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    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.
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    Immediate effect of two myofascial interventions on navicular position, great toe extension and balance measures in asymptomatic subjects with pronation : placebo controlled
    (2016) Puttergill, Jeff; Kretzmann, Heidi
    Background: Myofascial therapies are widely researched with regards to their effects on pain, disability and range of motion. The benefits of such therapies are attributed to the mechanical changes that myofascial therapies are proposed to have on the fascial and myofascial structures. Breakthrough imaging and laboratory techniques, have allowed the in vivo study of these structures, resulting in new hypotheses regarding the roles that connective tissues might play in proprioception. Objectives: The purpose of this investigation was to assess the effects of two myofascial therapies, in terms of immediate changes in navicular pronation, great toe extension measurements and balance tests, as indicated by the postural stability (eyes open and closed) and limits of stability tests. Pre-, post-intervention analysis was used to determine if there were significant changes between the groups. Aims: The myofascial interventions aimed to reduce myofascial restriction and adhesions, within the plantar and crural fasciae’s of individuals with bilateral pronation. Methods: The study recruited 45 subjects with bilateral pronation (2 or more degrees) and randomly allocated them into a placebo ultrasound, ischaemic compression or myofascial release group. Each subject underwent a case history, physical examination, foot, ankle and knee regional examinations, as well as screened for contraindications. A blinded assistant examiner helped measured and record the baseline measurements for navicular position and great toe extension, using a standard two arm goniometer. The researcher then tested participants for postural stability (eyes open, eyes closed) and limits of stability, on the Biosway Portable Balance System. Subjects were then examined and treated bilaterally, for myofascial restrictions in the foot, lower leg and ankle, related or unrelated to the pronation present. Pre- and post-intervention measurements were recorded within a 20 minute window immediately before and after the relevant intervention. Statistical Analysis: Repeated measures ANOVA testing was used to compare the rate of change (between pre- and post-intervention measurements) amongst the three groups, and a p-value <0.05 was considered statistically significant. Post hoc Bonferroni adjusted tests were done to compare all pair wise groups, as well as identify trends between groups. Results and Discussion: The data showed that both myofascial groups, significantly improved in postural stability (eyes closed) overall, post hoc testing showed the ischaemic compression group (p=0.004) and myofascial release group (p=0.031), compared to changes in the placebo ultrasound group.The overall changes were predominantly found in the anterior-posterior axes, with significant improvements in ischaemic compression (p=0.007) and myofascial release group (p=0.053) axes compared to placebo. For the other outcome variables, statistically significant treatment effects were not consistant bilaterally between the groups. Significant (p=0.051) time*group differences for changes in right navicular position. Post hoc testing revealed a borderline significant (p=0.056) improvement in pronation for the myofascial release group in comparison to the ischaemic compression group, which on average got worse. With regards to passive non-weight bearing great toe extension left, significant (p=0.067) improvements for the ischaemic compression group were shown compared to placebo, although this was not consistent for all the great toe extension tests. A borderline significant (p=0.059) time*group effect for postural stability (eyes open) medial-lateral test was obtained. Post hoc Bonferroni adjusted testing showed a non-significant (p=0.063) correlation between the myofascial release group and placebo ultrasound group. Conclusion: The results of this study, rejects the Null hypothesis for changes in balance measurements and suggests that both myofascial interventions had a significant positive outcome for postural stability, compared to placebo. The postural stability (eyes closed) test gave an indication of positive or negative changes in centre of pressure displacement, about the centre of gravity. It is noted that the sham ultrasound, used as a placebo intervention may have produced a treatment effect and is therefore not a reliable placebo measure for this type of investigation.
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    The relationship between postural stability sway, balance, and injury in adolescent female soccer players in the eThekwini district of KwaZulu-Natal
    (2014-07-24) Koenig, Jean-Pierre; Puckree, Threethambal
    Background: Poor balance is a risk factor for injury in adolescent sport including soccer. Despite the rapid growth in female adolescent soccer especially in South Africa, the association between balance and injury in this population has not been fully explored. This study aimed to determine the relationship between injury and balance. Static and dynamic balance was monitored as sway index (SI) and limits of stability direction control (LOSDC). Objectives: The objectives of this study were to determine the body mass index of adolescent female soccer players; to determine the prevalence of injury in adolescent female soccer players; to determine static balance as revealed by the sway index (SI); to determine dynamic stability as revealed by limits of stability direction control (LOSDC) and to correlate body mass index (BMI) to sway index and limits of stability. Method: Eighty adolescent female soccer players, between the ages of fourteen and eighteen, were recruited through convenience sampling from schools in the eThekwini district of KwaZulu-Natal. After obtaining informed consent and assent, participants completed questionnaires and were scheduled for the balance and BMI assessments. The objective data for each participant consisted of height, weight, Sway Index (SI) and Limits of Stability Direction Control (LOSDC) readings, measured using a stadiometer, electronic scale and Biodex Biosway Balance System (Biodex Medical Systems Inc., Shirley, New York) respectively. The subjective and objective data were analyzed using SPSS version 21.0 (SPSS Inc. Chicago, Ill, USA). Statistical tests included descriptive statistics using frequency and cross-tabulation. Inferential statistics using t-tests and Pearson’s correlations at a significance level of 0.05 was also incorporated. The testing of hypotheses was performed using Fisher’s Exact tests for nominal data and ordinal data. A p value of < 0.05 was considered as statistically significant. The statistical analysis also included Odds Ratio calculations. Results: The mean body mass index of the injured participants was 23.54±3.56 kg/m2 and the mean body mass index of the uninjured participants was 23.00±4.63. Only 27.5% of the participants sustained an injury. Injured participants performed poorly on average in the SI assessment involving their eyes open when standing on a soft surface. The results were similar for the LOSDC in the overall, right, left, backward-right and backward-left directions. However, there were no significant correlations calculated. Significant relationships existed between BMI and the SI assessments in the injured participants which involved standing on a firm surface with their eyes open (p = 0.05), their eyes closed when also standing on a firm surface (p = 0.05), their eyes open when standing on a soft surface (p = 0.02), and their eyes closed when standing on a soft surface (p = 0.04). A significant relationship also existed between BMI and LOS right direction control (p = 0.02). Conclusion: This research paper revealed that the body mass index as investigated in this study is similar to other studies involving female adolescents; soccer injury as investigated in this study is similar to other studies involving female adolescents; poor static and dynamic balance is not associated with injury in adolescent female soccer players and lastly, body mass index is linked to the balance of an individual.