Faculty of Health Sciences

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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, Threethambal
Background 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.
The effect of cervical spine manipulation on grip strength and muscle activity in asymptomatic participants with cervical spine dysfunction
(2018) Fenton, Daniel James; O'Connor, Laura
Objective: The effects of spinal manipulation are well documented, however there is a gap in the current literature regarding the neurophysiological mechanisms responsible for these effects. Further evidence is required to reveal the specific neurophysiological mechanisms of spinal manipulative therapy and its effect on muscle activity. The objectives of this study were to investigate the short-term effects of a single cervical spine manipulation on grip strength and muscle activity of the forearm flexors and extensors in an asymptomatic sample when compared to a control. Methods: A randomised, controlled, pre-test, post-test, repeated measures design allowed for 46 participants, aged 18-35 years old, with joint dysfunction at C7 to be allocated to either a cervical spine manipulation or a control group. Force output and muscle activity of the forearm flexors and extensors were measured before and immediately after the intervention and again at 5, 10 and 15-minutes. IBM SPSS was used to analyse the data with significance set at (p=0.05). Repeated measures ANOVA testing and Post hoc contrast studies were used to determine significance within, and between, groups. Results: In the treatment group there was a statistically significant change in muscle activity over time in the Extensor carpi radialis (p=0,013) and Extensor digitorum (p=0,021). Similarly, force output increased within the treatment group over time (p=0,012). A statistically significant beneficial treatment effect was identified between the groups in the Extensor carpi radialis (p=0,001) and Flexor digitorum superficialis (p=0,019) muscles only. Conclusion: Though statistical significance was not detected in all muscle groups, this study showed a trend of a treatment effect following cervical spine manipulation (C7) with most values lying just outside the parameters set for significance. Specific muscles of the forearm were affected more than others. Future studies are required with a larger sample to validate the trends observed in this study.
A systematic review of non-invasive manual therapies in the management of irritable bowel syndrome
(2019) Badenhorst, Nannick; Korporaal, Charmaine Maria
Background: Practitioners are increasingly required to practice within an evidence-based setting, with the demand being driven by patients as well as health management organisations. This is compounded by large volumes of literature that is available, making it difficult for the practitioner to synthesise and apply this knowledge. A systematic review provides an avenue for literature to be organized, critiqued and available in a condensed form for practitioners. The objective of this study was, therefore, to formulate such a review in order to provide practitioners with consolidated evidence of the efficacy of non-invasive manual interventions for patients with irritable bowel syndrome. Method: A systematic search of the literature as well as a hand search were conducted with the following key terms: ”irritable bowel syndrome”, “conservative”, “manual”, “manipulation”, “manual manipulation”, “osteopathic manipulation”, “manual therapy”, “movement therapies”, “physical therapies”, “massage”, “exercise”, “kinesiology”, “reflexology”, “thermotherapy” and “yoga” (alone and in combination). The databases included: CINAHL Plus, Google Scholar, MEDLINE, Metalib, Pubmed, Science Direct, Springerlink and Summons. Once screened for inclusion and exclusion criteria, a final 18 articles earned inclusion status. The criteria included: Citation Inclusion- to be available in electronic format for purposes of accessing the citation; the title to include one or more of the following term(s): irritable bowel syndrome, conservative, manual, manipulation, manual manipulation, osteopathic manipulation, manual therapy, movement therapies, physical therapies, massage, exercise, kinesiology, reflexology, thermotherapy and yoga (alone and in combination). Full abstract / publication inclusion criteria -studies published in, or translated to, English; randomised controlled clinical trials, clinical trials, case reports or series and observational studies were included in the study; studies pertaining to the non-invasive manual therapy of IBS (as per the key terms above); studies pertaining to medicinal and non-surgical interventions. Exclusion criteria - non-English studies; studies inaccessible in full article format; studies defined as a systematic review, review of literature or expert opinions. The articles were then individually rated by seven independent reviewers. Ratings were achieved via the application of published and validated scales. These include the Newcastle-Ottawa, PEDRO as well as Liddle rating scales, each specifically formulated to systematically evaluate the methodological rigour of articles as per their particular study type. Data Collection and Analysis: The data obtained from the independent reviewers was then analysed and used to rank the articles, first individually according to the results achieved via aforementioned rating scales, and then collectively per intervention to determine the level of evidence in support of the non-invasive manual therapy interventions for irritable bowel syndrome. Results: A total of 1542 potential citations were initially identified, with 15 articles enduring the screening process. A secondary hand-search added three additional articles, rendering a total of 18 articles for review. On analysis of the results, it was found that osteopathic care, yoga therapy and traditional Chinese spinal orthopedic manipulation interventions had the strongest and most consistent outcome for positive benefit for IBS patients. Chiropractic care and massage therapy presented with limited evidence, while no evidence was produced in support of reflexology in the treatment of patients with IBS. Conclusion: It is evident that future research is required in all of the above fields in order to expand on the limited available evidence while addressing the limitations of previous studies, as highlighted in this systematic review. This would strengthen the literature and allow for improved clinical decision making based on available evidence that is of high quality and practical value.
The immediate effect of ipsilateral and contralateral sacroiliac joint manipulation on the hip range of motion and kicking velocity in soccer players
(2015) Rehman, Zia ul Mustafa; Kretzmann, Heidi
Background There is a close biomechanical relationship that exists between the sacroiliac and hip joints. It is essential to have optimum hip range of motion originating from the pelvis in both the kicking and support limbs as both limbs play a role in achieving a high speed kicking velocity. Due to the strenuous activity of soccer players, both hip ranges of motion may be decreased, thus predisposing the player to injuries. This may also affect the kicking velocity. The effects of sacroiliac joint manipulation on hip range of motion and kicking velocity were investigated. Objectives The objective of this study was to determine the effect of ipsilateral sacroiliac joint manipulation versus contralateral sacroiliac joint manipulation on bilateral hip range of motion and kicking velocity. Methods There were three groups of twenty soccer players. The ipsilateral sacroiliac joint manipulation group, the contralateral sacroiliac joint manipulation group, and the sham laser intervention group. The case history, physical, regional, lumbar and hip exams were done in the Chiropractic Day Clinic. The hip ranges of motion were measured pre- and post- Chiropractic manipulation in all three groups on both limbs in the Fred Crookes Sports Centre (Durban University of Technology). Hip ranges of motion were measured by the Saunders (The Saunders Group, Chaska, MN) digital inclinometer. The kicking velocity of all players were measured pre- and post- manipulation by a speed sport radar gun (Bushnell Speedster Speed Gun; Bushnell Inc, Lenexa, KS). This was a purposive, investigational study trial where the data was reduced and analysed with the help of a statistician, using the statistical software SPSS version 20.0.The statistical aspect of the research encompassed the following: descriptive statistics used Fischer values, Eta tests, frequency, cross-tabulation tables and various types of graphs (bar charts, scatter graphs etc.); Inferential statistics used Pearson’s and/or Spearman’s correlations at a significance level of 0.05; testing of hypotheses used chi-square tests for nominal data and ordinal data at a level of significance of 0.05. Results The ipsilateral group showed statistically significant results for the right hip in flexion, extension, internal rotation and external rotation, as well as for extension, internal rotation and external rotation in the left hip. The contralateral group showed statistically significant results for the right hip in extension, internal rotation and external rotation, as well as for extension and internal rotation in the left hip. There was a statistically significant improvement in the kicking velocity of the ipsilateral and contralateral group after treatment. There was a strong association between the perception changes to the actual kicking velocity in the soccer players. There was a correlation between the change in hip range of motion and change in kicking velocity, however statistically it was not significant. Conclusion The manipulation of ipsilateral or contralateral sacroiliac joint has an effect on the right and left hip range of motion
The effect of lumbar spine, sacro-iliac and/or hip joint manipulation on muscle activity and performance in road cycling
(2018) Fuller, Pia Alexa; Matkovich, Grant; Puckree, Threethambal
BACKGROUND Cycling is a highly competitive sport where athletes are continuously looking for ways to improve their performances in order to gain what might be seconds over their components. Chiropractic manipulation has been shown to restore the balances of the kinematic chain and stimulate motoneuron pools and therefore by implementing this technique into their training regime, it may show improvement in muscle activity distributions, demands and efficiency thus resulting in better cycling performance. OBJECTIVES To determine the participants muscle activity (amplitude of surface EMG) and cycling performance in terms of power output (W), cycling speed (km/h), cadence (rpm), and completion time (seconds) before and after lumbar spine, sacro-iliac joint and/or hip joint manipulation intervention. METHOD Sixty-one asymptomatic amateur cyclists performed two 1.5km time-trials pre- and post- manipulative intervention. The pre- and post-intervention data of muscle activity (amplitude of surface EMG) and cycling performance (power output (W), cycling speed (km/h), cadence (rpm), and completion time (seconds)) were captured. IBM SPSS version 24 was used to analyse the data. A p value <0.05 was considered as statistically significant. RESULTS There was no significant change in muscle activity post-lumbar spine manipulation. There was a significant decrease in cycling performance post-lumbar spine manipulation. Sacro-iliac joint showed no significant change in muscle activity post-manipulation. The study data demonstrated a significant decrease in cycling performance post sacro-iliac joint manipulation. There was no significant change in muscle activity post hip joint manipulation. A significant decrease in power output and speed post hip joint manipulation, no significant effect of overall performance. Combination manipulation intervention showed a significant decrease in muscle activity of iliopsoas muscle. Combination manipulation showed no significant change in cycling performance. CONCLUSIONS There was a visual trend that showed, although there was a decrease in overall cycling performance in the lumbar spine and sacro-iliac joint manipulation groups post-intervention, with no significant changes in the hip joint and combination manipulation groups post- intervention – these athletes were more efficient cyclists post manipulative intervention particularly those who received the combination of adjustments.
The effect of cervical spine manipulation on elbow proprioception, electrical activity of the triceps and biceps muscles and balance
(2018) McKay, Hannah Lenka; Matkovich, Grant
Objectives The purpose of this study was to determine the effect of cervical spine manipulation (CSM) on joint position sense (JPS) of the elbow; electrical (muscular) activity of the biceps and triceps brachii muscles and balance. Background Balance is a complex process requiring constant communication between the visual, the vestibular and the somatosensory (nervous) systems. JPS and electrical activity of muscles play an important role in maintaining balance. Many of the tracts relaying information regarding JPS, electrical activity and balance pass through the cervical spine. It is thought that cervical spine fixations have a negative effect on the surrounding neurology and thus affect somatosensory integration. Therefore, correction of cervical spine fixations with CSM may improve and restore normal function, including, but not limited to, elbow JPS, electrical activity of the biceps and triceps brachii muscles and balance. Methods Institutional Research Ethics Committee (IREC) approval of the study was obtained (IREC reference number: REC 115/16). A quantitative, descriptive, pre-test post-test randomised control trial investigation design was utilised. A pilot study was performed to validate the experimental procedures. Potential participants were assessed through a telephonic interview, a case history and a physical examination, to screen them against the inclusion criteria. Eighty-one participants between the ages of 18-35 years were randomly allocated to either the control (n = 20) or the intervention group (n = 61). The intervention group was further stratified into three subgroups, namely upper cervical spine fixations only (C0-C3); lower cervical spine fixations only (C4-C7) and both upper and lower cervical spine fixations. Each participant completed two pre-tests for static balance (eyes open and closed) and dynamic balance (eyes open and closed) [Biosway Biopac balance system]; one pre-test for electrical activity of biceps and triceps brachii muscles at rest and then during an active movement; and one pre-test of the ipsilateral elbow for JPS [Biopac AcqKnowledge sEMG machine and goniometer]. All tests were performed on the dominant arm. The intervention group then received CSM to correct the fixated segments. The control group underwent a 20 second rest period instead of the CSM. The electrical activity of the biceps and triceps brachii muscles was recorded during the intervention period. The pre-tests were then repeated as post-tests immediately following the intervention. Analysis was by paired sample t-tests (pre and post outcomes for intra-analysis). Independent t-tests were conducted to determine mean differences between the control group and intervention group. An ANOVA test was conducted for mean differences from pre- and post-intervention readings between the control group and the three intervention subgroups. If the null-hypothesis was rejected, then post hoc tests were conducted to detect where the differences lay. A p- value < 0.05 was considered statistically significant. The effect size (Cohen’s d), was also used to determine the magnitude of the effect of interest. Results There was no statistically significant improvement in elbow JPS immediately following CSM. The combined intervention group showed a statistically significant increase in the electrical activity of biceps (p < 0.001) and triceps brachii (p = 0.004) muscles during the CSM. The group that received upper CSM only had the greatest increase during CSM in both muscles (p = 0.04 for biceps and p = 0.024 for triceps. This group also had a sustained increased electrical activity that was statistically significance for a 10% level of significance (p = 0.09), during the rest period. There was a statistically significant improvement in dynamic balance for the combined intervention group (p = 0.012). Of the subgroups, the lower CSM only group had the greatest improvement in dynamic balance (p = 0.035) followed by the upper CSM only group (p = 0.074, significant for a 10% level of significance). Comparison of the four groups indicated two trends in the outcomes. The first trend was that the upper CSM only group had the greatest effect size for elbow JPS improvement and increased electrical activity for the biceps and triceps brachii muscles during the intervention and rest period, as well as a statistically significant difference in dynamic balance at a 10% confidence interval (p = 0.074). The second trend was in the lower CSM only group, which had the greatest effect size in decreasing electrical activity during the active movement as well as the greatest statistically significant improvement in dynamic balance (p = 0.035). Conclusion This preliminary study indicates that there is no immediate improvement in elbow JPS following CSM as a once off intervention. CSM has an immediate effect on increasing electrical activity of the biceps and triceps brachii muscles during the CSM. CSM also improves dynamic balance. Upper CSM has the greatest effect on electrical activity during the CSM and rest period. Lower CSM has the greatest effect in improving dynamic balance.
Origins and control of bacterial contamination during spinal manipulation
(2018) Amod, Fariya; Swalaha, Feroz Mahomed; Reddy, Poovendhree
Background: Research has revealed that healthcare workers’ hands serve as a source and vehicle for the transmission of micro-organisms within the healthcare sector, thus resulting in nosocomial infections, better known as healthcare-associated infections. The chiropractic profession is traditionally known as a hands-on profession, where the fundamental treatment protocol includes manual manipulation of the spine. In order to perform these procedures hand-to-patient interaction is required, resulting in skin-to-skin contact. Poor hand hygiene practice has been attributed by the World Health Organization as the primary cause for the spread of micro-organisms within the healthcare environment. Unwashed hands harbour microbes, thus increasing contamination levels and subjecting patients to these potential pathogens. This study aimed to determine the presence and transfer of bacterial contamination occurring during spinal manipulation, as well as analysing the efficacy of decontaminants used by chiropractic practitioners against the isolated bacteria cultivated. Research design: The study was located in the quantitative experimental paradigm and conducted as a cross-sectional investigation. Method: Samples were obtained from chiropractors’ hands before and after spinal manipulation. Samples were then serially diluted, plated in duplicate (using the spread plate technique) and incubated for 24-48 hours at 37°C. Viable counts of colony forming units (CFUs) were then enumerated in order to verify the presence of bacteria on the chiropractors’ hands, as well as to establish the direction of transfer occurring during spinal manipulation. Macroscopic and microscopic characteristics of each bacterial isolate were used to identify the bacteria cultivated. A modified Kirby Bauer technique was used to ascertain the efficacy of decontaminants commonly used by chiropractors, against the isolated bacteria obtained from their hands. Results: Bacterial flora were present on 100% of the chiropractors hands both pre- and post-spinal manipulation. A mean of 16,456 (27,718) cfu/ml⁻¹ were enumerated from the samples collected from the chiropractors’ hands during manipulation. A paired t-test indicated a significant difference noted in the viable count of bacteria found on the chiropractors’ hands before and after manipulation (p<0.001). A significant difference was observed in the viable count of bacteria post-manipulation (70%), as opposed to the pre- manipulation readings (30%).This was indicative of a higher rate of bacteria being transferred from the patient to the chiropractor during spinal manipulation. The majority of the microorganisms identified were either primary or opportunistic pathogens. Staphylococci were most prevalent in the pre-spinal manipulation readings accounting for 53% of the colonies, followed by micrococci with 39%, bacilli with 4%, Staphylococcus aureus with 3% and streptococci with 1%. Pseudomonas spp. were present but uncommon. Escherichia coli were not present on the chiropractors’ hands in any of the samples obtained pre-manipulation. The post-manipulation readings constituted a high prevalence of micrococci accounting for 57% of the colonies, followed by staphylococci with 32%, Pseudomonas spp. with 5%, E. coli with 3%, Staphylococcus aureus with 2% and bacilli with 1%. Streptococci were present but uncommon. The decontaminants tested were most effective against gram-positive bacteria such as Bacillus, Micrococcus, Staphylococcus, Staphylococcus aureus and Streptococcus. The bacteria isolated were most susceptible to the D-Germ hand disinfectant, while the Dis-Chem instant hand sanitizer was the least effective decontaminant tested. Ciprofloxacin was the antibiotic used as a positive control. A significant difference was noted between the performance of the positive control and the decontaminants on the bacteria isolated. Conclusions and recommendations: The study proved the presence of primary and opportunistic pathogens found on the chiropractors’ hands. These included Staphylococcus spp., Micrococcus spp., Bacillus spp., Pseudomonas spp., E. coli, Streptococcus spp. and Staphylococcus aureus. A higher rate of bacteria was observed being transferred from the patient to the chiropractor during spinal manipulation. The majority of the microorganisms identified were either primary or opportunist pathogens, thus predisposing both the patient and the chiropractor to potential infection. A significant difference was noted between the performance of the positive control and the decontaminants on the bacteria isolated. None of the decontaminants were as effective against the bacteria isolated as the positive control. It can therefore be deduced that each bacterial flora was not removed by some of the decontaminants currently used by chiropractic practitioners in practice.
The immediate effect of sham laser and three different spinal manipulative protocols on the throwing speed of baseball players in the KwaZulu-Natal Baseball Union
(2018) Robson, Michael; Haswell, Garrick David
Background: ABSTRACT Baseball pitching is a whole body ballistic movement that requires transfer of energy from the lower extremity to the upper extremity via the trunk. Adverse changes can occur within the surrounding ligaments, tendons and muscular tissue of the trunk when immobilization or restricted motion within a joint segment occurs. Improper transfer of energy is thought to cause abnormal stresses on the joints and may lead to injury and/or decreased performance. Spinal manipulation therapy (SMT) was the focus of this study, aimed to improve flexibility and joint mobility (Range of motion), thereby allowing for a more efficient closed kinetic chain movement, which could result in a faster speed of the baseball pitch. Objective: To determine and compare the immediate effect of placebo and SMT of the thoracic and lumbar spines in respects of range of motion (ROM) and the velocity of the pitching participants. Methods: Fourty asymptomatic baseball players were divided randomly into four groups. Group A received thoracic spine manipulation, Group B received lumbar spine manipulation, Group C received combined thoracic and lumbar spine manipulation and Group D received the sham laser intervention as a placebo controlled group. Pre- and post- intervention trunk flexion and lateral flexion ROM and pitching speeds were measured, using a digital inclinometer and a radar gun respectively. A subjective measurement of the participant’s perception of a change in pitching speed post-intervention was also recorded. SPSS version 23 was used to analyse the data. Results: There was a significant increase in pitching speed in the SMT interventions groups (p<0.05). However, between the SMT and placebo groups they were not considered significantly different at 5% (p>0.05). A significant increase in Thoracic RLAT ROM was noticed on the inter-group analysis (p<0.05). There was no correlation seen between subjects’ perception of change in throwing speed post-intervention and the objective results obtained. Conclusion The immediate effect of SMT on baseball pitching speed was inconclusive. The outcome of this study suggests that SMT results in an increase in the average speed of baseball pitching but not at a level of statistical significance.
The effectiveness of an electromechanical adjusting instrumental compared to cervical spine manipulation in the treatment of cervicogenic headaches
(2018) Whittaker, Russell; Varatharajullu, Desiree
Background: Cervicogenic headaches are usually chronic, debilitating and tend to be unresponsive to common headache medications. Manual therapy has been shown to be an effective form of management for cervicogenic headache. The Electromechanical Adjusting Instrument is a hand-held device offered as an alternative to manual therapy for musculoskeletal treatment. Aim: The aim of this study was to determine the effectiveness of the Electromechanical Adjusting Instrument compared to cervical spine manipulation in terms of subjective and objective measures in the treatment of cervicogenic headache. Methodology: This study was a randomised single-blinded clinical trial. There were 41 participants between the ages of 18 and 59 years who were randomly divided into two groups of 21 and 20 respectively by means of a randomisation table drawn up by the statistician. Participants in Group A received cervical spine manipulation while those in Group B received the Electromechanical Adjusting Instrument. Subjective headache intensity was determined using a Numerical Pain Rating Scale. The effect of neck pain on the participants’ activities of daily living before and after treatment was assessed using the Neck Disability Index. The effect of the headache on the participants’ activities of daily living before and after treatment was assessed using the Headache Disability Index. Objective cervical range of motion in all six planes of motion was assessed using a CROM goniometer. Participants in both groups received six interventions over a three-week period with a minimum interval of 48 hours between each intervention. The subjective and objectives assessments were taken at baseline, post-third and post-sixth interventions. The data was analysed using the IBM SPSS version 24.0. Repeated measures ANOVA was used to examine the effect on each outcome measure separately of time and treatment group interaction. Profile plots were generated to show the rates of changes in outcomes over time by the intervention group. A p value <0.05 was considered statistically significant. Results: For most of the outcomes, there was no clinical or statistical interaction present, i.e. the intervention effect was similar in both groups irrespective of the intervention. Conclusion: The trends in each of the outcomes suggest that the Electromechanical Adjusting Instrument is as effective as cervical spine manipulation for the treatment of cervicogenic headache
The effect of low back manipulation compared to combined low back and hip manipulation for the treatment of chronic non-specific low back pain
(2018) Roberts, Jesse Bruins; Haswell, Garrick David
Background: Chronic non-specific low back pain (CNSLBP) is a common ailment treated by chiropractors. Most chiropractors focus on the localised lumbar area of pain. Other chiropractors focus on restoring function to compensating articulations in the ‗full kinematic chain‘ by assessing and treating the lower extremity in conjunction to the low back. Patients with LBP often exhibit decreased hip-related ranges of motion that may result in future LBP, relapse and a prolonged recovery time. Studies investigating the effect of treating the kinematic chain in relation to LBP are limited and the literature, although widely taught and practiced, is largely anecdotal. Chiropractic manipulation has shown to be effective in the treatment of LBP and many lower extremity conditions. Objectives: This study set out to determine if a combination of low back and hip manipulation would result in a more beneficial outcome for the participant, suffering with CNSLBP, than low back manipulation alone in terms of objective and subjective outcomes. Method: The study was a randomised controlled clinical trial which, through purposive sampling, consisted of 50 participants with CNSLBP and hip joint dysfunction. The participants were randomly divided into two groups of 25 each [A and B]. Group A received low back manipulation alone and Group B received combined low back and hip manipulation. Subjective data was obtained through the Oswestry Low Back Pain Disability Index (ODI) and the Numerical Pain Rating Scale (NPRS). Objective data was obtained through the use of a Force Dial Algometer and an Inclinometer. Data collection occurred at the first, third and fifth consultations and was coded and analysed using IBM SPSS version 24.0. A p-value value of less than 0.05 was considered to be statistically relevant. Results: Intra-group testing showed that there was a significant difference over time, within both groups, with regards to internal rotation and external rotation of the hip, flexion of the lumbar spine, increased pain tolerance in Algometer tests, decreased NPRS values and decreased ODI scores. Within Group A, the mean scores for hip flexion reflected a more significant increase over time than those of Group B. Within Group B, the mean scores for left and right rotation of the lumbar spine reflected a more significant change over time than those of Group A. Inter-group testing showed no significantly differential treatment effect for any of the subjective and objective outcomes. This means that both treatments were equally effective and the hypothesis, that suggested that Group B would improve more than Group A, was incorrect. Conclusion: Both treatment groups improved subjectively and objectively with regards to CNSLBP. Inter-group testing showed that statistically, and for all outcome measurements, there were no significant differences between the two treatment group‘s results. This suggested that there was no additional benefit in combining hip joint manipulation with low back manipulation in the treatment of CNSLBP.

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