Theses and dissertations (Health Sciences)
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Item The epidemiology of musculoskeletal injuries in competitive lifesavers in KwaZulu-Natal(2020-11-30) Billson, Carmel Beth; O'Connor, Laura; Clifton, Stuart RonaldLifesaving is a multidimensional sport which can lead to injury and a high likelihood of overuse-related injuries. The environment within which lifesaving occurs is unique, with the soft beach sand and unpredictable nature of the ocean. It is difficult to assess the effects that injuries may have on the training and competitive performance of lifesavers as the incidence and severity of these injuries have not previously been studied in South Africa. Thus, this study investigated the epidemiology of lifesaving induced musculoskeletal (MSK) injuries in competitive lifesavers in KwaZulu-Natal. Lifesavers are under-investigated, yet the growth and development of the sport requires that athletes are assessed for injury. This study could aid in educating federations, coaches and athletes regarding MSK injuries sustained by lifesavers, thereby assisting athletes to be more competitive at national and international competition levels. Method: A quantitative, descriptive, cross-sectional epidemiological survey was used to collect data from 100 competitive lifesavers in KwaZulu-Natal. The questionnaire was pre-validated and hand delivered to the lifesaving clubs that agreed to participate, where the lifesavers selfselected to participate. Informed consent was obtained. The survey contained questions related to demographics, activity participation, psychosocial factors and the occurrence of lifesaving related musculoskeletal pain. Results: The respondents were male (65%, n=65) and had a mean age of 28.6 years (±SD 14, range 16-73). The lifetime prevalence of MSK injury from lifesaving was 72% (n=72), with a total of 177 injuries being reported with shoulder pain being the most prevalent (38%). The 12- month prevalence showed 133 injuries were sustained whereas for current prevalence there were 86 injuries. Lower back pain was most frequently reported over these periods (26% and 22% respectively). The board race was the most popular event participated in at 76% (n=76), followed by surf ski 69% (n=69) and thirdly surf swim 67% (n=67). Seventy-four percent (74%) of board paddlers, 68% of surf ski paddlers and 67% of beach sprint and flags participants had experienced MSK pain related to lifesaving. Of the 72 competitors that experienced lifesaving MSK injuries more than half reported that it negatively affected them psychologically either in training, competition or overall. Injuries cause athletes to miss training sessions, which result in loss of fitness and falling behind the other athletes, this could cause a lack of confidence, lack of self-belief and lack of motivation to continue training and competing. The worst injury that the respondents had sustained occur mostly due to running (44%), was overuse related (43%), occurring in season (70%) and was described as a sharp, shooting severe pain with a constant and recurrent nature. It affected the athlete’s participation in the sport (75%) and required them to seek medical attention (89%). The only factor found to be related to MSK injuries was the number of rest days, which was significantly lower in those who suffered injuries (p=0.04). All other demographic, health, lifestyle and lifesaving activity participation factors were not associated with MSK lifesaving injuries (p < 0.05). Conclusion: This is the first study to document MSK injuries in lifesaving athletes in South Africa. The high prevalence of injuries necessitates that mechanisms are put in place to prevent injury. In addition, the mechanics of running on sand requires further investigation to understand its impact on injuryItem The effect of talocrural joint manipulation on muscle activity of the lower limb, balance, pain and disability in participants with chronic ankle instability syndrome(2019-09-05) McLaren, Murray James; O’Connor, Laura; Puckree, ThreethambalBackground and Purpose: Ankle sprain injuries are prevalent in both the sporting and general population and can develop into chronic ankle instability syndrome (CAIS). When this occurs, there is a tendency for the ankle to re-sprain following an acute ankle sprain. Deficits in proprioception and neuromuscular control, specifically of the peroneal muscles, may lead to altered balance and postural stability in patients with CAIS. Recent research suggests that the ankle invertors and plantarflexors are also affected. Joint manipulation has been shown to result in reduced pain and improved foot and ankle functioning in individuals with CAIS, however, the exact mechanism(s) through which joint manipulation brings about these effects is not clear and the field of extremity joint manipulation on arthrogenic muscle inhibition (AMI) is under-investigated. This study aimed to determine the immediate effect of talocrural joint manipulation on postural stability and the muscle activity of the ankle invertors, evertors and plantarflexors by assessing surface electromyography (sEMG) of these muscles during static single-limb postural stability testing. Subjective outcomes of pain and disability were also measured through the use of the foot and ankle disability index (FADI). Methods: This study used a randomized, single blinded placebo controlled pre-test, and a repeated post-test measures experimental design. A sample of 42 participants, with grade I or II CAIS, aged 18-45 years, were randomly allocated into two groups. One group received a long axis distraction talocrural joint manipulation and the other group, a sham manipulation. General pain and disability (FADI), postural stability (Biosway Portable Balance System) and muscle activity (Biopac wireless EMG system) measurements were taken before the intervention. Muscle activity and postural stability were assessed again immediately after the intervention and then again 20 minutes later. Postural stability and muscle activity were measured both with participants’ eyes opened and eyes closed. FADI measurements were taken 24 hours after the intervention. Results: The two groups were comparable at baseline for age, gender, body mass index, pain and disability, postural stability and muscle activity (p > 0.050). An inter-group analysis showed a significant improvement in FADI (p= 0.005) and general pain scores (p= 0.039) when compared to the placebo group post-manipulation. There were no significant changes in the manipulation group for muscle activity and postural stability when compared to the placebo group (p > 0.050). Intra-group analysis showed an overall improvement over time for eyes opened postural stability in the manipulation group (p= 0.040) and decreased fibularis longus muscle activity in the placebo group with eyes open balance testing (p= 0.047) and eyes closed balance testing (p= 0.023). Conclusion: The results of this study showed that talocrural joint manipulation had a positive effect on pain and disability in individuals with CAIS. No significant differences were found between the intervention and placebo groups for limb muscle activity and postural stability. Intra-group analysis showed that the manipulation had a positive effect on eyes-open postural stability performance and that there may have been a trend of an effect of manipulation counteracting muscle fatigue experienced in the fibularis longus of the placebo group. Further investigation to further elucidate the effect of manipulation in CAIS is recommended.Item Back pain and its relationship to socio-demographic and psycho-social factors in a cohort of pregnant women attending a primary health care clinic in the eThekwini municipality(2019) Hawker, Carmen; O'Connor, LauraBackground: The prevalence of back pain and general discomfort is not uncommon in pregnant women, often being under-reported until it affects their daily routine. South Africa, a third world developing country has unique risk factors and demographic profile. Although many studies have previously studied the various factors relating to back pain in pregnancy, this topic is far from being exhausted as a research area. Specifically, new studies should be conducted on the prevalence of back pain in pregnancy to analyse the impact it has on women worldwide. Little research has been conducted on rural communities in Africa especially in South Africa, to assess the risk of pregnancy-related back pain. Therefore, the information obtained from this study will provide a better understanding of the demographics, physical demands and psycho-social stresses experienced by pregnant women in this understudied population. Back pain and general discomfort is not uncommon in pregnant women, but it is often under- reported and can be disabling. International studies report a high prevalence especially in the last trimester. Little is known about the prevalence of and risk factors for back pain in South African pregnant women. Thus, this study aimed to determine the relationship between socio-demographic and psychosocial factors in a cohort of pregnant women attending a primary health care clinic in the eThekwini municipality of the province of KwaZulu-Natal, South Africa. Method: A retrospective descriptive cohort design was utilized whereby 382 participants’ files were assessed for eligibility. The files consisted of a socio-demographic questionnaire, a chart review and two epidemiological questionnaires that were administered to the participants during the first and third trimester. Permission to access these files was obtained from the principle investigator of the MRC/DUT project. All participants signed consent forms for research purposes. The data relevant to this study was extracted and analysed using Statistical Package for the Social Science version 24.0 (IMB Analytics). Descriptive statistics were used to describe the data in terms of means and standard deviations or frequencies and count where appropriate. Inferential statistics allowed for relationships between the variables to be assessed. A p - value of less than 0.05 was used to indicate statistical significance. Results: The total of 303 files were included. Participants were Black Africans, mostly single (81.2%, n=229) with a mean age of 25.84 (±SD 6.04). There was a high unemployment rate (70.8%, n=199), with most having obtained a secondary education (77.1%, n=213), and 44.1% (n=122) residing in squatter camps. There was a high human immunodeficiency infection rate (40.5%, n=94). Of the 303 participant files eligible for the study only 46 returned for the third trimester follow up. The prevalence of BP in the first trimester was 12.4% (n=35) and 10.9% (n=5) in the third trimester. LBP was the most (8.5%, n=24) in the first and 10.9% (n=5) in the third trimester, followed by UBP and NP. The incidence of back pain over the duration of pregnancy was zero. Being single (p = 0.03), reporting no stress (p = 0.04), not using pain killers (p = 0.01), and no alcohol consumption in the current pregnancy (p = 0.03) were associated with a decreased risk of back pain. There were no relationships found between the variables and back pain prevalence in the third trimester. Conclusion: The women attending this primary health care clinic are relatively young, come from a low socio-economic area with low reported levels of stress and substance abuse. They reported low levels of back pain. The follow up rate at the third trimester was low and this may skew the results of this study. Further research is needed in this community and South Africa to appreciate the prevalence and impact of back pain in pregnancy.Item The relative effect of proprioceptive neuromuscular facilitated stretching immediately after eccentric exercise vs proprioceptive neuromuscular facilitated stretching post delayed onset muscle soreness in healthy, sedentary male subjects(2007) Schlebusch, Helen Beverleigh; Docrat, AadilDelayed onset muscle soreness (DOMS) is muscular pain which ranges from mild discomfort to severe debilitating pain, caused by eccentric exercise. It generally sets in 12 - 24 hours after the causative activity and subsides within approximately seven days. The aim of this study was to determine whether proprioceptive neuromuscular facilitated (PNF) stretching immediately after eccentric exercise was more beneficial than PNF stretching 24 hours after eccentric exercise on the muscle pain experienced in DOMS. This study was a prospective, randomised clinical trial. Thirty healthy sedentary male participants were randomly selected to participate in the study by advertising in local newspapers and pamphlet distribution in Durban and its surrounding areas. The patients' ages ranged from 20 to 32 years of age. Subjective and objective readings were taken at the beginning and end of each visit, over the three-day study period. This was done with the numerical pain rating scale and the algometer force gauge, respectively. Baseline measurements were taken before any exercise or stretching at the initial visit. All participants then were asked to do squats until fatigue to induce delayed onset muscle soreness. III The participants were divided randomly into two groups, Group A and Group B. The former group underwent PNF stretching immediately after exercise and the latter group underwent PNF stretching twenty four hours after exercise. Both groups were asked to return for two subsequent days following the initial visit and they again underwent PNF stretching at each visit. Comparison was made between the individual patients' pain perception over time, as well as between each group. Descriptive analysis was done using frequency tables (reporting counts and percentages) for categorical variables and summary statistics (reporting mean, standard deviation and range), for quantitative variables. Baseline and demographic characteristics were compared between the two treatment groups using independent t-tests for quantitative variables and Pearson's chisquare tests for categorical variables. The treatment effect was assessed using repeated measures ANOVA testing. Statistical analysis revealed that there was no difference in the improvement of pain experienced between the two groups. However, Group B (PNF stretching 24 hours after exercise) appeared to improve at a greater rate than Group A (PNF stretching immediately after exercise). A larger study needs to be conducted in order to provide statistically relevant results.Item The relative effectiveness of a conservative multi-method treatment protocol (S.M.T. and Diclofenac) for the management of chronic mechanical thoracic spine pain(2001) Bhoola, Nayna Ratilal; Kretzmann, HeidiThe aim of this study was to determine the relative effectiveness of the combination of spinal manipulative therapy (SMT) and non-steroidal anti-inflammatory drugs (NSAIDs) versus SMT with the administration of a placebo medication in the treatment of chronic mechanical thoracic facet syndrome. It was hypothesised that SMT and NSAIDs over a three week period would be more effective than SMT and placebo medication in terms of the objective and subjective clinical findings. The study design was that of a double blind randomized clinical trial. Sixty patients diagnosed with thoracic facet syndrome were randomly assigned to either the manipulation and NSAID group or the manipulation and placebo medication group. The age range of the patients was eighteen to fifty-nine years. Each patient in the NSAID group received 139mg of diclofenac free acid per day over five days. The placebo group received the same dosage of a similar appearance to that of diclofenac free acid over the same period. The placebo medication was in the form of lactose powders. Each group of thirty patients received six treatments of SMT over a three-week period. Group A received SMT and placebo medication while Group B received SMT and NSAIDs. The patients were assessed by means of obtaining subjective information consisting of three questionnaires; the McGill Short-Form Pain Questionnaire, the Numerical Pain Rating Scale -lOl and the Oswestry Pain Disability Index. Objective data was gathered from goniometer measurements. The objective data was collected before theItem The relative effectiveness of combined "action potential therapy" and patella mobilization versus combined placebo "action potential therapy" and patella mobilization in the treatment of patellofemoral pain syndrome(2000) Goldberg, Jenifer; Myburgh, CorneliusThe purpose of this study was to determine the relative effectiveness of combined Action Potential Therapy (APT) and patella mobilization versus combined patella mobilization and placebo Action Potential Therapy in the treatment of Patellofemoral Pain Syndrome. The study was a prospective, randomized, placebo controlled study. The study involved 60 subjects, 30 in each group which were selected from the general population. Group one received patella mobilization and APT while group two received patella mobilization and placebo APT. Patients received four treatments over a period of two weeks. The first treatment consisted of patella mobilization and APT (group one) or patella mobilization and placebo APT (group two), treatment 2,3 and 4 consisted of APT (group one) or placebo A,PT (group two). Subjective assessment was by means of the short form Me Gill pain Questionnaire, Numerical Pain Rating Scale - 101 Questionnaire and the Patient Specific Functional Scale. Objective assessment of tenderness was by means of an algometer. Assessments were taken on the first, second and fifth consultations for all subjective and objective measures. Statistical analysis was completed under the supervision of Dr Myburgh at Technikon Natal, at a 95% confidence interval. The parametric two-sample paired t-test and the non-parametric Wilcoxon signed rank tests were used to analyze data within each group, while the parametricItem The relative efficacy of a homoeopathic pain complex (Arnica montana 30CH, Bellis perennis 30CH, Calendula officinalis 30CH, Hypericum perforatum 30CH, Phosphorus 30CH, Stapysagria 30CH) and allopathic analgesic (Stopyane) in the post-operative management of haemorrhoidectomy(2001) Leong, Lilly Sao Lai; Singh, BhugwanThe purpose of this double-blinded study was to evaluate the relative efficacy of a homoeopathic pain complex (Arnica montana 30CH, Bellis perennis 30CH, Calendula officinalis 30CH, Hypericum perforaturn 30CH, Phosphorus 30CH, Staphysagria 30CH) and on allopathic analgesic (Stopayne\xAE) in the management of post-operative pain after haemorrhoidectomy; in terms of the patients' perception of the treatment. The hypothesis was to show that the homoeopathic pain complex would result in a similar response when compared to the allopathic analgesic without the dismay of adverse effects. Thirty patients with haemorrhoids were carefully screened by an appointed nurse and selected according to a selection criteria (3.3.1 and 3.3.2). Haemorrhoidectomies were performed by two surgeons on all participating patients. The selected patients were then divided into two groups (allopathic or homoeopathic) using a simple random sampling method. Data were collected at the King Edward VIII Hospital. IV Patients in group one received the allopathic analgesic i.e. Stopayne\xAE and patients in group two received the homoeopathic pain complex consisting ofArnica montana 30CH, Bellis perennis 30CH, Calendula officinalis 30CH, Hypericum perforaturn 30CH, Phosphorus 30CH and Staphysagria 30CH. These medications were administrated three times daily over a period of three days. Questionnaires (both in English and Zulu) were filled out by each patient over three consecutive days. Results were statistically analyzed using the Mann-Whitney U-test for the inter-group relationships and the Wilcoxon Signed Rank test for the intra-group relationships. It was found that both groups improved significantly by the thrid consultation compared to the firstItem The effectiveness of spinal manipulation compared to passive oscillatory mobilization in the management of chronic mechanical thoracic spine pain(2001) Pillay, Vanessa Kogilam; Myburgh, CorneliusThe purpose of this study was to investigate the effectiveness of spinal manipulation compared to passive oscillatory mobilization in order to evaluate the more effective treatment in the management of chronic mechanical thoracic spine pain. It was hypothesized that spinal manipulation and passive oscillatory mobilization would both be effective in the treatment of chronic mechanical thoracic spine pain. It was further postulated that spinal manipulation would be comparatively more effective than passive oscillatory mobilization in terms of objective and subjective clinical findings. This randomised controlled clinical trial consisted of a study population of 60, obtained by convenience sampling. Those patients diagnosed as suffering from chronic mechanical thoracic spine pain were randomly allocated to two groups of 30 each. One group received spinal manipulation and the other group passive oscillatory mobilization on the affected segments. Both groups of patients received 5 treatments over a two-week period. The subjective data was obtained by the use of the short-form McGill Pain Questionnaire and the Numerical Pain Rating Scale-101 Questionnaire. These were filled in by the patient before the first, third and fifth treatments. The objective data was acquired through the use of the algometer. Readings were taken before and after the first, third and fifth treatments. Intra-group analysis of the short-form McGill Pain Questionnaire was done using the Wilcoxon Signed Ranks Test. The paired t-test was used for the Numerical Pain Rating Scale -101 Questionnaire and the Algometer Readings (intra-group analysis). Inter-group analysis of the short-form McGill Pain Questionnaire was done using the Mann Whitney unpaired Utest. The unpaired t-test was used for the Numerical Pain Rating Scale-l 0 I Questionnaire and the Algometer Readings (inter-group analysis). a was set at a 0.05 level of significance. The results were illustrated by means of tables andItem The presence and extent of quadriceps femoris weakness in individuals with patellofemoral pain syndrome(2003) Clifton, Stuart Ronald; Kruger, Brian; Wright, JimmyThe purpose of the investigation was to evaluate the presence and extent of Quadriceps Femoris weakness in subjects with patellofemoral pain syndrome by the use of an isokinetic dynamometer.