Faculty of Health Sciences
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Item 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 MariaSpinal 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.Item 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 KirstyBackground: 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.Item The immediate effects of thoracic spine grade III mobilisation on the muscle activity of the middle and lower trapezius muscle(2022-05-13) Smit, Shinay Elizabeth; Abdul-Rasheed, AshuraBackground: Thoracic spine dysfunction often presents with regional hypomobility which is often caused by abnormal muscle activity in the overlying area. Such as the trapezius muscle. Joint dysfunction is often treated by manual therapies such as joint mobilisation. Previous studies have established that joint mobilisation improves joint mobility, achieves hypoalgesia, improves stability, range of motion and proprioception. Although documented in the literature, the direct benefits of joint mobilisation on muscle activity are not well understood. Therefore, an investigation into the effects of mobilisation on muscle activity was explored. Aim: This study aim was to determine the immediate effects of thoracic spine grade III mobilisation on the muscle activity of the middle and lower trapezius muscles. Methods: This was a quantitative, experimental, study with a pre-test post-test design. Surface electromyography was used to measure the muscle activity of the middle and lower trapezius muscle. A sample size of 48 asymptomatic participants were recruited and randomly divided into the intervention or control group. The intervention group received thoracic grade III mobilisation and the control group remained prone between the pre-test and post-test readings. Within group comparisons was achieved using paired T-tests. Within group and between group comparisons of the change between pre and post intervention was achieved using repeated ANOVA testing. A p-value below 0.05 was considered significant. Results: Spinal mobilisation had no effect on muscle activity. Despite the lack of statistical evidence, there was a positive trend in the effects of thoracic spine mobilisation with a borderline treatment effect in the left middle trapezius muscle (p = 0.063). There was an overall decrease in muscle activity in the intervention group. Conclusion: The results showed that mobilisation did not produce a noteworthy change in muscle activity of middle and lower trapezius muscles between the intervention and control groups and the null hypothesis was not rejected.Item The epidemiology of work related back pain in full-time restaurant waitron staff within the eThekwini Municipality(2020-11-30) Wolff, Alexia Michaela; Haffejee, FirozaBackground Low back pain (LBP) is one of the leading causes of morbidity in high-, middle- and lowincome populations and is one of the most common and most expensive occupational health problems in developed and developing countries. This affects the working population as LBP has a detrimental effect on work performance, therefore it is an important clinical, social, economic, and public health problem affecting the population. Internationally, risk factors in the development of LBP in the working population include prolonged standing, awkward posture and incorrect lifting. There is limited literature on prevalence of LBP, the risk factors associated with LBP and its impact on waitrons in South Africa. This study aims to determine the prevalence, clinical presentation, risk factors and impact of work-related LBP amongst full-time restaurant waitron staff within the eThekwini Municipality. Methodology This study was a mixed methods study comprising qualitative and quantitative components. The quantitative research tool consisted of a previously validated selfadministered questionnaire whilst the qualitative component consisted of voice recorded semi-structured interviews using an interview guide to obtain information on low back pain from participants. The data collected from the questionnaires were entered into an Excel spreadsheet and thereafter analysed using SPSS. Descriptive statistics were used to describe categorical outcomes, whilst Pearson’s chi square or Fisher’s exact tests in the case of categorical variables, and t-tests for continuous variables were used to assess factors associated with LBP. The audio recordings from the qualitative interviews were transcribed verbatim and exported into a Microsoft Word document. Thereafter, thematic analysis was used to analyse the qualitative data to identify common themes and subthemes. Results Of the 340 questionnaires which were distributed, a total of 180 questionnaires were completed by waitrons in the eThekwini Municipality, resulting in a 52.9% response rate. The point, three-month period and annual prevalence was recorded at 50.0%, 62.2% and 78.2%, respectively. Within this population, LBP was associated with the ethnicity of the participants (p=0.002) where Indians had a 7.7 times increase in the odds of prevalent LBP compared with Black Africans (OR = 7.713; 95% CI = 1.273-46.718; p = 0.026) and Whites a 5.9 times increase in the odds of prevalent LBP than Black Africans (OR = 5.891; 95% CI = 1.429-24.289; p = 0.014). Low back pain was associated with the education of the participants (p = 0.002) where participants with high school education had an almost 12 times increase in the odds of prevalent LBP than those with tertiary education (OR = 11.967; 95% CI = 1.399-102.387; p = 0.023). Prolonged standing or walking during a work shift was associated with LBP (OR = 42.808; 95% CI = 2.346-780.985; p = 0.011). Onset of LBP was common during a long single shift or when working a double shift and pain sessions tended to last between one to two hours. The frequency of LBP experienced averaged two to three times a week, where pain was at its worst in the evenings. Low back pain in waitrons commenced gradually without injury and the severity of LBP was unchanged since it initially started. Low back pain resulted in moderate impact on the work of waitron staff, sometimes resulting in absenteeism and bed rest. Eight in-depth, qualitative interviews were conducted. Two main themes emerged from the data: low back pain characteristics and type of treatment. Interviewees discussed pain, onset and duration, and relieving factors as part of LBP characteristics, where they reported first experiencing LBP as young adults. Their onset of LBP was common during a long single work shift or when working a double shift. They re-iterated that prolonged standing and lifting or carrying heavy objects aggravated their LBP. Various therapies were used by interviewees to relieve the pain which included analgesics, antiinflammatories, heat therapy and topical gels. Type of treatment included chiropractic. There was good knowledge of the services offered by chiropractors and various types of chiropractic treatment available. Conclusion The prevalence of LBP amongst waitron staff within the eThekwini Municipality was high. Work-related factors were associated with the onset of LBP. These included prolonged standing, constant walking for long periods of time, carrying heavy loads and falling. Low back pain negatively impacted on their work due to absenteeism as bed rest was required. Various treatment options, including chiropractic were utilized. Participants had some knowledge of what constitutes chiropractic treatment and the types of services offered.Item The epidemiology of low back pain in male adolescent field hockey players in the eThekwini municipality(2019-09-05) De Wit, Dale Cameron; Pillay, Julian David; Ducray, Jennifer FrancesBackground: Field hockey is a popular international sport which is played in 132 countries across the world. Due to the nature of hockey, players repeatedly perform a combination of forward flexion and rotational movements of the spine in order to strike the ball. These movements have been shown to increase the risk for pain and injury to the lumbar spine. Due to the popularity of the sport of field hockey more empirical randomised controlled studies and/or observational studies need to be conducted to determine the pathomechanics of the nature of lower back pain and injury among players. Objectives: The objectives of this study were to determine the prevalence and incidence of low back pain in male adolescent field hockey players; to determine the characteristics of the low back pain in terms of location, chronicity, disability and treatment sought; and to determine the selected risk factors (demographics, equipment, health and lifestyle) of low back pain in male adolescent field hockey players. Method: A descriptive study of cross-sectional design, using a survey data collection tool was used on 112 male adolescent field hockey players in the eThekwini Municipality. The questionnaire data were then statistically analysed using IBM SPSS version 25 with statistical significance set at p value <0.05. Descriptive statistics such as mean and standard deviation, or median and inter-quartile range were used to summarise responses to continuous variables as appropriate. Categorical variables were described using frequency tables. Associations between risk factors and low back pain were tested using Pearson’s chi square test and t-tests as appropriate. Results: A total of 68 participants completed and returned their questionnaires yielding a participation rate of 60.7%. The period prevalence of low back pain was 63.2% and the incidence was 38.2%. Point prevalence at the beginning of the season, mid-season, and end of season was 25%, 32.4% and 22.1% respectively. The most common location for low back pain was the middle low back region (39.5%), and the most common duration of pain was a few hours (32.6%). Most participants (79.1%) did not classify their pain as a disability, and only 44.2% of participants received medical treatment for their low back pain. The results were found to be statistically significant between hydration and low back pain (p = 0.050) i.e. those individuals who did not hydrate frequently during matches and training were significantly more likely to experience low back pain. Conclusion: Low back pain in male adolescent field hockey players is a common phenomenon. The results of this study, although limited to a select group of adolescents, showed a slightly higher prevalence of LBP to that of previous studies. More importantly, even though most participants did not experience low back pain classified as a disability, low back pain still had a large impact on participants, as nearly half of participants consulted with a medical professional for treatment. The study further indicates the need for frequent hydration during matches and training as inadequate hydration was found to be significantly related to low back pain. We highlight this as a novel finding and recommend special consideration to this by athletes and coaches. Moreover, the need for the development of strategies in the prevention and management of low back pain in field hockey is further recommended.Item The effect of a lumbar support pillow on low back pain in long distance truck drivers in the eThekweni District(2019) Van Wyk, Brittany; van der Meulen, Anthony G.BACKGROUND A lack of adequate lumbar support when driving has been said to be an important causative factor of low back pain (LBP) in long-distance truck drivers. Health practitioners prescribe a lumbar support pillow even though the findings of several studies are uncertain. EnVision Tomorrow After Pain (ENTAP) claims that its lumbar support pillows result in an improved posture, a decrease in pain and an increase in comfort (ENTAP 2016). The ‘ENTAP Lumbar Support’ has not yet been tested on participants and, therefore, these claims cannot be currently validated. Therefore, this study intended to determine the effectiveness of the ‘ENTAP Lumbar Support Pillow’ in decreasing LBP in long-distance truck drivers. OBJECTIVE To determine the effect of the ‘ENTAP Lumbar Support Pillow’ on LBP in long-distance truck drivers in terms of pain parameters (intensity and duration of pain), activities of daily living and disability when compared with a polyester lumbar support pillow and no lumbar support pillow. METHODS Sixty-three long-distance truck drivers experiencing LBP were recruited from a trucking company by random allocation. The study was a quantitative paradigm, double blinded, true experimental study design. Participants had to fill out a general questionnaire to determine whether they met the inclusion criteria. A baseline, three-week and six-week questionnaire, consisting of the Numerical Pain Rating Scale (NPRS), the Oswestry LBP Scale and the Patients‟ Global Impression of Change (PGIC) Scale. Statistical Package for the Social Sciences (SPSS) version 25.0 was used to analyse the data. The mean body mass and height were compared between the three treatment groups using one-way Analysis of Variance (ANOVA) tests. Repeated measures ANOVA testing was used to assess the treatment effect of the intervention group compared to the other groups (Esterhuizen 2018). Post hoc comparison of the intervention effect between time points and between treatment groups was done using a Bonferroni correction for multiple testing (Esterhuizen 2018). RESULTS The NPRS within the subjects‟ contrast showed a progressive variation from baseline testing to the three week (p=0.04) and the six week (p=0.001). The profile plot revealed that the mean pain score decreased much faster in Group B ‘ENTAP Lumbar Support Pillows’ compared with both the other groups. The Oswestry LBP Disability Questionnaire score revealed that the score tests within the subjects‟ contrasts showed that the interaction of time x group was significant only at six weeks (p<0.001) compared with baseline. The profile plot showed that the mean Oswestry LBP Disability Questionnaire score decreased (improved) much faster in Group B ‘ENTAP Lumbar Support Pillow’ compared with both the other groups. There was a highly significant treatment effect overall (time x group p<0.001) for the PGIC Scale, indicating that the change in score over time was different in the two groups (p<0.001). The profile plot showed that the mean PGIC score increased (improved) in the Group B ‘ENTAP Lumbar Support Pillow’ while it decreased (worsened) in the polyester group. There was a highly significant treatment effect overall (time x group p<0.001) for the degree of change score, meaning that the change in score over time was different in the two groups. The profile plot showed that the mean degree of change score decreased (improved) in Group B ‘ENTAP Lumbar Support Pillow’ while it increased (worsened) in the Group C (polyester-filled lumbar support). All participants in both lumbar support groups answered “yes” to the question on whether they found the support comfortable at both three weeks and six-week time points. CONCLUSION The ‘ENTAP Lumbar Support Pillow’ was effective in decreasing LBP in long-distance truck drivers. It was considered to decrease LBP, improve activities of daily living and decrease disability, and it was also considered as comfortable. Therefore, the Alternate Hypothesis (Ha) which states that there will be a statistically significant (p<0.05) improvement in LBP in the participants who use the ‘ENTAP Lumbar Support Pillow’ compared to no lumbar support pillow and the polyester-filled lumbar support pillow is accepted and the Null Hypothesis is rejected.Item 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 DavidBackground: 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.Item The effect of thoracic spine manipulation compared to thoracic spine and costovertebral joint manipulation on mechanical mid-back pain at the Durban University of Technology Chiroptractic Day Clinic(2017) Petersen, Gabriela Elisa da Silva; Kretzmann, Heidi MariseMid-back pain (mbp) is defined as pain occurring within the limits of the third thoracic (T3) and ninth thoracic (T9) vertebrae, caused by the dysfunction of the musculoskeletal structures in the thoracic spine. It can present as pain and/ burning between the shoulder blades with reduced thoracic spine mobility and increased muscle tension. Congenital disorders such as scoliosis and Scheuermann’s disease, or acquired disorders such as thoracic facet and costovertebral joint dysfunction may cause mbp. The thoracic facet and costovertebral joints are similar in anatomy and share a mutually dependent biomechanical relationship. There were a handful of controlled studies that highlighted the effectiveness of thoracic facet manipulation on mbp, but there were none on the effects of costovertebral manipulation on mbp. Objectives The aim of this study was to investigate the immediate effects of the combination of thoracic facet and costovertebral joint manipulation on mbp in terms of pain perception, pressure pain thresholds (PPT) and thoracic spine range of motion (ROM). Design A prospective single-blind randomised comparative clinical trial. Setting This study was conducted in a university setting at the Durban University of Technology Chiropractic Day Clinic Participants Fifty participants were recruited via responses to advertisements placed around the Durban University of Technology (DUT) campuses and individuals presenting at the Chiropractic Day Clinic (CDC). Intervention The participants were divided into two groups of twenty-five. Group A received the thoracic facet joint manipulations and Group B received a combination of the thoracic facet and costovertebral joint manipulations. Outcome measures All subjective and objective measurements were taken before and after the application of the manipulations. Pain perception i.e. subjective measurement) was measured by the Numerical Pain Rating Scale (NPRS), pressure pain thresholds (PPT) (i.e. objective measurement) were measured by the Wagner’s FDK Force Gage Algometer and thoracic spine range of motion (ROM) i.e. objective measurement was measured by the Saunders Digital Inclinometer. Results The data was analyzed using the latest version of SPSS and a p-value = 0.05 was used to determine statistical significance. Descriptive statistics in the form of univariate analysis described the data in terms of measures of central tendency and measures of dispersion. Data that was distributed normally was analyzed using the t-test and ANOVA. Data that was distributed abnormally was analyzed using the non-parametric Wilcoxon ranked and Mann Whitney tests. Nominal and ordinal data was analyzed using the Chi squared test. The results of the intra-group analysis indicated a statistically significant decrease in pain perception (p ≤ 0.000), increase in PPT (p ≤ 0.05) and decrease in thoracic spine ROM (p ≤ 0.000). However, the results for the inter-group analysis indicate there was no statistically significant difference in pain perception (p = 0.386), PPT (p > 0.05) and thoracic spine ROM (p >0.05) between Group A and Group B. Conclusions These results showed that the combination of thoracic facet and costovertebral joint manipulation was as effective as thoracic facet joint manipulation alone, in the treatment of mbp. These findings suggested that manipulation of the costovertebral joints may not be necessary for the effective treatment of mbp.Item The effectiveness of manual manipulation versus the Activator Adjusting Instrument in the management of acute facet syndrome of the lumbar spine(2003) Gillespie, David McKenzie; White, Horace LindsayThe purpose of this study was to compare the relative effectiveness of manual manipulation versus the Activator Adjusting Instrument in the management of acute facet syndrome of the lumbar spineItem A comparative study of spinal manipulative therapy and spinal manipulative therapy combined with soft tissue therapy in the management of mechanical low back pain(1997) Gomes, Adrian Neil; Mathews, RobertThere have been few studies performed to determine the combined effects of spinal manipulative therapy with other modalities known to have beneficial physiological effects, especially in terms of mechanical low back pain (Ottenbacher and Difabio 1985).