Faculty of Health Sciences

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The epidemiology of work-related neck pain in diagnostic radiographers working in the eThekwini Municipality
(2023-05-31) Devnarain, Akshoy; Abdul-Rasheed, Ashura
Diagnostic radiography is a branch of radiography that is primarily involved with the diagnosis of disease through diagnostic imaging. Additionally, diagnostic radiographers are predisposed to work-related risk factors due to the work that they perform daily and, as result, they are at risk of developing work-related neck pain (WRNP). Investigating the prevalence and work-related risk factors associated among diagnostic radiographers will create awareness amongst diagnostic radiographers and healthcare providers. Furthermore, in a South African context, this will add updated knowledge to the current literature that exists. AIM The aim of the study was to determine the epidemiology of work-related neck pain in diagnostic radiographers working within the eThekwini municipality. METHODOLOGY The study used a quantitative approach and a descriptive cross sectional survey design. A total 130 participants were recruited for this study. The population sample included qualified diagnostic radiographers who were employed within the eThekwini municipality in the public and private sectors. The questionnaire was distributed and answered either via Hardcopies or QUESTIOPRO® link. All the data were then imported into SPSS version 26 for analysis RESULTS A total of 61 participants had reported WRNP and hence the prevalence rate was 65.6%. The study also reported that females are more likely to have WRNP. Furthermore, the selected risk factors showed that more than 50% of radiographers with WRNP had worked over-time shifts, 75.4% of radiographers experienced neck pain from wearing lead protective gear, 78.7% of radiographers from the study had neck pain from lifting and positioning heavy equipment and machinery, and 47.5% of the participants who had WRNP had a history of a previously diagnosed neck condition. Additionally, 59% of participants had taken leave from work because of WRNP. CONCLUSION This study revealed a high WRNP prevalence rate among diagnostic radiographers working within the eThekwini municipality. The results found in this study shared similar findings from various local and international studies. Due to the high prevalence of WRNP, it is highly recommended that management protocols at work should be investigated to aid diagnostic radiographers.
Normal craniovertebral angle range in asymptomatic Black South African females : a pilot study
(2022-09-29) Antony, Reenu; Varatharajullu, Desiree; Venketsamy, Yomika
Introduction: Forward head posture (FHP) has become more prevalent in modern times and is described as carrying the head anterior to the centre of the shoulder. As the head moves forward, the centre of gravity shifts. To compensate for this shift, the upper body shifts backward to maintain balance, which eventually leads to fatigue and subsequent myofascial pain when this position is maintained for prolonged periods of time. The craniovertebral angle (CVA) measures the degree of FHP and is formed between a horizontal line passing through C7 of the cervical spine and a line extending from the tragus of the ear to C7 spinous process. Previous studies have concluded that a smaller CVA indicates FHP. Global studies have reported possible associations between FHP and postural related musculoskeletal complaints and chronic pain especially in Black females in South Africa. Studies have also reported various therapies that would increase CVA, thus correcting or improving FHP to manage or prevent the negative impacts associated with FHP. Normal cervical spine radiographic parameters may differ in males and females, and among the various South African ethnic groups, suggesting that normal CVA ranges may also differ among the sexes and various ethnic groups. A generally accepted normal CVA range to accurately measure and quantify FHP warrants the need to determine a standardised and normalised range for CVA for Black females in South Africa, so as to a set reference point for clinical practice and research. Aim: The aim of this study was to determine a normalised range for CVA among Black South African females to be utilised for further studies and clinical practice. Method: This was a pilot study that used a quantitative, non-experimental, observational design. Black South African females between the ages of 18 and 45 years were recruited through advertisements placed in and around the Durban University of Technology and greater Durban area and via word of mouth. A total of 51 participants were recruited. Symptomatic participants and participants who presented with FHP on visual assessment were excluded from the study. Markers were placed at the tragus of the ear and at C7 spinous process. Lateral photographs were taken with a digital camera of the participants in seated and standing positions. The Posture Pro Software Analysis was used to measure CVA from the photographs obtained. The data captured were sent to a statistician for statistical analysis. Results: The mean CVA while seated was 41.88 degrees, with a standard deviation of 5.23; and the mean CVA while standing was 37.15 degrees, with a standard deviation of 4.30. The paired t-test result showed a significant difference between CVA in seated and standing position (p < 0.001). Furthermore, the correlation between BMI and CVA seated and standing had a significant weak positive correlation of 0.320 (p<0.05) and 0.391 (p<0.01) respectively. Conclusion: The results indicated that CVA differs significantly between the seated and standing position and that CVA in the seated position was more increased when compared to the standing position.
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 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.
An exploration into the diagnosis and management of neck pain by Ayurvedic practitioners in South Africa
(2019-09-05) Manda, Karmen; Maharaj, Madhu; Ashura, Abdul-Rasheed
Background The health care system of South Africa is growing exponentially and providing patients with various treatment options. Recently, Ayurveda has become popular because of its nature-based and spiritual approach to ailments. Neck pain has been researched to a great extent in allopathic medicine, but not in the context of Ayurvedic medicine. Although there is a wealth of information regarding Ayurveda and its basic principles, there are limited publications on the Ayurvedic approach to common musculoskeletal conditions such as neck pain. Therefore, the aim of this study was to determine the Ayurvedic approach to the diagnosis and management of neck pain by Ayurvedic practitioners in South Africa. Method A qualitative exploratory descriptive study was conducted using standardized open-ended questions. Eight Ayurvedic practitioners, from South Africa, from the provinces of KwaZulu-Natal and Gauteng, were interviewed to establish their methods of diagnosis and management of neck pain. The interviews were semi– structured and conducted in English and later transcribed verbatim. The transcripts were then analysed using thematic analysis to establish codes, categories and themes. Results Eight out of thirteen registered Ayurvedic practitioners in South Africa participated in the study. Five main themes emerged from the data: the Ayurvedic approach to management of neck pain, the Ayurvedic diagnosis of neck pain, the Ayurvedic treatment of neck pain, the use of modalities in the Ayurvedic profession for the management of neck pain and the basis of referral in the Ayurvedic profession to manage a patient with neck pain. Participants discussed the importance of the three dosha principle and the importance of knowing the “root cause” of an ailment as an integral part of the management of a patient with neck pain. The three dosha principle focuses on vata, pitta and kapha, which are the constituents of the human body. It is essential that there is homeostasis of the three doshas to maintain good health and a disease-free state. The participants, in this study, discussed the root cause of an ailment as being the underlying factors that bring about pain in the body. Participants stressed the importance of the “pulse diagnosis,” the integration of modern technology and the threefold principle of darshana, sparshna and prashana in order to properly diagnose a patient. These diagnostic tools emphasize the holistic approach of the Ayurvedic system of medicine. The treatment method varied amongst participants. Although each practitioner practices differently, the basic principles of the profession are still applied when administrating treatment to a patient. Treatment focused on panchakarma therapy, greeva basti, shirodhara, massage and potli therapy, herbal oils and medication. The goal of Ayurvedic treatment is to pacify the aggravated doshas, utilizing these various treatment options. Participants in this study focused on yoga, marma therapy and patient education as modalities that are utilized by the profession to assist in the management of neck pain. They discussed the importance of referral to the appropriate health care professional, so that the patient receives the best possible care. The results of this study revealed that the Ayurvedic system of medicine is a holistic system of medicine that addresses all aspects of the mind, body and spirit. In Ayurveda, the management of a patient relies on the patient, practitioner and the “three dosha principle”. The foundation of the “three dosha principle” focuses on vata, pitta and kapha. Essentially, various ratios of vata, pitta and kapha exist in every individual, however, when there is lack of homeostasis between these three elements, disease occurs in the body. The therapeutic goal in Ayurveda is to restore doshic balance in the body. Conclusion This is the first South African study to be conducted on the Ayurvedic management and diagnosis of the musculoskeletal condition, neck pain. This study will add to the body of literature and enable other practitioners to have a better understanding of Ayurveda, thus giving the patient the best, appropriate care available. The foundation of Ayurveda is the “three dosha principle” which the profession applies to holistic patient management, focuses on the mind, body and spirit of the patient, rather than the disease per se.
The prevalence of and risk factors for neck pain in first year Faculty of Health Science students at the Durban University of Technology
(2018) Gevers, Giselle Lara; Maharaj, Praveena; Puckree, Threethambal
INTRODUCTION: Neck pain is considered to be one of the most disabling conditions, with a universal prevalence among youth, adult and elderly populations. However, despite its disabling nature and its high prevalence there is still much uncertainty surrounding the aetiology of the pain and the extent to which the condition is influenced by the intrinsic and extrinsic characteristics of an individual. While there is growing evidence to support the notion that marked bio-psychosocial associations exist with neck pain, this literature is heavily weighted toward an adult and a developed nation context leaving developing nations and the student population largely under-researched in comparison. Moreover, while a high prevalence of neck pain and its associated risk factors exist in the student population among health sciences and non-health sciences programmes, across many levels of study, the literature is ambivalent about which faculty and level of study is more at risk, if any. The first year of university stands out among the rest in that the students undergo a significant transition and are required to adapt to a new environment and style of learning compared to what they have been used to. Furthermore, students have been observed to exit first year with higher levels of distress than were present in the beginning of the year, suggesting that this unique environment may influence the psychosocial well-being of students. The extent and strength of this relationship is yet to be determined in a South African tertiary educational context and this is even more true of the first year student population at the Durban University of Technology. Research on the unique bio-psychosocial factors of these students would provide a more holistic understanding of the extent to which these factors exist and the role they play in the general well-being of the students and in the development of neck pain. AIMS AND OBJECTIVES: This study aimed, firstly, to determine the prevalence and psychosocial risk factors of neck pain in registered first year Faculty of Health Sciences students at the Durban University of Technology and, secondly, to determine the association between neck pain presentation, demographic characteristics, socio-demographic and psychosocial risk factors. The outcomes of this study could possibly have a threefold benefit (for the student, the institution, and the chiropractic profession at large). RESEARCH DESIGN: A quantitative, descriptive, cross-sectional survey design was adopted in this research. This design was chosen as it was believed to be the best suited to achieving the aims and objectives of the study. RESEARCH METHODOLOGY: Neck pain questionnaires were administered to the first year Faculty of Health Sciences students at the Durban University of Technology towards the end of the academic year in order to determine the prevalence of neck pain and its associated demographic, socio-demographic, and psychosocial risk factors. There was a final sample size of 135 participants achieving a response rate of 54.7% for the study. Data was captured by the researcher and sent to a statistician for statistical analysis. RESULTS: A high prevalence of neck pain was found among the students (72%) with symptoms of depression (59.8%), anxiety (68.1%), and stress (53.6%) also being highly prevalent among this group. However, when neck pain was quantified by its characteristics the related impact was comparatively low. There was a common theme observed in the results highlighting the association between stress and neck pain, with stress furthermore being determined as an independent risk factor for neck pain (p = 0.023) with an odds ratio of 1.1. This result was not surprising, however, considering the stressors which emerged in the results highlighting factors such as transport protests, student protests, upcoming tests and financial aid as stress causing factors among the participants. The results provided valuable insight which enabled recommendations to be made about the direction of future research as well as recommendations for the Institution and the Chiropractic profession in the approach and management of students enrolled in tertiary education and with neck pain.
The comparative effectiveness of adjustments versus mobilisation in treating mechanical neck conditions
(1996) Scott-Dawkins, Craig Anthony; Penter, C. S.
The aim of this study was to determine the effectiveness of adjustments versus mobilisation in the treatment of mechanical neck pain. It was hypothesized that treatment with adjustments over a three week period, with a further three week follow-up period, would be more effective than mobilisation in terms of improving the patients' cervical ranges of motion and their perceptions of pain and disability.
The effectiveness of the Impulse Adjusting Instrument® compared to dry needling in the treatment of upper trapezius myofascial trigger points
(2017) Laing, Mandy; Varatharajullu, Desiree
Aim: There is a paucity in the literature regarding the effectiveness of the Impulse Adjusting Instrument® (IAI) in treating myofascial trigger points (MFTPs) and regarding the effectiveness between dry needling and the IAI in the treatment of MFTPs. There are many limitations and an array of contraindications for dry needling. Therefore, an alternative method should be sought as this will be beneficial to the patient. Thus, the aim of this study was to determine the effectiveness of the IAI compared to dry needling in the treatment of MFTPs found in the upper trapezius muscle. Methodology: This study was a randomised single-blinded clinical trial. This study consisted of 41 participants between the ages of 18 and 40 who were divided into two groups. The participants were randomly allocated into their respective groups using a blinded allocation method that was drawn up by the statistician. Groups were divided into dry needling (Group one (n=18)) and IAI (Group two (n=23)) treatment groups. Subjective neck pain level was determined using a numerical pain rating scale (NRS). The neck disability index (NDI) subjectively assessed the effect neck pain had on the participants’ activities of daily living before and after treatment. The Patients Global Impression of Change (PGIC) tool was used to determine the participants’ subjective impression of treatment outcomes since the beginning of the treatment. Objective pain pressure thresholds (PPT) were measured with an algometer. Objective cervical range of motion (CROM) in lateral flexion (LF) was measured with a goniometer. Each participant had four visits over a two week period, which included three treatments and a final visit for final measurements. Data was analysed using IBM SPSS version 23. Repeated measures ANOVA was used to examine the effect on each outcome measure. Directional trends in effectiveness were drawn up using profile plots to assess the direction and trends of the effects. A p value of < 0.05 was considered to be statistically significant. Results: Intra-group and inter-group statistical analysis revealed all subjective measurements improved in both groups with no significant differences between the groups. With respect to objective measurements, there was no statistical improvement in LF CROM and dry needling had no improvement in PPT. Impulse Adjusting Instrument trigger point therapy showed an increase in PPT, however, when compared to dry needling there was no statistical difference in PPT. Conclusion: The conclusion for this study states that the trends in each of the outcomes suggest that the IAI is as effective as dry needling for the treatment of MFTPs.
The effect of intermittent, mechanical cervical traction in the chiropractic management of mechanical neck pain
(1998) Wood, Roger Simon; Brantingham, James W.
Mechanical neck pain is an extremely common condition. At any specific time, as many as 12% of the adult female population and 9% of the adult male population experience pain in the neck, with or without associated arm pain, and 35% of people can recall an episode of previous neck pain (Bland 1994:3). However, to date little research has been conducted to investigate which treatment protocolIs may be the most effective in the management of mechanical neck pain syndromes. The aim of this study was to investigate whether the combination of chiropractic manipulative therapy and intermittent, mechanical cervical traction would be more effective in the treatment of mechanical neck pain than chiropractic manipulative therapy alone. It was hypothesized that chiropractic cervical manipulative therapy and the combination of chiropractic cervical manipulative therapy and intermittent, mechanical cervical traction would both be effective in the treatment of mechanical neck pain. Moreover, with reference to objective and subjective clinical findings, it was hypothesized that the combination of chiropractic cervical manipulative therapy and intermittent, mechanical cervical traction would be more effective in the treatment of mechanical neck pain than chiropracic manipulative therapy alone.
The effect of intermittent, mechanical cervical traction in the chiropractic management of mechanical neck pain
(1998) Wood, Timothy George; Mathews, Robert
Purpose: The purpose of this study was to determine the relative effectiveness of two seemingly different approaches to manipulation of the cervical spine in the treatment of cervical spine dysfunction. The researcher postulated that a manual manipulation would have a greater effect in reducing pain and increasing range of motion that accompanies cervical dysfunction than an instrumental, low force, high velocity thrust delivered by means of an Activator Adjusting Instrument. The reason for this is that it provides greater joint movement. Methods This randomised controlled trial consisted of two treatment groups. Each group consisted of 15 subjects, between the ages of 16 and 65 years, selected from the general population and randomly allocated to treatment group A or B. Group A received instrumental thrusts delivered by an Activator Adjusting Instrument (AAI), while group B received standard diversified manual manipulations to the dysfunctional joints in the cervical spine. Each subject was assessed by using subjective measures of the CMCC Neck Disability Index, Numerical Pain Rating Scale and McGill Short- Form questionnaire; and the objective measure of degrees of cervical range of motion obtained using a cervical goniometer (CROM). Two tailed statistical analysis was conducted at a = 0.05, using the non-parametric Wilcoxin Signed Rank Test and the Mann-Whitney U Test comparing intra-group and inter-group data respectively. Further assessment of the data was conducted using power analysis. This data as well as the descriptive statistics were presented in tables and bar charts.

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