Theses and dissertations (Health Sciences)
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Item The effectiveness of lower thoracic spinal manipulation on lumbar extensor muscle endurance and range of motion in asymptomatic males : a placebo controlled study(2015) Matsebula, Lindelwe; O'Connor, LauraBackground: Spinal manipulative therapy (SMT) is a commonly used treatment for many musculoskeletal conditions although the exact mechanism explaining its effectiveness is not well understood. Several studies have investigated the effect of SMT on the paraspinal muscles where neuromuscular effects have been observed, however few studies have assessed whether these changes result in a change in the functioning of the paraspinal muscles. This study aimed to determine the effect of lower thoracic spinal manipulation compared to a placebo intervention on lumbar extensor muscle endurance in asymptomatic participants. Methodology: This was a quantitative, pre-test post-test, placebo controlled trial involving 40 male participants between the ages of 20 and 40 years. The participants were randomly allocated to either the lower thoracic spinal manipulation group or a placebo group. Manipulation was delivered using the Impulse Adjusting Instrument®. Objective measures included lumbar spinal range of motion, a paraspinal muscle endurance test, and surface electromyography readings. Subjective measures were the verbalisation of pain and/or discomfort during the paraspinal muscle endurance test. IBM® SPSS® statistics version 21 and STATA 11 were used to analyse the data. A p-value of <0.05 was considered statistically significant. Results: There were no statistically significant differences between the groups in terms of subjective and objective measurements. A trend of treatment effect was observed for paraspinal muscle endurance where the intervention group showed noticeable improvements in endurance scores. Conclusion: Further studies need to be conducted to determine if the trends observed would occur in a larger study population.Item The effectiveness of spinal manipulation at L3 on lumbar paraspinal extensor muscle endurance in asymptomatic males(2014) Thiel, Gregory Justin; O'Connor, LauraBackground Spinal manipulative therapy (SMT) is a commonly used therapeutic modality. It has been shown that neuromuscular reflexes are elicited during spinal manipulation resulting in changes in the surrounding muscle tonicity and seen as changes in surface electromyography. Despite this little is known about the effect that SMT may have on muscle function. Increased maximum voluntary contraction (MVC) of the paraspinal muscles has been observed following lumbar SMT compared to a control and sham treatment; however its effect on muscle endurance has not been investigated. The aim of this study was to determine the effect of lumbar SMT compared to a placebo treatment on lumbar extensor muscle endurance in asymptomatic individuals. Method This study was a quantitative double blinded, pre-test and post-test placebo controlled experimental trial. Forty asymptomatic participants were randomly allocated to one of two treatment groups. One group received a single SMT applied to the L3 vertebrae and the other received the pre-load force of the SMT but no thrust. Subjective (a self-report of pain/discomfort while performing the Biering-Sorensen test) and objective [surface electromyography (sEMG), paraspinal muscle endurance time and lumbar spine range of motion] measurements were taken pre- and post-intervention. The latest version of SPSS version (IBM SPSS Inc.) was used to analyse the data. A p-value < 0.05 was considered statistically significant. Independent t-tests were used to compare means and two-way factor ANOVA (for repeated measures) was used to compare the change in the two time points between the two treatment groups (intervention and control). RESULTS There were no statistically significant differences between the intervention and placebo groups in terms of subjective reports of pain/discomfort and objective evidence of surface EMG readings, paraspinal muscle endurance time and lumbar spine range of motion.Item A randomized clinical trial comparing the effects of two different durations of muscle energy technique on neck pain, trigger points, range of motion and neck disability index(2015-05-18) Naidoo, Kerisha; Korporaal, Charmaine MariaBACKGROUND Mechanical neck pain (MNP) has been described as any condition which changes joint mechanics and muscle structure / function. A review of the current literature shows that Muscle Energy Technique (MET) is an effective manual therapy for patients with acute or chronic MNP. The most useful contraction of MET however remains unknown. Some authors advocate the use of a two to seven second MET (Brous, 2005; Greenman, 2003 Mitchell, Moran, and Pruzzo, 1979) whilst other authors have recommended contraction durations of 30 to 60 seconds (Chaitow, 2006; Feland et al., 2001; Bandy and Irion, 1994). This study aimed to establish the most suitable contraction duration of MET in the treatment of chronic MNP by comparing a short duration MET to a long duration MET. OBJECTIVES Objectives included the comparison of a five-second (short duration) MET and a 45-second (long duration) MET in terms of subjective and objective findings in the treatment of chronic MNP. METHOD This randomized clinical trial, with 53 participants utilised a randomization table for group allocation. For the purpose of this study an average of the short contraction durations reported in the literature i.e. five seconds, was used for the short duration MET treatment and an average of the long contraction durations reported in the literature i.e. 45 seconds, was used for the long duration MET. Group A (n=26) received the five-second MET contraction and Group B (n=27) received the 45-second MET contraction treatment. Objective measures included the cervical range of motion (CROM Goniometer) and tenderness levels (algometer). The subjective measures were pain (Numerical Rating Scale-101) and MNP related disability (CMCC Neck Disability Index). Each participant received four treatments over a two week period, with all data collected prior to the first and third consultations and at the final follow up. Data were analysed using the SPSS version 20 (IBM), with a statistically significant p value set at <0.05. Repeated measures ANOVA testing determined the intergroup effects. To assess intergroup effects and effects of the intervention a time x treatment group interaction analysis was conducted. Profile plots assessed direction and trend of the effect of the treatment. RESULTS Intra-group analysis of both groups showed significant improvement in all of the range of motion measures (over time) except for Flexion, Right Lateral Flexion and Left Rotation in Group A and Flexion, Extension, Right Lateral Flexion and Left Lateral Flexion in Group B. The intra-group analysis also showed a significant improvement in the neck disability index scores and the tenderness measurements in both groups. The results of the inter-group analysis revealed that only Left Lateral Flexion showed a significant treatment effect (p=0.011) where increased scores were shown in Group A and not in Group B. There was no treatment effect for the neck disability index scores or the tenderness measurements. CONCLUSION It may be concluded that both treatment protocols were equally effective for all outcomes except for Left Lateral Flexion where the five-second MET seemed to show greater degree of improvement than the 45-second MET. The neck disability index scores and the pain levels of participants in both groups showed an improvement. No treatment was better than the other in terms of these two variables. This therefore seems to support the use of the shorter duration MET in clinical practice.