Theses and dissertations (Health Sciences)
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Item Gymnastics injuries: a quantitative profile of athletes in the greater Durban area(2006) Adamson, Ingrid; Lakhani, EktaThe aim or purpose of this study is to determine the injury profile of gymnasts in the greater Durban area of KwaZulu-Natal, South Africa; and to compare it with the international data that are available. Factors that should be considered regarding differences in the injury profile of South African gymnasts as compared with international gymnasts include: 1. Difference in standard of gymnastics (Cameron-Smith, 2005) 2. Sudden increase in the standard of South African gymnastics in an attempt to match that of other countries, which may lead to an increase in training hours, and attempts at more risky new manoeuvres. This, in turn, may increase the risk of injury (Cameron-Smith, 2005). For the purpose of this study, the following information was gathered in terms of: - Demographics of South African gymnasts - The participants’ gymnastics history - The presence of any past or current injuries, and - If present, factors relating to these injuries were investigated. This information mentioned above was gathered with the aim of helping to identify any problems that may exist, quantifying the extent of these problems and identifying to some extent the potential risk factors. This would be beneficial to South African gymnasts if recommendations for prevention of potential injuries were made, should any common injuries, or possible risk factors or associations be discovered/identified (Chadwick, 2004).Item The relative effectiveness of myofascial trigger point manipulation as compared to proprioceptive neuromuscular facilitative stretching in the treatment of active myofascial trigger points: a pilot clinical investigation(2006) Berry, Jason; Mac Dougall, TarrynMyofascial pain syndrome (MPS) is defined as the sensory, motor and autonomic symptoms caused by myofascial trigger points (MFTPs), or hyperirritable spots within skeletal muscles that are associated with palpable nodules in a taut band. The fact that MFTPs have been described in the literature for acupuncturists, anaesthesiologists, chronic pain managers, dentists, family practitioners, gynaecologists, neurologists, nurses, orthopaedic surgeons, paediatricians, physical therapists, physiologists, rheumatologists and veterinarians is evidence of the syndrome’s clinical importance. As a result of a large amount of research, a large number of different treatments have been shown to be clinically effective in the treatment of MFTP. These treatments include amongst others: - Ischaemic compression. - Myofascial manipulation. - Spray and stretch. - Ultrasound. - Transcutaneous electrical nerve stimulation. - Dry needling. As can be seen from the above, it is important to be able to treat MPS effectively because it is such a common disorder. According to Schneider an effective treatment is needed for MPS, despite the array of treatments available to a clinician. Han and Harrison agree that more studies are required to determine the efficacy of these treatments. The aim of this study is to evaluate the relative effectiveness of Myofascial Trigger point Manipulation (MFTPM) as compared to Proprioceptive Neuromuscular Facilitative (PNF) stretching in the treatment of active Myofascial Trigger Points (MFTPs) in the trapezius muscle (TP 1 and/or TP 2) in terms of subjective and objective clinical findings. The study required a total of 60 patients, which following acceptance were then randomly divided into two groups of 30, with an equal number of male patients in Group one (MFTPM) and two (PNF), and female patients in Group one and Group two. Each patient had four consultations (three treatments and one follow up visit) in a two week period. Subjective and Objective Data was recorded at each consultation prior to the treatment. Subjective measurements (Numerical Pain Rating Scale and Short Form McGill Pain Questionnaire) were taken prior to the treatment at all four visits. Objective measurements (Cervical Range of Motion Meter and Algometer) were also taken prior to the treatment at all four visits, except for Algometer readings which were taken at the initial consultation and the fourth treatment only. SPSS version 11.5 was used for analysis of data (SPSS Inc, Chicago, Ill, USA). Baseline comparisons were done between treatment groups using Pearson’s chi square tests or Fisher’s exact tests as appropriate for categorical variables, and student’s t-tests for quantitative normally distributed variables. Treatment effect was assessed with repeated measures ANOVA. A significant time by group interaction indicated a significant differential treatment effect. A p value <0.05 designated statistical significance. The direction of the treatment effect was assessed with profile plots. Evaluation of data collected from both groups showed a significant improvement in terms of objective and subjective clinical findings to a value of p=< 0.001. There was no statistical difference between the two groups in terms of objective and subjective clinical findings, although a trend was shown when looking at the objective findings that suggest that MFTPM was more effective than PNF stretching. The sample population was drawn from a very homogenous group of people (i.e. SARS call centre), in order to achieve greatest emphasis on clinical outcomes. This process however limits the clinical applicability of the results and thus will not always be applicable to all patients within the population. It is therefore the researcher’s conclusion that there is no statistical difference between MFTPM and PNF stretching in terms of objective and subjective clinical findings. Both treatment modalities have been shown to be equally effective in the treatment of subacute active TPs in the upper tarpezius. There is a definite trend when looking at the objective data that may support the hypothesis that MFTPM is as effective as, if not more effective than PNF stretching. It is of the opinion of the author that a larger sample size is needed to make it clinically significant.Item The assessment of the knowledge and perception of personal trainers within Durban with respect to chiropractic(2006) Kew, Michelle FelicityIf the professions of chiropractic and personal training are to work together for the total well-being of the client, then it has to be assessed whether or not a milieu of co-operation exists, and if it does not, possible reasons for the lack thereof. It was the purpose of this study to determine the current knowledge and perceptions of personal trainers (PTs) with respect to the chiropractic profession in Durban. This study therefore established a knowledge base to facilitate greater understanding and co-operation between PTs and chiropractors regarding the referral of clients, who may benefit from a combined treatment program from the PT and chiropractor.Item A clinical investigation into the effect of spinal manipulative therapy on chronic idiopathic constipation in adults(2006) Vadachia, Ruwaida; Korporaal, Charmaine MariaChronic Idiopathic Constipation (CIC) is a common patient complaint (Browning 1999) and as such is defined as : “Constipation” being the infrequent or difficult evacuation of faeces, “idiopathic”, denoting the condition occurs in the absence of any known cause and “chronic”, implying a problem that has persisted for a long time (Anderson 1989). It has been suggested that the bony subluxation or motion segment dysfunction in the spine, could produce these symptoms (e.g. altered visceral function) in the segmentally related visceral structures (Korr 1976, Nansel and Slazak 1995, Budgell 2000). In support of this three case reports in the literature suggest that spinal manipulative therapy to effect removal of these bony subluxations or motion segment dysfunctions, may relieve chronic idiopathic constipation (Hewitt 1993, Marko 1994, Redly 2000). However all three cases involved a single patient case analysis, where patients received spinal manipulation and a vast improvement in bowel function within three weeks of the initiation of the intervention was noted. Only one case report measured global wellbeing outcomes and was able to document a steady increase in the patient’s sense of wellbeing (Redly 2000). As a result of the above evidence in the literature, the researcher was led to the following hypotheses regarding spinal manipulation and chronic idiopathic constipation: • That spinal manipulation would affect a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. • That placebo would affect an increase in the subject’s abdominal pain intensity and level of constipation and a decrease in the subject’s sense of wellbeing and spinal range of motion. • That spinal manipulation would be more effective than placebo in bringing about a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion.Item The effectiveness of sacroiliac manipulation alone versus sacroiliac manipulation following ischaemic compression of gluteus medius trigger points in the treatment of sacroiliac syndrome(2002) Thompson, NeilIn recent years, sacroiliac syndrome has been widely accepted by many different health professions as one of the major contributors to mechanical low back pain. Manipulation to effect the relief of the condition has thus far proven to be one of the most effective methods. However, comparatively little research has been done on the different forms of physical therapy that can be used in conjunction with a manipulation so as to maximise its effect. This study focussed on the use of ischaemic compression (a well-accepted technique for the treatment of myofascial trigger points) of the gluteus medius muscle.Item An epidemiological study of low back pain in a student population of a South African tertiary educational institution(2004) Smith, Craig DesmondEpidemiological studies, conducted in various countries around the world suggest that low back pain (LBP) represents a serious health risk, affecting populations all over the world. Evidence suggests that the prevalence of LBP is relatively high among people in their 20’s and 30’s. A few epidemiological studies on student populations in other countries suggest prevalence rates of 27 to 71% (Gemmel et al. 1990, Klaber-Moffet et al. 1993, Reis et al. 1996, Lebowski 1997), however LBP among students in South Africa had not yet been investigated. This study concentrated on the prevalence of LBP among the student population of a South African tertiary institution, i.e. Durban Institute of Technology (DIT). This study also proposed to investigate the level and nature of care seeking among those people suffering from LBP. A third aim of this study was to investigate the correlation between potential risk factors and the prevalence of LBP among the student population of South Africa. These were: age, gender, race, height, weight, smoking habits, parity, physical exercise and occupation.Item The treatment of myofascial pain syndrome using therapeutic ultrasound, on upper trapezius trigger points : a double-blinded placebo controlled study comparing the pulsed and continuous waveforms of ultrasound(2003) Pillay, Magendran GanasThis study was a prospective, randomised, double blinded, placebo controlled, comparative clinical trial to establish the efficacy of therapeutic ultrasound and compare the effectiveness of the two waveforms of ultrasound in the treatment of myofascial pain syndrome.Item The immediate effect of sacroiliac manipulation on hip strength in patients suffering from chronic sacroiliac syndrome(2004) Matkovich, GrantThe aim of this investigation was to investigate whether an immediate objective increase in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome. The actions of hip flexion, extension, abduction and adduction were assessed. The study also investigated the patients’ subjective perception of pain due to the chronic sacroiliac syndrome before and after the manipulation. The proposed increases in strength would have been as a result of a reduction in arthrogenic muscle inhibition. Stimulation of nociceptors caused by the chronic sacroiliac syndrome would have lead to the presence of the arthrogenic muscle inhibition within the joint. Arthrogenic muscle inhibition has been described as an inability of a muscle group to utilise all its muscle fibres when performing a maximum voluntary contraction of that muscle group. Arthrogenic muscle inhibition is a joints natural response to pain, damage or distension within the joint. The response is an ongoing reflex inhibition of the muscles surrounding the joint in order to protect the joint. The inhibition of the surrounding musculature clinically manifests itself as a decrease in strength of the affected muscles. The decreased strength levels hampers rehabilitation of the affected joints as active exercise forms a vital role in the rehabilitation process. Current treatment options used to reduce arthrogenic muscle inhibition include lidocaine injection into the joint, cryotherapy and transcutaneous nerve stimulation. These treatments are aimed rather at the reduction of pain, joint effusions and atrophy of the related musculature than at the reduction of arthrogenic muscle inhibition. Recent studies have proposed that manipulation reduced arthrogenic muscle inhibition by causing excitation of the joint receptors, called the Wyke receptors. Stimulation of these joint receptors is thought to cause an alteration in the afferent input to the motorneuron pool resulting in a reduction of arthrogenic muscle inhibition. This study aimed to investigate whether sacroiliac manipulation could reduce arthrogenic muscle inhibition at the hip by assessing the immediate gains in hip muscle strength. The problem statement was to evaluate if an immediate subjective or objective change in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome.Item The immediate effect of spinal manipulative therapy on club head velocity in amateur golfers suffering from mechanical low back pain(2004) Jermyn, Gareth JohnBackground: Back pain among the golfing population is considered endemic as it has been recommended to golfers that they should attempt to use a state of maximal spinal rotation in their golf swing in order to achieve maximum ball distance. Evidence suggests that maximum spinal rotation range of motion will be more restricted in the golfers with low back pain, even though this maximum rotated position has been considered ideal for developing optimal Club Head Velocity (CHV). Research has demonstrated an approximate 1:3 relation between CHV and air travel (i.e. distance) of the golf ball. An increase in 1mph in CHV would increase air travel of the golf ball by approximately 3 yards. If one considers that CHV is primarily influenced by the strength and power of the torso (low back and abdominal muscles), muscle balance and flexibility, which are responsible for the static and dynamic postural stability of the golf swing, it stands to reason that low back pain, which has been identified as the most common problem affecting amateur golfers, will affect CHV. Objective: The purpose of this investigation was to evaluate the immediate effect of spinal manipulative therapy on club head velocity in amateur golfers suffering from mechanical low back pain in terms of subjective and objective measures.Item A comparative investigation into the effectiveness of two mobilizations in the treatment of symptomatic Hallux abductovalgus (bunions)(2003) Herholdt, Carel Theron; Kretzmann, HeidiThe purpose of this study was to compare two forms of mobilization in the treatment of symptomatic Hallux abductovalgus (bunions). The study was a prospective, randomized clinical trial involving sixty subjects, thirty in each group, which were selected by means of convenience sampling from the general population within the greater Durban area. Group A received a Strain counter-strain mobilization (SCSM) of the first metatarso- phalangeal joint, used in conjunction with cryotherapy. Group B received Brantingham's mobilization (BM) of the first metatarso-phalangeal joint, used in conjunction with cryotherapy. Each group received five treatments over a two-week period and were required to attend a one-week follow up consultation for data collection. Subjective assessment was carried out by means of the Numerical Rating Scale-101 (NRS-101) and the Foot Function Index (FFI). Objective assessment included measuring the pain pressure threshold using a digital algometer, the hallux valgus angle and passive dorsiflexion and plantarflexion of the first metatasal phalangeal joint were also measured using a goniometer. The Hallux-metatarsophalangeal-interphalangeal Scale (HAL) included assessment of both subjective and objective measurements. Subjective and objective assessments were performed and data collected on the first, third, fifth and one week follow up consultations. Statistical analysis was completed at a 95% confidence interval. Inter-group analysis was done, using the Mann-Whitney U-test for subjective data and the unpaired t-test for objective data. Intra-group analysis was carried out using Friedman’s test and Dunn’s procedure. In terms of subjective findings, both groups revealed a statistically significant improvement in terms of pain perception (NRS-101) over the treatment period. Both groups experienced a significant improvement in the Foot Function Index (FFI) in terms of pain and disability. Despite both groups improving, it seemed that Group B (Brantingham’s Mobilization) improved considerably more that Group A ( Strain counter-strain mobilization) when comparing the percentage improvement over the treatment period.