Theses and dissertations (Health Sciences)
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Item An analysis of the combined effects of swimming and overhead throwing on the shoulder complexes of male first division waterpolo players(2021-05-10) Gibb, Conor Beckett; Matkovich, GrantBackground Abstract Waterpolo is often compared to other sports, mainly swimming and overhead throwing sports. Swimming favours a posture of glenohumeral internal rotation and horizontal adduction. Overhead throwing sports can characteristically cause posterior shoulder immobility with a loss in glenohumeral internal rotation and horizontal adduction. Based on the fact that waterpolo players combine both swimming and overhead throwing whilst playing and training, it is the purpose of this study to investigate the sport-specific characteristics of the shoulder complexes of waterpolo players in an effort to determine how these unique characteristics may relate to the development of overuse injuries. Aim The aim of this study is to compare the dominant and non-dominant shoulder complexes of male water polo players in terms of posture, range of motion and sport- specific overuse injuries in order to develop an understanding of the combined effects of swimming and overhead throwing on the shoulders of water polo players. Methods The study used an observational based research design and consisted of 33 male waterpolo players currently competing in the Kwa-Zulu Natal mens 1st division waterpolo league. Participants underwent a shoulder digital posture examination as well as a shoulder-complex physical examination consisting of range of motion and orthopaedic testing which was then compared between the dominant and non- dominant shoulders. Participants were assessed for the presence of rotator cuff injury, glenoid labrum and LHBT injury, and anterior glenohumeral instability using the following physical tests: Empty can test, painful arc test, external rotation resistance, Hawkins-Kennedy test, Neer test, Yergassons test, Biceps Load test II, and the apprehension-relocation-surprise test. Glenohumeral range of motion was assessed using manual goniometry to measure passive internal and external rotation and horizontal adduction. Statistical analysis was performed using IBM SPSS version 27 statistical analysis software. Paired tests were used to compare outcomes from the dominant and non-dominant shoulders of the participants. To compare the posture measurements, as well as injuries present between the dominant and non-dominant shoulders, McNemar’s chi square tests were used. To compare the Range of motion measurements between the dominant and non-dominant shoulders, paired t-tests were used. A p value < 0.05 was considered statistically significant. Results Forward head posture with rounded shoulders was extremely common, with 73% of the participants in this study displaying a bilateral forward shoulder position ranging from moderate to severe, and 45% of participants displaying a bilateral forward head posture ranging from mild to severe. Glenohumeral internal and external rotation ROM measurements showed no difference between sides. There was a borderline significant difference (p=0.05) in the horizontal adduction measurements, with the non- dominant side showing greater values. The only injury test that yielded significant results was the empty can test for supraspinatus injury that had a higher prevalence for being positive on the dominant side. Conclusion The results of this study suggest that water polo players are prone to the development of a bilaterally equal forward head posture with rounded shoulders and are susceptible to similar mechanisms of bilateral overuse injury as swimmers. In addition, the dominant shoulders of these athletes are susceptible to damage caused by the repetitive, traumatic forces experienced by the posterior cuff musculature and posterior glenohumeral joint capsuloligamentous structures during the follow-through and deceleration phases of overhead throwing, resulting in an increased risk of supraspinatus-specific rotator cuff injury and a loss of glenohumeral horizontal adduction that potentially increases the risk of glenoid labrum and LHBT injury.Item Sagittal spinal alignment in long-term surfers of eThekwini(2021-12-01) Mudge, Alexander; Pillay, Julian D.Background: Sagittal spinal alignment and posture deteriorate with age, but may be affected by physical activity. Surfers catch and ride breaking waves using a surfboard, which they paddle while prone with their spine extended. Spinal extension exercise is generally beneficial to postural development with age. This study aimed to investigate whether an association exists between long-term surfing and the progression of sagittal spinal alignment and posture i.e. cervical lordosis (C-angle (flex and Cobb)), thoracic kyphosis (T-angle (flex and Cobb)), lumbar lordosis (Langle (flex and Cobb)), and sagittal posture (Posture Number) in ostensibly healthy males over the age of 50. The objectives of this study included: 1) Assessing the. C, T, L-angles, and Posture Numbers in long-term male surfers and physically active non-surfer ; 2) Determining whether any significant differences exist between the selected sagittal spinal alignment and posture parameters within or between the surfing and non-surfing groups; and 3) Determining the association, if any, between age, years of surfing and selected spinal alignment parameters. Methodology: 52 males over the age of 50 underwent a case history and postural examination. Their C, T, and L-angles were plotted onto graph paper to analyse using BiomechFlex. Anterior and lateral full-body photographs were taken to analyse using Posture Pro version 8. The generated statistics were analysed using STATA version 16. The summary measures used included the mean, median, standard deviation, range and percentiles of spinal angle and posture variables, as well as the age, anthropometric variables, activity hours per week and activity years. Results: The mean body mass index (BMI) of the S group (24.9kg/m²) was significantly lower than the 27.6kg/m² mean of the NS group, p=0.00. The average time spent on activities per week was over 3 hours in both groups (S group - 3.28hrs and NS groups - 4.67hrs, p=0.0004). On average, the S group (45.6 years) had been practising surfing for significantly more years than the NS group (32 years) had been practising their respective primary activities, p=0.0008. There were no significant differences between the S and NS groups in terms of C- (flex p=0.6234), T- (flex p=0.5758 and Cobb p= 0.5518), or L-angles (flex p=0.6171 and Cobb p=0.6142), or Posture Number (p=0.5348). The T-angles (flex and Cobb) obtained from both NS and S groups were greater than 40⁰, which is classified as hyperkyphotic. There was a positive correlation between age and Posture Number in the S group (r = 0.4307 and p-value = 0.0316), but not the NS group. There was a significant association between Posture Number and T-angle (flex p=0.027 and Cobb p=0.026). The NS group had a 2.15⁰ (flex) and 2.09⁰ (Cobb) greater T-angles for any given posture Number. The NS group had an average of 2.9⁰ (flex) and 2.23⁰ (Cobb) lower Langles than the S group for any given BMI. Thus, surfing may suggest benefit of surfing to sagittal spinal alignment and posture. Conclusion: The results of this study show that long-term surfing is beneficial to the aging individual in terms of body composition. However, it is no more effective at mediating the effect of age on sagittal spinal alignment and posture than other forms of physical activity included in this study. Nevertheless, slight differences between the NS and S groups were present, which may indicate that the biomechanical or even postural effects/adaptations of long-term surfing differ from those of other activities. These subtle differences indicate the need for further research around physical activity, sagittal spinal alignment and posture.Item The effect of a lumbar support pillow on low back pain in long distance truck drivers in the eThekweni District(2019) Van Wyk, Brittany; van der Meulen, Anthony G.BACKGROUND A lack of adequate lumbar support when driving has been said to be an important causative factor of low back pain (LBP) in long-distance truck drivers. Health practitioners prescribe a lumbar support pillow even though the findings of several studies are uncertain. EnVision Tomorrow After Pain (ENTAP) claims that its lumbar support pillows result in an improved posture, a decrease in pain and an increase in comfort (ENTAP 2016). The ‘ENTAP Lumbar Support’ has not yet been tested on participants and, therefore, these claims cannot be currently validated. Therefore, this study intended to determine the effectiveness of the ‘ENTAP Lumbar Support Pillow’ in decreasing LBP in long-distance truck drivers. OBJECTIVE To determine the effect of the ‘ENTAP Lumbar Support Pillow’ on LBP in long-distance truck drivers in terms of pain parameters (intensity and duration of pain), activities of daily living and disability when compared with a polyester lumbar support pillow and no lumbar support pillow. METHODS Sixty-three long-distance truck drivers experiencing LBP were recruited from a trucking company by random allocation. The study was a quantitative paradigm, double blinded, true experimental study design. Participants had to fill out a general questionnaire to determine whether they met the inclusion criteria. A baseline, three-week and six-week questionnaire, consisting of the Numerical Pain Rating Scale (NPRS), the Oswestry LBP Scale and the Patients‟ Global Impression of Change (PGIC) Scale. Statistical Package for the Social Sciences (SPSS) version 25.0 was used to analyse the data. The mean body mass and height were compared between the three treatment groups using one-way Analysis of Variance (ANOVA) tests. Repeated measures ANOVA testing was used to assess the treatment effect of the intervention group compared to the other groups (Esterhuizen 2018). Post hoc comparison of the intervention effect between time points and between treatment groups was done using a Bonferroni correction for multiple testing (Esterhuizen 2018). RESULTS The NPRS within the subjects‟ contrast showed a progressive variation from baseline testing to the three week (p=0.04) and the six week (p=0.001). The profile plot revealed that the mean pain score decreased much faster in Group B ‘ENTAP Lumbar Support Pillows’ compared with both the other groups. The Oswestry LBP Disability Questionnaire score revealed that the score tests within the subjects‟ contrasts showed that the interaction of time x group was significant only at six weeks (p<0.001) compared with baseline. The profile plot showed that the mean Oswestry LBP Disability Questionnaire score decreased (improved) much faster in Group B ‘ENTAP Lumbar Support Pillow’ compared with both the other groups. There was a highly significant treatment effect overall (time x group p<0.001) for the PGIC Scale, indicating that the change in score over time was different in the two groups (p<0.001). The profile plot showed that the mean PGIC score increased (improved) in the Group B ‘ENTAP Lumbar Support Pillow’ while it decreased (worsened) in the polyester group. There was a highly significant treatment effect overall (time x group p<0.001) for the degree of change score, meaning that the change in score over time was different in the two groups. The profile plot showed that the mean degree of change score decreased (improved) in Group B ‘ENTAP Lumbar Support Pillow’ while it increased (worsened) in the Group C (polyester-filled lumbar support). All participants in both lumbar support groups answered “yes” to the question on whether they found the support comfortable at both three weeks and six-week time points. CONCLUSION The ‘ENTAP Lumbar Support Pillow’ was effective in decreasing LBP in long-distance truck drivers. It was considered to decrease LBP, improve activities of daily living and decrease disability, and it was also considered as comfortable. Therefore, the Alternate Hypothesis (Ha) which states that there will be a statistically significant (p<0.05) improvement in LBP in the participants who use the ‘ENTAP Lumbar Support Pillow’ compared to no lumbar support pillow and the polyester-filled lumbar support pillow is accepted and the Null Hypothesis is rejected.Item Immediate effect of two myofascial interventions on navicular position, great toe extension and balance measures in asymptomatic subjects with pronation : placebo controlled(2016) Puttergill, Jeff; Kretzmann, HeidiBackground: Myofascial therapies are widely researched with regards to their effects on pain, disability and range of motion. The benefits of such therapies are attributed to the mechanical changes that myofascial therapies are proposed to have on the fascial and myofascial structures. Breakthrough imaging and laboratory techniques, have allowed the in vivo study of these structures, resulting in new hypotheses regarding the roles that connective tissues might play in proprioception. Objectives: The purpose of this investigation was to assess the effects of two myofascial therapies, in terms of immediate changes in navicular pronation, great toe extension measurements and balance tests, as indicated by the postural stability (eyes open and closed) and limits of stability tests. Pre-, post-intervention analysis was used to determine if there were significant changes between the groups. Aims: The myofascial interventions aimed to reduce myofascial restriction and adhesions, within the plantar and crural fasciae’s of individuals with bilateral pronation. Methods: The study recruited 45 subjects with bilateral pronation (2 or more degrees) and randomly allocated them into a placebo ultrasound, ischaemic compression or myofascial release group. Each subject underwent a case history, physical examination, foot, ankle and knee regional examinations, as well as screened for contraindications. A blinded assistant examiner helped measured and record the baseline measurements for navicular position and great toe extension, using a standard two arm goniometer. The researcher then tested participants for postural stability (eyes open, eyes closed) and limits of stability, on the Biosway Portable Balance System. Subjects were then examined and treated bilaterally, for myofascial restrictions in the foot, lower leg and ankle, related or unrelated to the pronation present. Pre- and post-intervention measurements were recorded within a 20 minute window immediately before and after the relevant intervention. Statistical Analysis: Repeated measures ANOVA testing was used to compare the rate of change (between pre- and post-intervention measurements) amongst the three groups, and a p-value <0.05 was considered statistically significant. Post hoc Bonferroni adjusted tests were done to compare all pair wise groups, as well as identify trends between groups. Results and Discussion: The data showed that both myofascial groups, significantly improved in postural stability (eyes closed) overall, post hoc testing showed the ischaemic compression group (p=0.004) and myofascial release group (p=0.031), compared to changes in the placebo ultrasound group.The overall changes were predominantly found in the anterior-posterior axes, with significant improvements in ischaemic compression (p=0.007) and myofascial release group (p=0.053) axes compared to placebo. For the other outcome variables, statistically significant treatment effects were not consistant bilaterally between the groups. Significant (p=0.051) time*group differences for changes in right navicular position. Post hoc testing revealed a borderline significant (p=0.056) improvement in pronation for the myofascial release group in comparison to the ischaemic compression group, which on average got worse. With regards to passive non-weight bearing great toe extension left, significant (p=0.067) improvements for the ischaemic compression group were shown compared to placebo, although this was not consistent for all the great toe extension tests. A borderline significant (p=0.059) time*group effect for postural stability (eyes open) medial-lateral test was obtained. Post hoc Bonferroni adjusted testing showed a non-significant (p=0.063) correlation between the myofascial release group and placebo ultrasound group. Conclusion: The results of this study, rejects the Null hypothesis for changes in balance measurements and suggests that both myofascial interventions had a significant positive outcome for postural stability, compared to placebo. The postural stability (eyes closed) test gave an indication of positive or negative changes in centre of pressure displacement, about the centre of gravity. It is noted that the sham ultrasound, used as a placebo intervention may have produced a treatment effect and is therefore not a reliable placebo measure for this type of investigation.Item A comparative study of a novel and school issued backpack on high school adolescent posture at the New Forest High School in the eThekwini district of KwaZulu-Natal(2015) Reddy, Kimera; Kretzmann, Heidi; Maharaj, PraveenaResearch has shown that more than 90% of the scholars, use backpacks, worldwide. The backpack has the ability to transport books, sports equipment and clothing between school and home, climaxing in a capacity that may affect posture. Therefore, it is noted that a backpack, which is not carried correctly, fitted improperly and/or over packed may pose a threat to the scholar’s posture Aim: To determine the effect between a novel and school-issued backpack in terms of postural symmetry measurements (photographic measurements), when compared to no backpack, on high school adolescent standing posture. Method: This research was a quantitative descriptive cross sectional experimental design. Each participating scholar underwent a BMI, height and weight screening, prior to inclusion into the data collection process. One hundred asymptomatic scholars, aged between 12 to 14 years, were recruited using convenience sampling. Thereafter, digital photographic images of each scholar was taken in 3 groups, i.e. no Backpack, with a school-issued backpack (Backpack A) and a novel backpack (Backpack B). These digital photographic images were then uploaded, by the researcher, onto the Posturepro 8 Computer Postural Software System. The objective measurement tool (Posturepro 8 Computer Postural Software System) calculated, in degrees, the postural measurements of the scholars’ neck, shoulder and pelvis, by manually constructing lines (horizontal and vertical) between the anatomical landmarks (bilaterally). IBM SPSS version 21 was used to analyse the data. A two-tailed p value of <0.05 was considered as statistically significant. Parametric summary statistics such as mean and standard deviations were used to describe the outcomes in each group. Postural measurements were compared between the pairs (i.e. no Backpack versus Backpack A, no Backpack versus Backpack B and Backpack A versus Backpack B) using paired sample t-tests. A one sample t-test was used to compare the symmetry measurements to a null hypothesis value of 0. Results: The mean age of the one hundred scholars was 13.5 (± 0.6 SD) years. The age of the scholars ranged between 12 and 14 years. This research was performed to determine which backpack (A or B) performed better in maintaining the scholar’s posture (with no backpack). A direct comparison was performed with no Backpack to that of Backpack A and Backpack B. The comparison for each of the differences closest to zero (‘0’) in the no Backpack, Backpack A and Backpack B groups was performed using a one sample t-test. The values closer to zero (‘0’) indicated a normal postural symmetry. None of the postural symmetry measurements were significantly different from zero in all 3 groups as the mean differences were very close to zero. Therefore, when comparing Backpack A to Backpack B, this research showed that there was no significant differences between the two backpacks when looking at postural symmetry (p=0.05). Conclusion: The trends observed in this study partly supported the claims by the company (‘Improved Postural Alignment for You’) of the novel backpack. The novel backpack (Backpack B) showed significant differences in some instances when assessing other outcome measurements, but showed no significant difference when comparing postural symmetry between the two backpacks. Further studies need to be done incorporating all aspects of postural analysis, and not just postural symmetry measurements.Item The effect of a scuba diving cylinder on static lumbar spine posture(2002) Ananiadis, ChristopherThe purpose of this study was to evaluate the effect of wearing a scuba diving cylinder on static lumbar spine posture, in terms of clinical objective findings, namely radiographic changes in the lumbar lordosis, lumbosacral angle, lumbosacral disc angle, and the lumbar gravity line, during upright standing on land.