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Theses and dissertations (Health Sciences)

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End date: 2019Subject: search.filters.subject.Spinal adjustment

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    The effect of cervical spine manipulation on grip strength and muscle activity in asymptomatic participants with cervical spine dysfunction
    (2018) Fenton, Daniel James; O'Connor, Laura
    Objective: The effects of spinal manipulation are well documented, however there is a gap in the current literature regarding the neurophysiological mechanisms responsible for these effects. Further evidence is required to reveal the specific neurophysiological mechanisms of spinal manipulative therapy and its effect on muscle activity. The objectives of this study were to investigate the short-term effects of a single cervical spine manipulation on grip strength and muscle activity of the forearm flexors and extensors in an asymptomatic sample when compared to a control. Methods: A randomised, controlled, pre-test, post-test, repeated measures design allowed for 46 participants, aged 18-35 years old, with joint dysfunction at C7 to be allocated to either a cervical spine manipulation or a control group. Force output and muscle activity of the forearm flexors and extensors were measured before and immediately after the intervention and again at 5, 10 and 15-minutes. IBM SPSS was used to analyse the data with significance set at (p=0.05). Repeated measures ANOVA testing and Post hoc contrast studies were used to determine significance within, and between, groups. Results: In the treatment group there was a statistically significant change in muscle activity over time in the Extensor carpi radialis (p=0,013) and Extensor digitorum (p=0,021). Similarly, force output increased within the treatment group over time (p=0,012). A statistically significant beneficial treatment effect was identified between the groups in the Extensor carpi radialis (p=0,001) and Flexor digitorum superficialis (p=0,019) muscles only. Conclusion: Though statistical significance was not detected in all muscle groups, this study showed a trend of a treatment effect following cervical spine manipulation (C7) with most values lying just outside the parameters set for significance. Specific muscles of the forearm were affected more than others. Future studies are required with a larger sample to validate the trends observed in this study.
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    The effect of cervical spine manipulation on elbow proprioception, electrical activity of the triceps and biceps muscles and balance
    (2018) McKay, Hannah Lenka; Matkovich, Grant
    Objectives The purpose of this study was to determine the effect of cervical spine manipulation (CSM) on joint position sense (JPS) of the elbow; electrical (muscular) activity of the biceps and triceps brachii muscles and balance. Background Balance is a complex process requiring constant communication between the visual, the vestibular and the somatosensory (nervous) systems. JPS and electrical activity of muscles play an important role in maintaining balance. Many of the tracts relaying information regarding JPS, electrical activity and balance pass through the cervical spine. It is thought that cervical spine fixations have a negative effect on the surrounding neurology and thus affect somatosensory integration. Therefore, correction of cervical spine fixations with CSM may improve and restore normal function, including, but not limited to, elbow JPS, electrical activity of the biceps and triceps brachii muscles and balance. Methods Institutional Research Ethics Committee (IREC) approval of the study was obtained (IREC reference number: REC 115/16). A quantitative, descriptive, pre-test post-test randomised control trial investigation design was utilised. A pilot study was performed to validate the experimental procedures. Potential participants were assessed through a telephonic interview, a case history and a physical examination, to screen them against the inclusion criteria. Eighty-one participants between the ages of 18-35 years were randomly allocated to either the control (n = 20) or the intervention group (n = 61). The intervention group was further stratified into three subgroups, namely upper cervical spine fixations only (C0-C3); lower cervical spine fixations only (C4-C7) and both upper and lower cervical spine fixations. Each participant completed two pre-tests for static balance (eyes open and closed) and dynamic balance (eyes open and closed) [Biosway Biopac balance system]; one pre-test for electrical activity of biceps and triceps brachii muscles at rest and then during an active movement; and one pre-test of the ipsilateral elbow for JPS [Biopac AcqKnowledge sEMG machine and goniometer]. All tests were performed on the dominant arm. The intervention group then received CSM to correct the fixated segments. The control group underwent a 20 second rest period instead of the CSM. The electrical activity of the biceps and triceps brachii muscles was recorded during the intervention period. The pre-tests were then repeated as post-tests immediately following the intervention. Analysis was by paired sample t-tests (pre and post outcomes for intra-analysis). Independent t-tests were conducted to determine mean differences between the control group and intervention group. An ANOVA test was conducted for mean differences from pre- and post-intervention readings between the control group and the three intervention subgroups. If the null-hypothesis was rejected, then post hoc tests were conducted to detect where the differences lay. A p- value < 0.05 was considered statistically significant. The effect size (Cohen’s d), was also used to determine the magnitude of the effect of interest. Results There was no statistically significant improvement in elbow JPS immediately following CSM. The combined intervention group showed a statistically significant increase in the electrical activity of biceps (p < 0.001) and triceps brachii (p = 0.004) muscles during the CSM. The group that received upper CSM only had the greatest increase during CSM in both muscles (p = 0.04 for biceps and p = 0.024 for triceps. This group also had a sustained increased electrical activity that was statistically significance for a 10% level of significance (p = 0.09), during the rest period. There was a statistically significant improvement in dynamic balance for the combined intervention group (p = 0.012). Of the subgroups, the lower CSM only group had the greatest improvement in dynamic balance (p = 0.035) followed by the upper CSM only group (p = 0.074, significant for a 10% level of significance). Comparison of the four groups indicated two trends in the outcomes. The first trend was that the upper CSM only group had the greatest effect size for elbow JPS improvement and increased electrical activity for the biceps and triceps brachii muscles during the intervention and rest period, as well as a statistically significant difference in dynamic balance at a 10% confidence interval (p = 0.074). The second trend was in the lower CSM only group, which had the greatest effect size in decreasing electrical activity during the active movement as well as the greatest statistically significant improvement in dynamic balance (p = 0.035). Conclusion This preliminary study indicates that there is no immediate improvement in elbow JPS following CSM as a once off intervention. CSM has an immediate effect on increasing electrical activity of the biceps and triceps brachii muscles during the CSM. CSM also improves dynamic balance. Upper CSM has the greatest effect on electrical activity during the CSM and rest period. Lower CSM has the greatest effect in improving dynamic balance.
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    Origins and control of bacterial contamination during spinal manipulation
    (2018) Amod, Fariya; Swalaha, Feroz Mahomed; Reddy, Poovendhree
    Background: Research has revealed that healthcare workers’ hands serve as a source and vehicle for the transmission of micro-organisms within the healthcare sector, thus resulting in nosocomial infections, better known as healthcare-associated infections. The chiropractic profession is traditionally known as a hands-on profession, where the fundamental treatment protocol includes manual manipulation of the spine. In order to perform these procedures hand-to-patient interaction is required, resulting in skin-to-skin contact. Poor hand hygiene practice has been attributed by the World Health Organization as the primary cause for the spread of micro-organisms within the healthcare environment. Unwashed hands harbour microbes, thus increasing contamination levels and subjecting patients to these potential pathogens. This study aimed to determine the presence and transfer of bacterial contamination occurring during spinal manipulation, as well as analysing the efficacy of decontaminants used by chiropractic practitioners against the isolated bacteria cultivated. Research design: The study was located in the quantitative experimental paradigm and conducted as a cross-sectional investigation. Method: Samples were obtained from chiropractors’ hands before and after spinal manipulation. Samples were then serially diluted, plated in duplicate (using the spread plate technique) and incubated for 24-48 hours at 37°C. Viable counts of colony forming units (CFUs) were then enumerated in order to verify the presence of bacteria on the chiropractors’ hands, as well as to establish the direction of transfer occurring during spinal manipulation. Macroscopic and microscopic characteristics of each bacterial isolate were used to identify the bacteria cultivated. A modified Kirby Bauer technique was used to ascertain the efficacy of decontaminants commonly used by chiropractors, against the isolated bacteria obtained from their hands. Results: Bacterial flora were present on 100% of the chiropractors hands both pre- and post-spinal manipulation. A mean of 16,456 (27,718) cfu/ml⁻¹ were enumerated from the samples collected from the chiropractors’ hands during manipulation. A paired t-test indicated a significant difference noted in the viable count of bacteria found on the chiropractors’ hands before and after manipulation (p<0.001). A significant difference was observed in the viable count of bacteria post-manipulation (70%), as opposed to the pre- manipulation readings (30%).This was indicative of a higher rate of bacteria being transferred from the patient to the chiropractor during spinal manipulation. The majority of the microorganisms identified were either primary or opportunistic pathogens. Staphylococci were most prevalent in the pre-spinal manipulation readings accounting for 53% of the colonies, followed by micrococci with 39%, bacilli with 4%, Staphylococcus aureus with 3% and streptococci with 1%. Pseudomonas spp. were present but uncommon. Escherichia coli were not present on the chiropractors’ hands in any of the samples obtained pre-manipulation. The post-manipulation readings constituted a high prevalence of micrococci accounting for 57% of the colonies, followed by staphylococci with 32%, Pseudomonas spp. with 5%, E. coli with 3%, Staphylococcus aureus with 2% and bacilli with 1%. Streptococci were present but uncommon. The decontaminants tested were most effective against gram-positive bacteria such as Bacillus, Micrococcus, Staphylococcus, Staphylococcus aureus and Streptococcus. The bacteria isolated were most susceptible to the D-Germ hand disinfectant, while the Dis-Chem instant hand sanitizer was the least effective decontaminant tested. Ciprofloxacin was the antibiotic used as a positive control. A significant difference was noted between the performance of the positive control and the decontaminants on the bacteria isolated. Conclusions and recommendations: The study proved the presence of primary and opportunistic pathogens found on the chiropractors’ hands. These included Staphylococcus spp., Micrococcus spp., Bacillus spp., Pseudomonas spp., E. coli, Streptococcus spp. and Staphylococcus aureus. A higher rate of bacteria was observed being transferred from the patient to the chiropractor during spinal manipulation. The majority of the microorganisms identified were either primary or opportunist pathogens, thus predisposing both the patient and the chiropractor to potential infection. A significant difference was noted between the performance of the positive control and the decontaminants on the bacteria isolated. None of the decontaminants were as effective against the bacteria isolated as the positive control. It can therefore be deduced that each bacterial flora was not removed by some of the decontaminants currently used by chiropractic practitioners in practice.
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    The immediate effect of sham laser and three different spinal manipulative protocols on the throwing speed of baseball players in the KwaZulu-Natal Baseball Union
    (2018) Robson, Michael; Haswell, Garrick David
    Background: ABSTRACT Baseball pitching is a whole body ballistic movement that requires transfer of energy from the lower extremity to the upper extremity via the trunk. Adverse changes can occur within the surrounding ligaments, tendons and muscular tissue of the trunk when immobilization or restricted motion within a joint segment occurs. Improper transfer of energy is thought to cause abnormal stresses on the joints and may lead to injury and/or decreased performance. Spinal manipulation therapy (SMT) was the focus of this study, aimed to improve flexibility and joint mobility (Range of motion), thereby allowing for a more efficient closed kinetic chain movement, which could result in a faster speed of the baseball pitch. Objective: To determine and compare the immediate effect of placebo and SMT of the thoracic and lumbar spines in respects of range of motion (ROM) and the velocity of the pitching participants. Methods: Fourty asymptomatic baseball players were divided randomly into four groups. Group A received thoracic spine manipulation, Group B received lumbar spine manipulation, Group C received combined thoracic and lumbar spine manipulation and Group D received the sham laser intervention as a placebo controlled group. Pre- and post- intervention trunk flexion and lateral flexion ROM and pitching speeds were measured, using a digital inclinometer and a radar gun respectively. A subjective measurement of the participant’s perception of a change in pitching speed post-intervention was also recorded. SPSS version 23 was used to analyse the data. Results: There was a significant increase in pitching speed in the SMT interventions groups (p<0.05). However, between the SMT and placebo groups they were not considered significantly different at 5% (p>0.05). A significant increase in Thoracic RLAT ROM was noticed on the inter-group analysis (p<0.05). There was no correlation seen between subjects’ perception of change in throwing speed post-intervention and the objective results obtained. Conclusion The immediate effect of SMT on baseball pitching speed was inconclusive. The outcome of this study suggests that SMT results in an increase in the average speed of baseball pitching but not at a level of statistical significance.
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    The effectiveness of an electromechanical adjusting instrumental compared to cervical spine manipulation in the treatment of cervicogenic headaches
    (2018) Whittaker, Russell; Varatharajullu, Desiree
    Background: Cervicogenic headaches are usually chronic, debilitating and tend to be unresponsive to common headache medications. Manual therapy has been shown to be an effective form of management for cervicogenic headache. The Electromechanical Adjusting Instrument is a hand-held device offered as an alternative to manual therapy for musculoskeletal treatment. Aim: The aim of this study was to determine the effectiveness of the Electromechanical Adjusting Instrument compared to cervical spine manipulation in terms of subjective and objective measures in the treatment of cervicogenic headache. Methodology: This study was a randomised single-blinded clinical trial. There were 41 participants between the ages of 18 and 59 years who were randomly divided into two groups of 21 and 20 respectively by means of a randomisation table drawn up by the statistician. Participants in Group A received cervical spine manipulation while those in Group B received the Electromechanical Adjusting Instrument. Subjective headache intensity was determined using a Numerical Pain Rating Scale. The effect of neck pain on the participants’ activities of daily living before and after treatment was assessed using the Neck Disability Index. The effect of the headache on the participants’ activities of daily living before and after treatment was assessed using the Headache Disability Index. Objective cervical range of motion in all six planes of motion was assessed using a CROM goniometer. Participants in both groups received six interventions over a three-week period with a minimum interval of 48 hours between each intervention. The subjective and objectives assessments were taken at baseline, post-third and post-sixth interventions. The data was analysed using the IBM SPSS version 24.0. Repeated measures ANOVA was used to examine the effect on each outcome measure separately of time and treatment group interaction. Profile plots were generated to show the rates of changes in outcomes over time by the intervention group. A p value <0.05 was considered statistically significant. Results: For most of the outcomes, there was no clinical or statistical interaction present, i.e. the intervention effect was similar in both groups irrespective of the intervention. Conclusion: The trends in each of the outcomes suggest that the Electromechanical Adjusting Instrument is as effective as cervical spine manipulation for the treatment of cervicogenic headache
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    The effect of sacroiliac joint manipulation compared to manipulation and static stretching of the posterior oblique sling group of muscles in participants with chronic sacroiliac joint syndrome
    (2017) Swanepoel, Shaylene; Kretzmann, Heidi Marise; Clifton, Stuart Ronald
    Sacroiliac joint syndrome is diagnosed in patients who complain of various painful symptoms associated to their lower back, for example: hip and groin pain, sciatica pain, and / or a need to frequently urinate. They further report that their pain is further intensified when standing from sitting, stair walking, bending forward or from sitting or standing too long. Sacroiliac joint syndrome has been widely accepted by health professions as a contributor to low back pain. Spinal manipulation has shown to be an effective method for pain relief of this condition. Studies have been done using physical therapy in conjunction with manipulation in treating sacroiliac joint syndrome. However, little research has been done on the effects of static stretching and manipulation combined. The posterior oblique sling group of muscles is created by the biceps femoris, gluteus maximus, erector spinae and latissimus dorsi muscles. The sacroiliac joint can be affected by the functional relationship of the posterior oblique sling muscles. These muscles are involved in forces across the sacroiliac joint. Tightness of muscles can affect the sacroiliac joint. Flexibility is an essential element of normal biomechanical functioning. Flexibility of muscles, tendons and ligaments can influence a joints range of motion. There is evidence that suggests that stretching could increase a joint’s range of motion which was evident one or more days after the stretching protocol in people without clinically significant contractures. Upon review of the related literature, it appears that there is insufficient literature assessing the clinical effectiveness of static stretching of the posterior oblique muscle sling group with respect to sacroiliac joint syndrome. Therefore this study is aimed at providing insight into the role of the posterior oblique muscle sling group in participants with and chronic sacroiliac joint syndrome. It is hypothesized that effective treatment of these muscles will allow for a more effective outcome of symptoms. The study design chosen was a randomised, clinical trial consisting of thirty voluntary participants’ between the ages 18 to 45 years suffering from chronic sacroiliac joint syndrome. There were two groups of fifteen participants, who received four treatment consultations within a two week period. Participants placed into Group One received sacroiliac joint manipulation only, while participants in Group Two received static stretching of the posterior oblique muscle sling and sacroiliac joint manipulation. Subjective and objective readings were taken at the first, third and fourth (final) consultations. The Numerical Pain Rating Scale (NRS) and the Oswestry Low Back Pain Disability Index (OSW) questionnaires were used to assess the subjective findings whilst the objective measurements were collected from results of algometer and inclinometer readings. The intra-group analysis revealed there was a statistically significant improvement within both groups for NRS, OSW, and inclinometer results. It appeared that Group Two fared better in terms of the algometer (pressure) results. The inter-group analysis revealed that all comparisons apart from the algometer readings had no statistically significant improvement between the two groups. From the intra-group comparisons of the objective data, participants in both groups experienced a statistically significant improvement. However, Group Two fared better in terms of the algometric pressure readings (p = 0.001). This study confirms that both treatment protocols were effective in reducing the signs and symptoms associated with sacroiliac joint syndrome. Although the readings were not statistically significant, there is evidence that Group Two responded better than Group One in terms of the algometer readings (Figure 4.13). There is insufficient literature on studies related to the posterior oblique sling muscles, and therefore, comparisons are needed with respect to the posterior oblique muscle sling group and its effects on the sacroiliac joint. This study concludes that overall there was no statistically significant difference between the two groups and recommends that further studies be undertaken with a greater number of participants to gauge if a more significant result can be achieved.
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    The relative effectiveness of spinal manipulation versus spinal manipulation in conjunction with low back strapping in the treatment of mechanical low back pain, in the dysfunctional phase
    (2000) Broughton, Amanda Lynne; Kretzmann, Heidi
    The absence of tested theory has resulted in a continued variation in protocols for the treatment of mechanical low back pain. This study was designed in order to determine the relative effectiveness of spinal manipulation versus spinal manipulation in conjunction with a low back strapping in the treatment of mechanical low back pain in the phase of dysfunction.
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    The effectiveness of manual manipulation versus the Activator Adjusting Instrument in the management of acute facet syndrome of the lumbar spine
    (2003) Gillespie, David McKenzie; White, Horace Lindsay
    The purpose of this study was to compare the relative effectiveness of manual manipulation versus the Activator Adjusting Instrument in the management of acute facet syndrome of the lumbar spine
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    The relative effectiveness of spinal manipulation as opposed to exercise therapy on mechanical low back pain in postnatal patients
    (1998) Bailes, Brendon John; Mathews, Robert
    The cause of postnatal low back pain is not clearly understood. There have been few studies performed to determine the cause, and several theories have attempted to explain the occurrence of postnatal low back pain. It is suggested that an exaggerated lumbar lordosis, laxity of the ligaments due to relaxin, biomechanical strain on the muscles and ligaments of the lumbar spine and pelvis and temporary compensatory posture are possible aetiologies of postnatal low back pain. (Calguneri et al. 1982; Bullock et al. 1987 ; Berg et al. 1988; Wisneski et al.1992: 711 ; Mantle 1994:799.)
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    A study of the relative effectiveness of the lumbar roll and the spinous push technique in the treatment of facet syndrome in the lumbar spine
    (1996) Jansen, Petrus C.; Till, A. G.
    Lower back pain due to mechanical dysfunction is a common cause of pain and disability in mankind. Lumbar spine facet syndrome is a major aetiology in mechanical lower back pain