treatment for the same categories of back pain. The results indicate that Chiropractic costs compare favourably with those of the General Practitioner (GP) and Physiotherapists on a stand alone basis. The data indicates however that the medical approach invariable leads to specialist referral that in turn often results in surgery with the associated imaging, theatre and hospitalisation costs. When these costs are considered it becomes obvious that Chiropractic involvement at an early stage has the potential to considerably reduce the cost of treatment of back pain.