Faculty of Health Sciences

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The immediate effect of chiropractic cervical spinal manipulative therapy on joint position sense and balance in elderly participants in the eThekwini Municipality
(2023-05-31) Bonsma, Robyn Debra; Varatharajullu, Desiree; Prince, Cleo Kirsty
Background The elderly population is growing due to medical advancements. Falls risk is one of the leading causes of death and injury in individuals over the age of 60 years, given that aging causes a degeneration of vestibular, visual and proprioceptive systems, aiding in balance. Chiropractic management has been identified as a strategy which may aid in the improvement of balance. There is a paucity in the literature when it comes to chiropractic treatment and its effect on joint position sense and balance, as well as paucity regarding the elderly population. Aim The aim of this study was to determine the immediate effect of cervical spine chiropractic manipulative therapy on joint position sense and sway index, as a part of balance in elderly participants in the eThekwini Municipality, in South Africa. Method This was a pre-post study in which 30 healthy participants with a mean age of 71 years of age participated. The elbow joint position sense was measured using a goniometer, and static balance was tested using the Biodex Biosway® portable balance system. The participants reproduced a predetermined angle of flexion of the elbow (blindfolded) pre- and post- intervention. The participants were tested for sway index on the Biodex Biosway® portable balance system with eyes open, pre- and post-intervention. The intervention of this study was a single cervical spine manipulation of the most restricted facet using the diversified technique. The location of the manipulation was not specific to a particular area of the cervical spine but the most restricted segment was adjustment. The joint position sense and balance of the pre- and post-intervention data were compared using statistical software IBM SPSS version 27. Results There was a significant improvement of joint position sense (p=0.032) after chiropractic spinal manipulation of the cervical spine; this was shown by the increase in accuracy of joint position sense. There was no significant improvement in static balance (p=0.683) after chiropractic spinal manipulation of the cervical spine. In this study, 76.7% of the participants were female and 23.3% were male and the ethnic distribution was as follows 90% white, 6.7% black and 3.3% Indian. Conclusion This study suggests that cervical spinal manipulation may alter sensorimotor functions associated with aspects of balance, such as joint position sense in the elderly, and thus decrease falls. This is due to the improvement in joint position sense post-chiropractic spinal manipulation however, it is unknown if this effect translates to the lower limb. Further studies need to be done to determine the effect of chiropractic manipulation on balance in the elderly as chiropractic spinal manipulation influences aspects of balance in the elderly but it is unclear as to the lasting length of its effects. It is also unclear as to the effect of longterm chiropractic treatment in both balance and falls prevention.
A systematic review of the effectiveness of the use of the Activator Adjusting Instrument in treating spinal pain
(2023-05-31) Melvill, Roxanne Patricia; Korporaal, Charmaine Maria
Spinal pain is commonly encountered by chiropractors and there are several adjustment techniques used to treat spinal pain. Practitioners are required to practice evidence-based chiropractic care in order to best care for their patients and to provide information to guide informed consent. A systematic review provides a well-structured summation and analysis of the available evidence and the effectiveness of the intervention. An analysis would be able to determine the level of evidence in support of the use of the Activator Adjusting Instrument (AAI) in treating spinal pain. The AAI can be used as an adjustment tool (as the AAI technique) outside of the AMCT protocol and the AAI can be used within the AMCT protocol. Both of these uses of the AAI are included in this study. Objectives: The aim of this dissertation was to review published literature regarding the use of the AAI in treating spinal pain. The effectiveness of the use of the AAI in treating spinal pain was evaluated to present current evidence available for its use to treat the different areas of the spine in clinical practice. Method: A literature search was conducted with the following key terms: “Activator”, “Instrument Adjusting”, “Joint Dysfunction”, “Manual Therapy”, “Activator Technique”, “Activator Adjusting” and “Instrument assisted manipulation”. Databases searched were PubMed and Scopus. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. All electronic or paper English articles, which possessed the required key indexing terms, met inclusion and exclusion criteria, and represented randomised controlled study, non-randomised controlled study and observational study designs, were included. Data Collection and Analysis: Blinded review of the articles was then conducted by six independent reviewers, as well as the researcher, utilising the PEDro Scale (for randomised controlled trials), Newcastle-Ottawa Scale for (non-randomised controlled trials) and Liddle Scale (for observational studies). This allowed the methodological rigour of each article to be ranked. The ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence to use the AAI in treating spinal pain. A total of 23 articles were identified and included in this systematic review. The review and ranking of these articles revealed limited evidence in support of the use of the AAI outside of the AMCT protocol (AAI technique) in the lumbar spine, sacroiliac, and coccygeal regions; however, there was no evidence in support of or against its use in the cervical, thoracic and full spinal regions. There is limited evidence supporting the use of the AAI within the AMCT protocol in treating the cervical spine. There is no evidence supporting or against the use of the AAI within the AMCT protocol for the remaining spinal regions. In the areas where limited evidence is available, spinal pain reduction as a result of the intervention (either AAI technique or AAI within the AMCT protocol) is comparable with the findings of manual manipulation. However, the majority of the spinal regions have no evidence available to base treatment guidelines and informed consent on, in clinical practice. Conclusion: Until further research is conducted surrounding the use of the AAI technique and the AAI within the AMCT protocol in the spinal areas where there is no evidence, practitioners are advised to use the AAI sparingly in these spinal regions, informing the patient of a lack of evidence, until such time as further studies have been carried out that produce reliable and valid evidence in these regions. It is evident that future research is required surrounding the use of the AAI technique as well as the AAI within the AMCT protocol in order for practitioners to apply evidence-based practice and compete informed-consent procedures with patients. Having more evidence in these domains will strengthen the literature and allow for improved clinical decision-making based on evidence that is of high quality and practical value.
The effect of cervical spine manipulation on laterality judgement ability in participants with persistent neck pain
(2022-09-29) Bradford, Benjamin; Docrat, Aadil
BACKGROUND Neck pain is among the top twenty most burdensome chronic health conditions worldwide. The severity of neck pain among patients varies, but it has been found that about 50% of episodes tend to become chronic. Previous research has used the accuracy with which the laterality of body parts can be identified as a proxy for cortical body schema accuracy and integrity. Treatments aimed at addressing such cortical maladaptations to pain have been effective in reducing pain and dysfunction in a number of conditions. More specifically, spinal manipulation (SM) has been shown to improve the laterality judgement reaction time (LJRT) of participants regarding alphabetical characters. However, the effect of SM on laterality judgment accuracy (LJA) regarding body parts has not been determined. Moreover, it has been shown that the neurological mechanisms by which the brain determines the laterality of letters and objects (allocentric mechanisms) are distinct from those involved in laterality judgements of body parts (egocentric mechanisms). This study investigated the effects of cervical spinal manipulation on LJA using Neck and Hand images as well as the ‘R’ alphabetical character to determine whether SM was able to address distortions in cortical body schema mapping that may have contribute to persistent neck pain. AIM The overarching aim of the study was to determine the immediate effect of cervical spinal manipulation on laterality judgement reaction time (LJRT) and laterality judgement accuracy (LJA) in participants with persistent neck pain. METHODOLOGY The study adopted a quantitative paradigm and was a pre-test, post-test experimental trial. People between the ages of 18 and 55 with a current history of non-traumatic neck pain for 4 weeks or more were invited to participate in the study. The selected participants were randomly allocated to either the intervention or the control group. Further screening was conducted by means of a telephonic interview, the elicitation of a medical history, a full physical examination, and a cervical regional examination to ensure that there were no contraindications to their participation in the study. Applicants were excluded if they had received any treatment for their neck pain in the foregoing three months. A total of 58 participants was formally included and randomly allocated to either the intervention or control group. Each participant was then submitted to a pre-intervention/control test for laterality judgment ability in terms of the letter ‘R’ and Hand and Neck images using the commercially available Recognize application. Following the application of the respective interventions (i.e., spinal manipulation and a set up for spinal manipulation without thrust), post-test measurements were taken as before. Each participant also completed a Central Sensitization Inventory (CSI) at the time of participation. The paired t-tests was used to compare paired means within groups from pre- to posttreatment. Repeated ANOVA measures were used to compare the changes over time between the two treatment groups, while profile plots were used to assess the direction and trend of the effect of the intervention. Correlations between changes in the scores of the alphabetical character ‘R’, Hand, and Neck were assessed using Pearson’s correlation analysis. The same was used to assess the correlation between changes in Laterality judgement performance and CSI scores. These correlations were done for the entire sample regardless of treatment group. Ethical approval (IREC 013/20) for the study was obtained from the relevant institution’s research ethics committee prior to commencement (Appendix A). FINDINGS Both groups showed significant improvements over time between the pre- and postintervention tests, but improvements in the intervention group were statistically indistinguishable from those of the control group. Additionally, there was no correlation between measures of allocentric and egocentric laterality judgement ability. No relationship was found between CSI scores and laterality judgement performance or improvement over time.
The relative effect of upper cervical spine manipulation, placebo and a control, on neck muscle activity, pain and disability in participants with cervicogenic headache
(2020-11-30) Brann, William Edward; O’Connor, Laura; Venketsamy, Yomika
Objectives: Cervical spinal manipulation (CSM) has been shown to be effective in treating cervicogenic headache (CGH) by reducing pain and disability. There is a paucity of research investigating whether changes in muscle activity account for the changes in patient reported outcomes in patients with CGH following CSM. The aim of this study was to determine the effect of upper CSM compared to a placebo and a control intervention in terms of subjective (pain and disability rating) and objective measures (muscle activity and force output of the trapezius, posterior cervical and sternocleidomastoid muscles) in the treatment of CGH. Methods: A randomized, controlled, pre-test, post-test, experimental design allowed for 45 participants, aged 18-50, with CGH to be allocated to a CSM, placebo or control group. Pain and disability were measured before and telephonically 48 hours after the intervention. Muscle activity and force output of the trapezius, posterior cervical and sternocleidomastoid (SCM) muscles were measured before and immediately after the intervention. IBM SPSS was used to analyse the data with significance set at p=0.05. The subjective and objective measures were not normally distributed and this resulted in nonparametric statistical tests being utilised to analyse the data. Wilcoxon Signed Rank Tests were used to determine significance within groups and Independent-samples KruskalWallis Tests and Pairwise multiple comparison tests were used to determine significance between groups. Results: No significant differences were found between the three groups for age (p=0.460) and gender (p=0.566), with a marginally significant finding for race (p=0.046). Subjective measure assessment found only a significant decrease in pain (p=0.001) and disability (p=0.001) from pre- post-test within the CSM group. Intergroup analysis found that the CSM group experienced the greatest reduction in pain (p=0.001) and disability (p=0.001) when compared to the placebo and control groups. Clinically, only pain in the CSM group decreased significantly. Objective findings showed significant intragroup increases in muscle activity, found bilaterally in the SCM (p=0.017 SCMR) (p=0.012 SCML) and trapezius muscles (p=0.041 TrapR) (p=0.041 TrapL) in the CSM group and only in the trapezius muscle (p=0.031 TrapR) (p=0.027 TrapL) bilaterally in the placebo group. Force output only increased in the trapezius muscle on the left (p=0.027) in the placebo group and bilaterally in the control group (p=0.031 TrapR) (p=0.041 TrapL) There were no significant intergroup differences between the groups for muscle activity and force output in the trapezius, posterior cervicals and SCM
The immediate effect of lumbar spine manipulation, thoracic spine manipulation and placebo manipulation on range of motion and bowling speed in asymptomatic male and female indoor cricket bowlers
(2020-11-30) Nayager, Prasanthi; Maharaj, Praveena; Sood, Kanwal
Background: Cricket bowling is a manoeuvre that consists of a sequence of body motions utilising the entire kinematic chain. Cricket like many sports is played both indoor and outdoor. To eliminate the factors of weather (dew and wind) and nature (grass top pitchers) the following study was conducted on indoor cricket bowlers. The phrase ‘proximal stability for distal mobility’ is best suited, as the lower extremities, pelvis and trunk play a vital role and assist the upper extremities in the bowling action. Therefore, bowling should be known as a combined movement of the entire body, culminating with rapid motions of the upper extremity. Restricted motion within a joint segment could lead to adverse changes in the surrounding muscles, tendons, and ligaments of the trunk. Restricted motion of the trunk and pelvis may result in abnormal loads being applied on the peripheral joints, thus resulting in injuries or a decline in an athlete’s performance. Spinal manipulation therapy is a technique that is used to improve flexibility and mobility in a joint. This study focused on the effects of SMT on the joint range of motion (trunk) and bowling speed. Objectives: The main objective of this study was to assess the immediate effects of lumbar spine, thoracic spine, and placebo manipulation on the range of motion of the thoracic and lumbar spine, as well as the bowling speed of the participants. Methods: A sample of asymptomatic male and female cricket bowlers (60 in total), playing for schools, local clubs and at provincial level were divided into three groups of 10 each. Group 1a and Group 1b received thoracic spine manipulation, Group 2a and Group 2b received lumbar spine manipulation and Group 3a and Group 3b received placebo spinal manipulation. The range of motion of the thoracic and lumbar spine was measured pre and post manipulation using a digital inclinometer. Bowling speed was measured pre and post warm-up and manipulation using a speed radar. The participants’ perception of changes in bowling speed post manipulation were also recorded. SPSS version 25 was used to statistically analyse the data. Results: There were statistically significant increases in thoracic range of motion post thoracic manipulation in male and female participants. Thoracic spine manipulation enhanced bowling speed significantly in male and female participants. Lumbar spine manipulation increased lumbar range of motion and thoracic range of motion, especially in the female athletes. However, it did not impact bowling speed. Post placebo manipulation showed that there were no significant differences in range of motion and bowling speed. However, both thoracic and lumbar manipulation showed significant changes in range of motion, compared to placebo manipulation. Conclusion: This study supported the findings of several authors, that spinal manipulation significantly influences athletes’ performance. In this study, post thoracic spine manipulation bowling speed increased significantly in both male and female athletes. It was also evident that female participants’ range of motion increased overall except for extension of the lumbar spine more post manipulation, while male participants had a higher bowling speed average.
The effect of lumbar spine manipulation on the muscle activity of the quadriceps femoris and hamstring muscle groups
(2020-11-30) Parkes, Jenna-Leigh; Abdul-Rasheed, Ashura
Background: The clinical use of spinal manipulative therapy is becoming increasingly evident in the treatment of musculoskeletal conditions. However, the exact neurophysiological mechanisms behind spinal manipulative therapy and its effects on muscle activity require further investigation. Fixated joints within the spine have been shown to cause changes in muscle activity in both segmentally related muscles and extremity muscles. When present in symptomatic or asymptomatic individuals, fixations in the spine may not only lead to local neurophysiological changes but may affect global neurophysiology. Chronic lower back pain has been associated with the presence of arthrogenic muscle inhibition in lower limb musculature which prevents an individual from fully activating the affected muscle. Although this form of inhibition is predominately present in symptomatic individuals, there is evidence to suggest that asymptomatic individuals undergo a similar neuromuscular change. However, further research is needed to determine if the extent of the effects of arthrogenic muscle inhibition differs between symptomatic and asymptomatic subjects. Aim: This study aims to determine and compare the effects of a lumbar spine manipulation on the muscle activity in the quadriceps femoris and hamstring muscle groups in asymptomatic and symptomatic participants. Method: This study was a randomised controlled trial which utilised a pre- and postexperimental design. A total of 48 participants between the ages of 18-45 years of both genders and all races were recruited. The sample population included a symptomatic and asymptomatic clinical group. Each clinical group had a treatment and control group. Once placed into their respective groups, individuals were randomly allocated to the intervention or control group. Muscle activity readings of the quadriceps femoris and hamstring muscles were obtained during sets of maximum voluntary contractions that occurred at the pre-intervention/control, post-intervention/control and post 10- minute intervention/control. IBM SPSS version 26 was used to analyse the data. Repeated measures ANOVA tests were used to compare each outcome between preand immediate post-treatment between the intervention and control groups for immediate effects, and pre- and 10-minute post-treatment between the intervention and control groups for short-term effects. This was initially done within the asymptomatic and symptomatic participants separately. Results: There were no statistically significant differences between the age and gender of the symptomatic and asymptomatic groups. With regards to muscle activity, no significant changes in the quadriceps femoris or hamstring muscle groups were identified in the asymptomatic group. Significant changes were detected in the right rectus femoris of the quadriceps muscle demonstrating evidence of a treatment effect (p=0.047). However, this change did not persist in the 10-minute readings. Although not statistically significant, there was clear evidence of a clinical trend that presented in the quadriceps femoris muscle (rectus femoris and vastus medialis) of the symptomatic group, as the overall muscle activity of the participants who received the intervention increased bilaterally. There were no statistically significant differences found when comparing the data between the symptomatic and asymptomatic clinical groups. Conclusion: The results showed that lumbar spine manipulation did not produce significant differences in the immediate post-readings and the 10-minute readings in the quadriceps femoris and hamstring muscles of the symptomatic and asymptomatic groups. When comparing the clinical groups, there was no significant difference between the asymptomatic and symptomatic groups in terms of the pre-intervention readings of muscle activity and the post-intervention measures immediately and at the 10-minute interval following lumbar spine manipulation.
The effect of cervical spine manipulation compared to muscle energy technique on neck muscle activity and range of motion in asymptomatic participants
(2020-06-10) King, Sasha Lee; Docrat, Aadil; Abdul-Rasheed, Ashura
Background: Clinical evidence supports the use of spinal manipulative therapy (SMT) and muscle energy technique (MET) for the treatment of cervical spine dysfunctions. However, the physiologic mechanism behind their effectiveness is not well understood. Joint dysfunctions are associated with hypertonicity of segmentally related muscles and can occur in both symptomatic and asymptomatic individuals. Neck pain (NP) has been associated with cervical muscle dysfunction, due to the presence of altered muscle activity and impaired kinematics, demonstrated in NP patients. This includes the upper trapezius and posterior cervical muscles, whose dysfunction can be a source of NP. Spinal manipulative therapy and MET are mechanical interventions, that when applied to joint dysfunctions, produce neurophysiological changes, specifically the modulation of muscle activity and improved range of motion (ROM). However, the demonstration and comparison of the neurophysiological effects of SMT and MET in the neck, and its related musculature, are unknown. Aim: The aim is to determine the effect of cervical spine manipulation compared to MET on neck muscle activity and range of motion in asymptomatic participants. Method: This is a quasi-experimental study utilising a pre-test, post-test design, which employed 50 asymptomatic participants aged between 18 – 35 years of both genders and all races. The participants were randomly allocated into one of two treatment groups. Group 1 received cervical spine manipulation (CSM) and Group 2 received MET. Before and after the respective interventions, resting upper trapezius and posterior cervical electromyographic muscle activity and the cervical spine range of motion (CROM) (lateral flexion and extension) were measured. The IBM SPSS version 24 was used to analyse the data. The intra-group changes were compared pre- and post-intervention using paired Wilcoxon signed ranks tests. Median changes between pre- and post- were compared between the two treatment groups using Mann-Whitney U tests. A p value < 0.05 was considered as statistically significant. Results: None of the demographic or background variables differed significantly between the two groups. Both treatments had an effect, although not all significant, involving mostly reductions in resting electromyographic muscle activity and improvements in CROM. This was significant for the right posterior cervical muscles in the SMT group (p = 0.012) and for ROM in both groups (p < 0.001). No evidence of a difference in treatment effect was found. Conclusion: The results of this study suggest that SMT and MET mostly decrease resting neck muscle activity and improve CROM. Muscle energy technique may possibly be equally as effective as CSM. Concurrent changes in both outcomes suggest that more than one physiologic mechanism may likely explain these effects.
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.
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.

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