Faculty of Health Sciences
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Item The effect of sacroiliac joint manipulation compared to manipulation and static stretching of the posterior oblique sling group of muscles in participants with chronic sacroiliac joint syndrome(2017) Swanepoel, Shaylene; Kretzmann, Heidi Marise; Clifton, Stuart RonaldSacroiliac joint syndrome is diagnosed in patients who complain of various painful symptoms associated to their lower back, for example: hip and groin pain, sciatica pain, and / or a need to frequently urinate. They further report that their pain is further intensified when standing from sitting, stair walking, bending forward or from sitting or standing too long. Sacroiliac joint syndrome has been widely accepted by health professions as a contributor to low back pain. Spinal manipulation has shown to be an effective method for pain relief of this condition. Studies have been done using physical therapy in conjunction with manipulation in treating sacroiliac joint syndrome. However, little research has been done on the effects of static stretching and manipulation combined. The posterior oblique sling group of muscles is created by the biceps femoris, gluteus maximus, erector spinae and latissimus dorsi muscles. The sacroiliac joint can be affected by the functional relationship of the posterior oblique sling muscles. These muscles are involved in forces across the sacroiliac joint. Tightness of muscles can affect the sacroiliac joint. Flexibility is an essential element of normal biomechanical functioning. Flexibility of muscles, tendons and ligaments can influence a joints range of motion. There is evidence that suggests that stretching could increase a joint’s range of motion which was evident one or more days after the stretching protocol in people without clinically significant contractures. Upon review of the related literature, it appears that there is insufficient literature assessing the clinical effectiveness of static stretching of the posterior oblique muscle sling group with respect to sacroiliac joint syndrome. Therefore this study is aimed at providing insight into the role of the posterior oblique muscle sling group in participants with and chronic sacroiliac joint syndrome. It is hypothesized that effective treatment of these muscles will allow for a more effective outcome of symptoms. The study design chosen was a randomised, clinical trial consisting of thirty voluntary participants’ between the ages 18 to 45 years suffering from chronic sacroiliac joint syndrome. There were two groups of fifteen participants, who received four treatment consultations within a two week period. Participants placed into Group One received sacroiliac joint manipulation only, while participants in Group Two received static stretching of the posterior oblique muscle sling and sacroiliac joint manipulation. Subjective and objective readings were taken at the first, third and fourth (final) consultations. The Numerical Pain Rating Scale (NRS) and the Oswestry Low Back Pain Disability Index (OSW) questionnaires were used to assess the subjective findings whilst the objective measurements were collected from results of algometer and inclinometer readings. The intra-group analysis revealed there was a statistically significant improvement within both groups for NRS, OSW, and inclinometer results. It appeared that Group Two fared better in terms of the algometer (pressure) results. The inter-group analysis revealed that all comparisons apart from the algometer readings had no statistically significant improvement between the two groups. From the intra-group comparisons of the objective data, participants in both groups experienced a statistically significant improvement. However, Group Two fared better in terms of the algometric pressure readings (p = 0.001). This study confirms that both treatment protocols were effective in reducing the signs and symptoms associated with sacroiliac joint syndrome. Although the readings were not statistically significant, there is evidence that Group Two responded better than Group One in terms of the algometer readings (Figure 4.13). There is insufficient literature on studies related to the posterior oblique sling muscles, and therefore, comparisons are needed with respect to the posterior oblique muscle sling group and its effects on the sacroiliac joint. This study concludes that overall there was no statistically significant difference between the two groups and recommends that further studies be undertaken with a greater number of participants to gauge if a more significant result can be achieved.Item The value of isometric and stretch exercises in the management of mechanical lower back pain(1995) Deall, Ashleigh Jane; Kretzmann, Heidi MariseMechanical low back pain is a common clinical entity which needs professional treatment (Margo 1994). Due to the nature of mechanical low back pain, recurrence of pain is a common entity that can cripple a patient and the ~tate financially. It is for'this reason that the professionals need to establish a cost effective method of treatment that helps maintain the pain free state and prevent recurrencesItem The relative effectiveness of manipulation with and without the crac technique applied to the hamstring muscles in the treatment of sacroiliac syndrome(1999) Salter, Neil Matthew; Perkin, Jonathan CharlesSacroiliac syndrome is a common condition causing low back pain (Mierau et al. 1984, Guo and Zhao 1994). It is a painful, debilitating condition that may cause considerable discomfort (Haldeman 1992:220). According to Frymoyer et al. (1991:2114), sacroiliac syndrome is a frequently overlooked source of low back pain as it may mimic other well known causes of low back painItem The relative effectiveness of proprioceptive neuromuscular facilitative stretching as compared to static stretching in the treatment of active myofascial trigger points(1999) MacDougall, Tarryn Clair; Nook, B. C.The purpose of this study is to determine the relative effectiveness of (Contract-Relax- Agonist-Contract) CRAC stretching, a component of Proprioceptive Neuromuscular facilitated (PNF) stretching, as opposed to static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. This was a randomised clinical trial consisting of two groups. Group A received static stretching as their treatment protocol and Group B received PNF (CRAC) as their treatment protocol. Each group consisted of fifteen people between the ages of 18 and 55 who were randomly allocated to their respective groups. It is hypothesised that PNF (CRAC) stretching would be relatively more effective than Static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. Subjects diagnosed with active myofascial trigger points in the Trapezius, Infraspinatus and Rhomboid muscles were included in the study. The treatment regime consisted of a course of five treatments spread over a period of two weeks and then a one - month follow up consultation. Subjective and objective measurements were taken at the first, fifth and follow up consultations. Subjective data consisted of the Short Form McGill Pain Questionnaire, the CMCC Neck Disability Index and the Numerical Pain Rating Scale -101. The objective data was collected by means of algometer and goniometer measurements. This data was used to perform statistical analysis using the non-parametric Wilcoxin signed-rank test and the Mann Whitney unpaired test to compare intra-group and intergroup data respectively, at a 95% confidence level. This study suggests that both static and PNF (CRAC) stretching are effective in the treatment of active myofascial trigger points. However there is no clinical statistical difference between these two treatments. Further studies with a larger sample size are needed to clearly evaluate the use of stretching in the treatment of active myofascial trigger points.Item The relative effectiveness of manipulation with and without the contract-relax-antagonist-contract technique of proprioceptive neuromuscular facilitation stretching of the piriformis muscles in the treatment of sacroiliac syndrome(2001) Ranwell, Ivan Henry; Mac Dougall, TarrynThis study aims to provide insight into the relative effectiveness of two different approaches in the treatment of sacro - iliac syndrome. Until recently, the sacro - iliac joints were not commonly considered to be mobile enough to suffer from detectable restriction of motion (Panzer and Gatterman 1995:453). Kirkaldy - Willis et al. (1992:126) however, states that sacro - iliac syndrome is a well defined and common type of dysfunction. Frymoyer et al. (1991 :2114) also reports sacro - iliac syndrome to be common, although it is frequently overlooked as a source of low back pain. This study will attempt to determine whether manipulation of the sacro - iliac joints together with Proprioceptive Neuromuscular Facilitation (P.N.F.) stretching of the piriformis muscles is a more effective treatment for sacro - iliac syndrome, than manipulation alone. This will be accomplished by determining which approach yields the best patient response in terms of subjective and objective clinical findings. The study conducted was a randomised clinical trial consisting of two groups of 30 patients each. The patients were randomly allocated into the two groups. All patients received four treatments over a two - week period. Group one received manipulation of the sacro - iliac joints alone, while Group two received manipulation of the sacro - iliac joints together with P.N.F. stretching of the piriformis muscles. Only the sacro - iliac joint on the side of the sacro - iliac syndrome was manipulated, and only the piriformis muscle on the side of the sacro - iliac syndrome was stretched. If any patients became asymptomatic within the treatment period, then the treatment was terminated. The patients were however required to return for all the remaining consultations for observational purposes. The results of the Numerical Pain Rating Scale, Oswestry Low Back Disability Index questionnaire, inclinometer and algometer readings, as well as the sacro - iliac orthopaedic tests, were recorded before the first and second treatments, and immediately following the fourth (final) treatment.Item Effectiveness of proprioceptive neuromuscular facilitative stretching combined with administration of Diclofenac compared to proprioceptive neuromuscular facilitative stretching and placebo medication for the treatment of cervical facet syndrome(2001) Upneck, Heidi Sian; Myburgh, CorneliusThe purpose of this study was to test the Effectiveness of Proprioceptive Neuromuscular Facilitative Stretching combined with administration of Diclofenac compared to Proprioceptive Neuromuscular Facilitative Stretching and placebo medication for the treatment of Cervical Facet Syndrome in a clinical experimental setting. Neck pain is a common disorder, which can often be attributed to mechanical dysfunction of the cervical spine. The patient with facet syndrome may complain of sudden onset of unilateral neck pain, often with referred pain. Muscle spasm is usually present causing restricted movement. Pain increases with movement and is relieved by rest. The pain is aggravated by hyperextension and relieved by flexion and often follows a sclerotomal rather than a dermatomal pattern. Forty subjects with mechanical neck pain were screened for facet syndrome and randomly divided into two groups of twenty. Each patient received Proprioceptive Neuromuscular Facilitative (PNF) stretching of the Posterior Cervical and Trapezius musculature. In conjunction with this, half the patients received Cataflam D while the other half received placebo medication. The patients were treated five times over a period of two weeks. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Numerical Pain Rating Scale 101, Short Form McGill Pain Questionnaire and the CMCC) and algometer and goniometer measurements respectively. The data was collected at the initial, middle and final treatments for each patient.Item The relative effectiveness of myofascial trigger point manipulation as compared to proprioceptive neuromuscular facilitative stretching in the treatment of active myofascial trigger points: a pilot clinical investigation(2006) Berry, Jason; Mac Dougall, TarrynMyofascial pain syndrome (MPS) is defined as the sensory, motor and autonomic symptoms caused by myofascial trigger points (MFTPs), or hyperirritable spots within skeletal muscles that are associated with palpable nodules in a taut band. The fact that MFTPs have been described in the literature for acupuncturists, anaesthesiologists, chronic pain managers, dentists, family practitioners, gynaecologists, neurologists, nurses, orthopaedic surgeons, paediatricians, physical therapists, physiologists, rheumatologists and veterinarians is evidence of the syndrome’s clinical importance. As a result of a large amount of research, a large number of different treatments have been shown to be clinically effective in the treatment of MFTP. These treatments include amongst others: - Ischaemic compression. - Myofascial manipulation. - Spray and stretch. - Ultrasound. - Transcutaneous electrical nerve stimulation. - Dry needling. As can be seen from the above, it is important to be able to treat MPS effectively because it is such a common disorder. According to Schneider an effective treatment is needed for MPS, despite the array of treatments available to a clinician. Han and Harrison agree that more studies are required to determine the efficacy of these treatments. The aim of this study is to evaluate the relative effectiveness of Myofascial Trigger point Manipulation (MFTPM) as compared to Proprioceptive Neuromuscular Facilitative (PNF) stretching in the treatment of active Myofascial Trigger Points (MFTPs) in the trapezius muscle (TP 1 and/or TP 2) in terms of subjective and objective clinical findings. The study required a total of 60 patients, which following acceptance were then randomly divided into two groups of 30, with an equal number of male patients in Group one (MFTPM) and two (PNF), and female patients in Group one and Group two. Each patient had four consultations (three treatments and one follow up visit) in a two week period. Subjective and Objective Data was recorded at each consultation prior to the treatment. Subjective measurements (Numerical Pain Rating Scale and Short Form McGill Pain Questionnaire) were taken prior to the treatment at all four visits. Objective measurements (Cervical Range of Motion Meter and Algometer) were also taken prior to the treatment at all four visits, except for Algometer readings which were taken at the initial consultation and the fourth treatment only. SPSS version 11.5 was used for analysis of data (SPSS Inc, Chicago, Ill, USA). Baseline comparisons were done between treatment groups using Pearson’s chi square tests or Fisher’s exact tests as appropriate for categorical variables, and student’s t-tests for quantitative normally distributed variables. Treatment effect was assessed with repeated measures ANOVA. A significant time by group interaction indicated a significant differential treatment effect. A p value <0.05 designated statistical significance. The direction of the treatment effect was assessed with profile plots. Evaluation of data collected from both groups showed a significant improvement in terms of objective and subjective clinical findings to a value of p=< 0.001. There was no statistical difference between the two groups in terms of objective and subjective clinical findings, although a trend was shown when looking at the objective findings that suggest that MFTPM was more effective than PNF stretching. The sample population was drawn from a very homogenous group of people (i.e. SARS call centre), in order to achieve greatest emphasis on clinical outcomes. This process however limits the clinical applicability of the results and thus will not always be applicable to all patients within the population. It is therefore the researcher’s conclusion that there is no statistical difference between MFTPM and PNF stretching in terms of objective and subjective clinical findings. Both treatment modalities have been shown to be equally effective in the treatment of subacute active TPs in the upper tarpezius. There is a definite trend when looking at the objective data that may support the hypothesis that MFTPM is as effective as, if not more effective than PNF stretching. It is of the opinion of the author that a larger sample size is needed to make it clinically significant.Item The short to medium term effectiveness of proprioceptive neuromuscular facilitation stretching as an adjunct treatment to cervical manipulation in the treatment of mechanical neck pain(2002) Wilson, Laura MaieThe purpose of this study was to determine the short to medium term effectiveness of Proprioceptive Neuromuscular Facilitaion (P.N.F.) stretching [using the Contract- Relax-Antagonist-Contract (C.R.A.C.) technique] as an adjunct treatment to cervical manipulation in the treatment of Mechanical Neck Pain.Item The effectiveness of manipulation of the subtalar joint combined with static stretching of the triceps surae muscles compared to manipulation alone in the treatment of Plantar Fasciitis(2003) Blake, Terri LyndalPlantar Fasciitis (PF) is a common injury, and one which is known to be stubborn to many forms of treatment. The purpose of this investigation was to determine the effectiveness of manipulation of the subtalar joint combined with static stretching of the Triceps Surae muscles compared to manipulation alone in the treatment of PF. Studies have shown chiropractic manipulation to be effective in treating this overuse injury, and gastro-soleus stretching is a treatment advocated by many authors, but which has not yet been investigated in combination with manipulation. This study consisted of 40 patients who were randomly divided into two equal groups. Group One received manipulation to restrictions in the subtalar joint, and Group Two received subtalar manipulation in addition to two static stretched of the gastro-soleus muscles.