Faculty of Health Sciences

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Muscle recruitment patterns of selected upper extremity muscles in Chiropractors within the eThekwini Municipality while performing a simulated sacroiliac joint manipulation
(2024) Luke Hardy, Benjamin; Murphy, Bernadette; O’Connor, Laura
Background: Spinal manipulative therapy in the form of a high velocity, low amplitude manipulation, is a specialised therapeutic technique utilised by chiropractors and other manual therapists. Little is known about the shoulder muscular recruitment pattern utilised by practitioners/student’s to deliver this technique. This study aims to profile the muscle recruitment patterns of selected upper extremity musculature during a simulated sacroiliac joint manipulation to provide objective teaching material for future spinal manipulative therapy students regarding this specific manipulation. Methods: A quantitative, descriptive, observational design in which surface electromyography (sEMG) was used captured muscle activation patterns of 11 shoulder muscles in 20 qualified chiropractors who practiced in the eThekwini Municipality. Muscle activity was recorded while the chiropractors performed a simulated sacro-iliac joint manipulation, while simultaneous live video recording was obtained. The manipulation was assessed during its three phases: preload, thrust and resolution. Participants gave informed consent. Raw data was processed and normalised for comparability. Results: All 11 muscles displayed activity throughout the three phases of the adjustment. During preload, the clavicular and sternal pectoralis major and biceps brachii had the greatest mean and median muscle activation magnitude, with the middle and upper trapezius and clavicular pectoralis major showing the greatest maximum muscle activation magnitude. In the thrust phase all muscles showed high activity levels, except for the posterior deltoid which showed moderate activation. The middle and lower trapezius and infraspinatus had the greatest mean, median and maximum muscle activation magnitude. During the resolution phase, the greatest median muscle activation magnitude was found in the middle and lower trapezius and posterior deltoid muscle. This was similar to the greatest mean and maximum muscle activation with the triceps brachii replacing the lower trapezius. The maximum force output during the adjustment was averaged at ± 1.9 Kg. Conclusion: This study highlights the role of the shoulder muscles, specifically the pectoralis and the scapular stabilizer muscles, especially the middle trapezius, in the execution of the spinal manipulative technique investigated in this study. Future studies should confirm these findings in larger population where subgroup analysis can be undertaken.
The effects of an upper cervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture
(2023-05-31) Petzer, Matthew; Abdul-Rasheed, Ashura
Background: Postural dysfunction in the cervico-thoracic spine often leads to segmental restrictions and hypomobility, and this is often caused by biomechanical alterations due to postural changes and over activity of skeletal muscles in that region. These muscles include the pectoralis and trapezius muscles. Postural dysfunction and joint restrictions are often treated by manual therapies, such as spinal manipulation. Previous studies have established that joint manipulation reduces postural dysfunction and improves joint mobility, which could be explained by a combination of neurophysiological,and biomechanical effects.In literature, the immediate benefitsof acervico-thoracicmanipulation on muscleactivityandposture are not well understood and, therefore, an investigation into the immediate effects of manipulation on muscle activity and posture was implemented in this study. Aim: This study aimed to observe the immediate effect of an uppercervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture. Methods: This study was a quantitative, observational study with a pre-test posttest design. Surface electromyography was used to measure the muscle activity of the pectoralis major, upper and middle trapezius muscles prior to and after the cervico-thoracic intervention. A sample size of 40 asymptomatic participants were recruited to participate. The participants were randomly divided into two groups: group A, which was the control group, and group B, which was the intervention group. The intervention group received a cervico-thoracic manipulation, but the control group received no intervention and remained prone for 3 minutes between the pre-test and post-test readings. The within-group comparisons of pre- and postmuscleactivity were achieved usingpairedT-tests. Within groupandbetween group comparisonsof the change between pre- andpost-intervention wereachieved using repeated ANOVA testing. A p-value below 0.05 was statistically significant. IBM Statistical Package for Social Sciences (SPSS) version 26 software was used to process the data. Results: There was no statistically significant treatment effect of cervico-thoracic spinal manipulation in the effects on muscle activity. Although there was not a statistically significant change in muscle activity, there was a positive change in pectoralis major compared to the upper or middle trapezius. The upper and middle trapezius muscles decrease activity followed an evident trend between the participants who received the intervention compared to the control group. Postural results were not statistically significant but positive correlations to treatment were found. The craniovertebral angle was seen to decrease at a higher rate compared to the control group. Additionally, the study provided evidence of a treatment effect on the acromiovertebral angle, decreasing overall in severity. Conclusion: The results of this study do not provide conclusive evidence that the intervention has any immediate statistical effect on the three muscle activity measurements outcomes observed. In terms of the Posture Pro Analysis System measurements, changes (decrease in angles) between the pre- and postintervention were mostly significant in both groups, but statistically there was no difference between the control and intervention groups. Posture Pro ratings did not provide evidence of changes in categories within the groups. Therefore, the null hypothesis was retained.
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 on the effectiveness of manipulation and mobilisation in the treatment of osteoarthritis
(2023-05-31) Khamissa, Ahmed; Korporaal, Charmaine Maria
Osteoarthritis (OA) is an increasing condition globally as the population ages and the number of elderly increases. However, there is a lack of relevant evidence-based guidelines for manual therapy in the treatment of OA especially involving OA of the spine, wrist, temporomandibular joint (TMJ), and the glenohumeral joint (GHJ). A systematic review organises and critiques literature in a more concise form for practitioners. This study aimed to briefly provide practitioners the evidence available on the effectiveness of manipulation and mobilisation on OA. Methods: A systematic review of available literature was performed using keywords including “manipulation”; “mobilization”; “manual therapy” and “osteoarthritis”; “spondylosis”; “degenerative joint disease”; “degenerative disc disease”. The database searches were through CINAHL, DUT summons, Google scholar, Pubmed and Scopus. Following a screening using inclusion criteria, 20 articles were chosen for review. Each of the studies were than reviewed by three reviewers using the Newcastle-Ottawa scale, the PEDRO scale, the Joanna Briggs Institute (JBI) scale for case series and the JBI scale for case reports. These scales evaluated the methodological rigour (internal validity) of the chosen articles. In addition, the external validity was determined through a critique of each article. The internal and external validity formed the basis for decisions on the level of evidence provided in support of manual therapy. Results: Of those chosen articles, 13 provided evidence of treatment programmes and could not contribute to evidence specific to mobilisation and manipulation. In contrast, four articles assessed the efficacy of mobilisation, one study assessed the efficacy of manipulation, and two studies assessed the efficacy of neural mobilisation. There was moderate evidence in support of mobilisation on thumb carpometacarpal (CMC) OA, but only limited evidence in support of its use on cervical spine OA and no evidence in support of its use on lumbar spine OA, GHJ OA and TMJ OA. Manipulation was suggested to have moderate to limited evidence in support of its use on lumbar spine OA, but no evidence for cervical spine OA. Neural mobilisation was suggested to have limited evidence in support of its use for treating thumb CMC OA. Conclusion: It was evident in this systematic review that there is limited evidence for mobilisation, manipulation and neural mobilisation. Further research is required to expand on the limited areas, as well as strengthen the current evidence for clinical use.
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.
An epidemiological investigation into low back pain in schoolteachers within the Greater Tzaneen Municipality in Limpopo, South Africa
(2022-09-29) Prinsloo, Imé Mari; Docrat, Aadil; Prince, Cleo Kirsty
Background: Low back pain (LBP) is a common and significant disease found in the entire population but increased among the working population. Studies have shown that prevalence among LBP in schoolteachers are increased, yet there has been limited studies looking at urban and rural schoolteachers simultaneously. Objectives: To determine the incidence and lifetime prevalence of low back pain among schoolteachers within the Greater Tzaneen Municipality, South Africa; to determine the risk factors (in terms of demographics, lifestyle, and occupational factors) of developing LBP; and to determine the management strategies sufferers of LBP use to get relief. Methods: This was a quantitative, descriptive, cross-sectional study conducted within schools of the Greater Tzaneen Municipality. Teachers working in both the urban and rural school setting were approached to partake in the study. Those who met the criteria were invited to complete the selfadministered questionnaires, online or hard copies. In total 345 questionnaires were completed. Results: Of the 345 completed questionnaires 67% reported having LBP. Significant associations were made between the prevalence of LBP and increased mental stress (51.5%). Similarly, LBP sufferers had a higher BMI (p=.010); have been teaching for longer, (p=.049); and spend more time working at a computer, p<.001. Aggravating factors of LBP included bending/twisting the body, lack of sleep, reaching overhead, sitting, standing, and stress/tension. The strongest corresponding factor being stress and tension (p<.001). Conclusion: In this specific community there was no significant difference in prevalence of LBP between urban and rural schoolteacher. Notwithstanding previous research, this study highlights that global statistics is not always appropriate in South African context. This draws attention to the need for research specifically based on our diverse country.
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.
A systematic review of non-invasive manual therapy in the management of rheumatoid arthritis patients
(2022-05-13) Sclanders, Kyle Donald; Korporaal, Charmaine Maria
Background: Rheumatoid arthritis (RA) is a common, chronic, and progressive autoimmune condition manifesting in a polyarticular pattern, with an agnogenic pathophysiology. The progressive effect on physical function (e.g., pain, quality of life, funcaitonal impairment and disability) and the side effects of pharmaceutical interventions, have led to patients seeking adjunctive therapy. Complementary and alternative medicine (CAM) therapy, is thought to reduce pain, increase range of motion, and improve quality of life. Yet, the evidence base for CAM therapies is vague. This systematic review of studies relating to non-invasive manual therapy (vis. exercise, manipulation, mobilisation, and massage), determined the level of evidence available for their use, and provided a summation of the available evidence to support evidence-based clinical practice. Finally, the study provides recommendations for further investigations. Method: This mixed methods systematic review complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and Cochrane Collaboration guidelines, required an electronic literature search (viz: Google Scholar and DUT Summons) using key terms including rheumatoid arthritis and variable combination one or more of the following: treatment, management, chiropractic, osteopathy, physiotherapy, physical therapy, massage, mobilization, manipulation, joint oscillation, and exercise. This along with hand search strategies and reviewer input produced 65 articles that were incorporated into the review (40 RCTs. 15 nRCTs, and 10 Cases). All selected articles were available in English in electronic format and represented RCTs, nRCTs and CR/CS (not limited to peer reviewed studies) and reflected interventions applied to adult, human subjects. The articles were reviewed by 13 reviewers, using as appropriate the PEDro, Newcastle-Ottawa or Liddle scales, to evaluate the methodological rigour (internal validity) of the studies, while qualitatively contextualizing these outcomes (external validity) to determine the impact of bias on the reported clinical outcomes. Thereafter an analysis of evidence per modality was completed utilising published grading systems. Results: The above evaluations and aggregated evidence available was then determined for the modalities. It was found that there is limited evidence available for manipulation, mobilisation, massage, and exercise in the treatment of the RA patient. The notable exceptions were the use of aerobic exercise with acetaminophen; exercise as part of an intervention programme in the treatment of the hands; and mixed exercise programme to improve bone mineral density and attaining muscular strength gains. Conclusion: Thus, excluding the exceptions, the reviewed interventions should be used cautiously in practice and patients should not be provided with expectations that are not confidently supported by available literature. The evidence suggests that for the most part, intervention by means of manipulation, mobilisation, soft tissue manipulation and massage, along with exercise, requires further research efforts to provide sufficient high-quality evidence for the practitioner to implement in clinical practice with confidence
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.

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