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Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

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Start date: 2023Subject: search.filters.subject.Manipulation (Therapeutics)

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    Muscle recruitment patterns of selected upper extremity muscles in Chiropractors within the eThekwini Municipality while performing a simulated sacroiliac joint manipulation
    (2024) Luke Hardy, Benjamin; Murphy, Bernadette; O’Connor, Laura
    Background: Spinal manipulative therapy in the form of a high velocity, low amplitude manipulation, is a specialised therapeutic technique utilised by chiropractors and other manual therapists. Little is known about the shoulder muscular recruitment pattern utilised by practitioners/student’s to deliver this technique. This study aims to profile the muscle recruitment patterns of selected upper extremity musculature during a simulated sacroiliac joint manipulation to provide objective teaching material for future spinal manipulative therapy students regarding this specific manipulation. Methods: A quantitative, descriptive, observational design in which surface electromyography (sEMG) was used captured muscle activation patterns of 11 shoulder muscles in 20 qualified chiropractors who practiced in the eThekwini Municipality. Muscle activity was recorded while the chiropractors performed a simulated sacro-iliac joint manipulation, while simultaneous live video recording was obtained. The manipulation was assessed during its three phases: preload, thrust and resolution. Participants gave informed consent. Raw data was processed and normalised for comparability. Results: All 11 muscles displayed activity throughout the three phases of the adjustment. During preload, the clavicular and sternal pectoralis major and biceps brachii had the greatest mean and median muscle activation magnitude, with the middle and upper trapezius and clavicular pectoralis major showing the greatest maximum muscle activation magnitude. In the thrust phase all muscles showed high activity levels, except for the posterior deltoid which showed moderate activation. The middle and lower trapezius and infraspinatus had the greatest mean, median and maximum muscle activation magnitude. During the resolution phase, the greatest median muscle activation magnitude was found in the middle and lower trapezius and posterior deltoid muscle. This was similar to the greatest mean and maximum muscle activation with the triceps brachii replacing the lower trapezius. The maximum force output during the adjustment was averaged at ± 1.9 Kg. Conclusion: This study highlights the role of the shoulder muscles, specifically the pectoralis and the scapular stabilizer muscles, especially the middle trapezius, in the execution of the spinal manipulative technique investigated in this study. Future studies should confirm these findings in larger population where subgroup analysis can be undertaken.
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    The effects of an upper cervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture
    (2023-05-31) Petzer, Matthew; Abdul-Rasheed, Ashura
    Background: Postural dysfunction in the cervico-thoracic spine often leads to segmental restrictions and hypomobility, and this is often caused by biomechanical alterations due to postural changes and over activity of skeletal muscles in that region. These muscles include the pectoralis and trapezius muscles. Postural dysfunction and joint restrictions are often treated by manual therapies, such as spinal manipulation. Previous studies have established that joint manipulation reduces postural dysfunction and improves joint mobility, which could be explained by a combination of neurophysiological,and biomechanical effects.In literature, the immediate benefitsof acervico-thoracicmanipulation on muscleactivityandposture are not well understood and, therefore, an investigation into the immediate effects of manipulation on muscle activity and posture was implemented in this study. Aim: This study aimed to observe the immediate effect of an uppercervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture. Methods: This study was a quantitative, observational study with a pre-test posttest design. Surface electromyography was used to measure the muscle activity of the pectoralis major, upper and middle trapezius muscles prior to and after the cervico-thoracic intervention. A sample size of 40 asymptomatic participants were recruited to participate. The participants were randomly divided into two groups: group A, which was the control group, and group B, which was the intervention group. The intervention group received a cervico-thoracic manipulation, but the control group received no intervention and remained prone for 3 minutes between the pre-test and post-test readings. The within-group comparisons of pre- and postmuscleactivity were achieved usingpairedT-tests. Within groupandbetween group comparisonsof the change between pre- andpost-intervention wereachieved using repeated ANOVA testing. A p-value below 0.05 was statistically significant. IBM Statistical Package for Social Sciences (SPSS) version 26 software was used to process the data. Results: There was no statistically significant treatment effect of cervico-thoracic spinal manipulation in the effects on muscle activity. Although there was not a statistically significant change in muscle activity, there was a positive change in pectoralis major compared to the upper or middle trapezius. The upper and middle trapezius muscles decrease activity followed an evident trend between the participants who received the intervention compared to the control group. Postural results were not statistically significant but positive correlations to treatment were found. The craniovertebral angle was seen to decrease at a higher rate compared to the control group. Additionally, the study provided evidence of a treatment effect on the acromiovertebral angle, decreasing overall in severity. Conclusion: The results of this study do not provide conclusive evidence that the intervention has any immediate statistical effect on the three muscle activity measurements outcomes observed. In terms of the Posture Pro Analysis System measurements, changes (decrease in angles) between the pre- and postintervention were mostly significant in both groups, but statistically there was no difference between the control and intervention groups. Posture Pro ratings did not provide evidence of changes in categories within the groups. Therefore, the null hypothesis was retained.
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    The immediate effect of chiropractic cervical spinal manipulative therapy on joint position sense and balance in elderly participants in the eThekwini Municipality
    (2023-05-31) Bonsma, Robyn Debra; Varatharajullu, Desiree; Prince, Cleo Kirsty
    Background The elderly population is growing due to medical advancements. Falls risk is one of the leading causes of death and injury in individuals over the age of 60 years, given that aging causes a degeneration of vestibular, visual and proprioceptive systems, aiding in balance. Chiropractic management has been identified as a strategy which may aid in the improvement of balance. There is a paucity in the literature when it comes to chiropractic treatment and its effect on joint position sense and balance, as well as paucity regarding the elderly population. Aim The aim of this study was to determine the immediate effect of cervical spine chiropractic manipulative therapy on joint position sense and sway index, as a part of balance in elderly participants in the eThekwini Municipality, in South Africa. Method This was a pre-post study in which 30 healthy participants with a mean age of 71 years of age participated. The elbow joint position sense was measured using a goniometer, and static balance was tested using the Biodex Biosway® portable balance system. The participants reproduced a predetermined angle of flexion of the elbow (blindfolded) pre- and post- intervention. The participants were tested for sway index on the Biodex Biosway® portable balance system with eyes open, pre- and post-intervention. The intervention of this study was a single cervical spine manipulation of the most restricted facet using the diversified technique. The location of the manipulation was not specific to a particular area of the cervical spine but the most restricted segment was adjustment. The joint position sense and balance of the pre- and post-intervention data were compared using statistical software IBM SPSS version 27. Results There was a significant improvement of joint position sense (p=0.032) after chiropractic spinal manipulation of the cervical spine; this was shown by the increase in accuracy of joint position sense. There was no significant improvement in static balance (p=0.683) after chiropractic spinal manipulation of the cervical spine. In this study, 76.7% of the participants were female and 23.3% were male and the ethnic distribution was as follows 90% white, 6.7% black and 3.3% Indian. Conclusion This study suggests that cervical spinal manipulation may alter sensorimotor functions associated with aspects of balance, such as joint position sense in the elderly, and thus decrease falls. This is due to the improvement in joint position sense post-chiropractic spinal manipulation however, it is unknown if this effect translates to the lower limb. Further studies need to be done to determine the effect of chiropractic manipulation on balance in the elderly as chiropractic spinal manipulation influences aspects of balance in the elderly but it is unclear as to the lasting length of its effects. It is also unclear as to the effect of longterm chiropractic treatment in both balance and falls prevention.
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    A systematic review on the effectiveness of manipulation and mobilisation in the treatment of osteoarthritis
    (2023-05-31) Khamissa, Ahmed; Korporaal, Charmaine Maria
    Osteoarthritis (OA) is an increasing condition globally as the population ages and the number of elderly increases. However, there is a lack of relevant evidence-based guidelines for manual therapy in the treatment of OA especially involving OA of the spine, wrist, temporomandibular joint (TMJ), and the glenohumeral joint (GHJ). A systematic review organises and critiques literature in a more concise form for practitioners. This study aimed to briefly provide practitioners the evidence available on the effectiveness of manipulation and mobilisation on OA. Methods: A systematic review of available literature was performed using keywords including “manipulation”; “mobilization”; “manual therapy” and “osteoarthritis”; “spondylosis”; “degenerative joint disease”; “degenerative disc disease”. The database searches were through CINAHL, DUT summons, Google scholar, Pubmed and Scopus. Following a screening using inclusion criteria, 20 articles were chosen for review. Each of the studies were than reviewed by three reviewers using the Newcastle-Ottawa scale, the PEDRO scale, the Joanna Briggs Institute (JBI) scale for case series and the JBI scale for case reports. These scales evaluated the methodological rigour (internal validity) of the chosen articles. In addition, the external validity was determined through a critique of each article. The internal and external validity formed the basis for decisions on the level of evidence provided in support of manual therapy. Results: Of those chosen articles, 13 provided evidence of treatment programmes and could not contribute to evidence specific to mobilisation and manipulation. In contrast, four articles assessed the efficacy of mobilisation, one study assessed the efficacy of manipulation, and two studies assessed the efficacy of neural mobilisation. There was moderate evidence in support of mobilisation on thumb carpometacarpal (CMC) OA, but only limited evidence in support of its use on cervical spine OA and no evidence in support of its use on lumbar spine OA, GHJ OA and TMJ OA. Manipulation was suggested to have moderate to limited evidence in support of its use on lumbar spine OA, but no evidence for cervical spine OA. Neural mobilisation was suggested to have limited evidence in support of its use for treating thumb CMC OA. Conclusion: It was evident in this systematic review that there is limited evidence for mobilisation, manipulation and neural mobilisation. Further research is required to expand on the limited areas, as well as strengthen the current evidence for clinical use.
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    A systematic review of the effectiveness of the use of the Activator Adjusting Instrument in treating spinal pain
    (2023-05-31) Melvill, Roxanne Patricia; Korporaal, Charmaine Maria
    Spinal pain is commonly encountered by chiropractors and there are several adjustment techniques used to treat spinal pain. Practitioners are required to practice evidence-based chiropractic care in order to best care for their patients and to provide information to guide informed consent. A systematic review provides a well-structured summation and analysis of the available evidence and the effectiveness of the intervention. An analysis would be able to determine the level of evidence in support of the use of the Activator Adjusting Instrument (AAI) in treating spinal pain. The AAI can be used as an adjustment tool (as the AAI technique) outside of the AMCT protocol and the AAI can be used within the AMCT protocol. Both of these uses of the AAI are included in this study. Objectives: The aim of this dissertation was to review published literature regarding the use of the AAI in treating spinal pain. The effectiveness of the use of the AAI in treating spinal pain was evaluated to present current evidence available for its use to treat the different areas of the spine in clinical practice. Method: A literature search was conducted with the following key terms: “Activator”, “Instrument Adjusting”, “Joint Dysfunction”, “Manual Therapy”, “Activator Technique”, “Activator Adjusting” and “Instrument assisted manipulation”. Databases searched were PubMed and Scopus. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. All electronic or paper English articles, which possessed the required key indexing terms, met inclusion and exclusion criteria, and represented randomised controlled study, non-randomised controlled study and observational study designs, were included. Data Collection and Analysis: Blinded review of the articles was then conducted by six independent reviewers, as well as the researcher, utilising the PEDro Scale (for randomised controlled trials), Newcastle-Ottawa Scale for (non-randomised controlled trials) and Liddle Scale (for observational studies). This allowed the methodological rigour of each article to be ranked. The ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence to use the AAI in treating spinal pain. A total of 23 articles were identified and included in this systematic review. The review and ranking of these articles revealed limited evidence in support of the use of the AAI outside of the AMCT protocol (AAI technique) in the lumbar spine, sacroiliac, and coccygeal regions; however, there was no evidence in support of or against its use in the cervical, thoracic and full spinal regions. There is limited evidence supporting the use of the AAI within the AMCT protocol in treating the cervical spine. There is no evidence supporting or against the use of the AAI within the AMCT protocol for the remaining spinal regions. In the areas where limited evidence is available, spinal pain reduction as a result of the intervention (either AAI technique or AAI within the AMCT protocol) is comparable with the findings of manual manipulation. However, the majority of the spinal regions have no evidence available to base treatment guidelines and informed consent on, in clinical practice. Conclusion: Until further research is conducted surrounding the use of the AAI technique and the AAI within the AMCT protocol in the spinal areas where there is no evidence, practitioners are advised to use the AAI sparingly in these spinal regions, informing the patient of a lack of evidence, until such time as further studies have been carried out that produce reliable and valid evidence in these regions. It is evident that future research is required surrounding the use of the AAI technique as well as the AAI within the AMCT protocol in order for practitioners to apply evidence-based practice and compete informed-consent procedures with patients. Having more evidence in these domains will strengthen the literature and allow for improved clinical decision-making based on evidence that is of high quality and practical value.