Theses and dissertations (Health Sciences)
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Item The effectiveness of spinal manipulation versus spinal manipulation in conjunction with core stabilisation exercises in the treatment of mechanical low back pain(2002) Boden, Langley Nicholas; Atkinson, M. J.Low back pain is estimated to effect 60-90% of the world's population sometime during their lives while 20-30% of people suffer from low back pain at any given time (Cassidy and Burton, 1992:3). Locally, epidemiological studies into low back pain have revealed incidence rates of 57.6% amongst black South Africans (Van der Meulen, 1997) and between 70 and 80% amongst Indians and Coloureds (Docrat, 1999). The use of spinal manipulation with the emphasis on restoring joint mobility, has been proven to be one of the most effective and cost effective approaches in the management low back pain of a mechanical origin (Di Fabio, 1992). McMorland (2000), showed in a study of 199 patients, that spinal manipulation resulted in an average of 52.5% and 52.9% reduction in low back pain and disability respectively. Panjabi (1992:1) has postulated a theory of a 'neutral zone' around which the passive lumbar spine operates. He describes the neutral zone as a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. It is, according to Panjabi (1992:1), possible for this neutral zone to increase with injury to the spinal column or with weakness of stabilising muscles, which could result in low back pain. The trunk muscles therefore have to be able to co-contract isometrically to control the neutral zone and protect the spinal tissue from excessive motion (Richardson et aI.1990). The transversus abdominis muscle and multifidus muscle have been identified as playing an important role in the complex synergistic interaction of the trunk (Norris, 1995). The above concept involving muscles attempting to maintain a neutral zone is commonly referred to as 'core stabilisation' (Norris, 1995).Item A systematic review of the non-invasive therapeutic modalities in the treatment of myofascial pain and dysfunction(2015-03-09) Roopchand, Adelle Kemlall; Korporaal, Charmaine Maria; Harpham, Graeme JohnBackground: Myofascial Pain and Dysfunction (MPD) is a diagnosis commonly encountered by practitioners, hence, there are several treatment approaches employed by various practicing physicians. Practitioners are required to perform evidence-based protocols on patients; however, such intervention becomes increasingly difficult with the increasing volume of evidence available with regards to treatment of MPD. A systematic review provides a well-structured, critical analysis of the available protocols, and as such, provides practitioners with an evidence-based summary of the available modalities and the effectiveness of these modalities. Thus, the aim of the study was to systematically review and evaluate the literature to determine the effects of various non-invasive modalities on MPD. Objectives: Studies investigating various non-invasive modalities were identified, evaluated against the inclusion criteria and then reviewed against PEDro criteria to present current available evidence regarding their effectiveness as a source of treatment for MPD. Methods: A literature search was conducted, based on key terms including: active and latent myofascial trigger points, manual therapy, manipulation, acupressure, massage, muscle stretching, ultrasound, transcutaneous electric nerve stimulation, electric stimulation therapy, magnetic field therapy, and exercise therapy. Databases searched were: PubMed, EBSCOhost, Medline, CINAL, Proquest, Health Source, Sport Discus, Science Direct, Springer Link, Google Scholar and Summons. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. Thereafter, the articles were reviewed by four independent reviewers and the researcher. The PEDro Scale was used to determine methodological rigor of the included studies. The results were then analysed and ranked. Results: Following the screening process during data collection for this study, a total of 25 studies were identified and included. The review and ranking of these studies revealed a moderate level of evidence present for the effectiveness of Topical Agents. A limited level of evidence was noted for TENS, Ischemic Compression, Ultrasound, Laser and Other Modalities. Approximately 25% of the reviewed studies involved combination therapies; hence their outcomes cannot be applied to the effectiveness of individual modalities. Conclusion: Upon comparison of the quality of evidence available for the various types of modalities present for the treatment of MPD, it was noted that Topical Agents were supported by a stronger level of evidence than TENS, Ischeamic Compression, Ultrasound, Laser and Other Modalities. However, due to a lack of strong overall evidence for any of these modalities it has been concluded that more research is required to establish which modality is in fact the most effective.Item The clinical effectiveness of therapeutic exercises alone and in combination with orthotic bracing in the treatment of lateral epicondylalgia(2012) Flanders, Megan; Korporaal, Charmaine MariaLateral epicondylalgia (L.E) is a common diagnosis in elbow pathology. The aetiology is poorly understood but it is generally accepted to be as a result of repetitive microtrauma, affecting the proximal end of the extensor carpi radialis brevis tendon. Elbow bracing and exercise modification are often utilised by sufferers in order to reduce symptoms. In addition, there have been multiple treatment regimes used in practice to treat L.E, but none has stood out as being more effective than another. Thus, the aim of this study was to investigate the relative clinical effectiveness of therapeutic exercises alone and in combination with orthotic bracing, in terms of subjective and objective clinical findings. Methods This stratified, quantitative, prospective clinical trial consisted of two equal groups (n=15) diagnosed with L.E. Group One consisted of a strengthening and stretching programme alone, and Group Two consisted of a combination of the same programme and an orthotic brace. The participants performed the programme daily at home for six weeks, and the brace was worn throughout the day for six weeks. Each participant was assessed before, during and after the programme, in terms of subjective and objective clinical data which was then statistically analysed using SPSS version 18. Repeated measures ANOVA testing was also used to compare the outcomes between the groups over the time points. Results Both groups showed significant statistical improvement in terms of all the outcome measures. The groups also showed a clinically significant improvement for all the outcome measures except pressure pain threshold where Group Two showed clinically significant improvement over Group One. v Conclusion The results show that there was negligible benefit when combining an orthotic brace with therapeutic exercises as opposed to performing the therapeutic exercises alone.