Dissertations / Theses on the topic 'Lumbar vertebrae treatment'

Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2007.
Includes bibliographical references (leaves 21-22).
Introduction: While there have been numerous studies demonstrating the effect of bisphosphonates in rats as either a preventative treatment or recovering treatment for osteoporosis, few have directly compared the two treatment alternatives with respect to their effects on bone microstructure and strength. This paper, then, investigates the effects of treatment timing using Zoledronate [ZOL], a potent bisphosphonate, on the lumbar and caudal vertebrae in ovariectomized [OVX], female Wistar rats. Methods: Twenty nine rats were divided into four groups according to their treatment: OVX at week 0 (n=5), OVX+earlyZOL (20 jig/kg s.c. week 0, n=8), OVX+late ZOL (20 jlg/kg s.c. week 8, n=7), and SHAM-OVX (n=9). Results: Micro-computed tomography (giCT) evaluation of six parameters characterizing bone morphology [BV/TV, ConnD, SMI, TbTh, TbNr, and TbSp] showed slightly favorable effects with early ZOL treatment in the fourth lumbar [L4] vertebrae. Compared to SHAM-OVX, OVX has a significantly (p<0.05) lower BV/TV, higher SMI, and TbSp. OVX+earlyZOL had a significantly higher BV/TV than OVX and SHAM-OVX and a lower TbSp than OVX.
(cont.) Decreasing trends but no statistically significant differences were reached in the cortical thickness with treatment, nor were there any differences in bone morphology between the groups in the sixth caudal vertebrae [CD6]. A two-way ANOVA revealed an interaction between the vertebral site and treatment group for BV/TV and TbSp. jCT and static compression tests on the L3 and L4 of rats in a secondary study revealed significant correlations in architectural parameters and biomechanical properties between the two vertebrae. L4 had a higher BV/TV, SMI, and minimum area [minA] and a lower TbNr and TbSp than L3, but L4 had lower values for stiffness, energy to failure [energy], and ultimate load. Regression analysis also showed statistically significant correlations between ultimate load [Uload] and total bone volume [BV], energy and BV, Uload and minA, stiffness and minA, and energy and minA. Conclusion: Results showed slightly favorable trends on bone microstructure for early treatment and demonstrated the potential for clinical advantages using preventative therapy. Upon further research in understanding the vertebrae's response to ZOL at different time points after OVX, treatment for osteoporosis may be better directed.
by Michal Ruchelsman.
S.B.

Uvod: Sindrom lumbalne radikulopatije obuhvata disfunkciju nervnog korena lumbalne kičme, prouzrokovano kompresijom, nastalom usled hernijacije (protruzije, prolapsa) intervertebralnog diska ili zbog inflamatornih i degenerativnih promena (najčešće osteofita) u foraminalnom otvoru. Kvalitet života predstavlja savremeni koncept posmatranja ishoda oboljenja i uspešnosti terapijske procedure kako u svim oblastima medicine, tako i u problematici lumbalne radikulopatije.Cilj: Proceniti kvalitet života operativno i neoperativno lečenih pacijenata sa lumbalnom radikulopatijom na početku lečenja i 3 meseca, odnosno 6 meseci nakon sprovedene medicinske rehabilitacije.Metode: Istraživanje predstavlja prospektivnu kliničku studiju kojom je analiziran kvalitet života bolesnika sa lumbalnom radikulopatijom. Obuhvaćen je randomiziran i stratifikovan uzorak pacijenata sa lumbalnom radikulopatijom diskalne geneze starosti 20 do 65 godina, oba pola (n=100), lečenih u Specijalnoj bolnici za progresivne mišićne i neuromišićne bolesti Novi Pazar. Jedna grupa ispitanika (n=50) lečena je isključivo neoperativnim metodama, dok je druga grupa bolesnika (n=50) lečena hirurškim i neoperativnim metodama. Kod svih pacijenata sproveden je konzervativni tretman primenom fizikalnih procedura, kineziterapijskih procedura, ergonomske edukacije. Medikamentna terapija je kod svih bila identična. Za procenu stanja pacijenata, kvaliteta života i efekta rehabilitacionog tretmana korišćena su dva standardizovana upitnika: opšti zdravstveni upitnik Medical Outcomes Study Short Form 36 (SF 36) i upitnik specifičan za oboljenje The Oswestry Disability Index (ODI).Rezultati: Vrednosti SF-36 upitnika prikazanih sumarnim fizičkim (SFS) i mentalnim (SMS) skorom, i kod neoperativno lečenih ispitanika (FSFS=450,221 i p<0,001; FSMS=106,543 i p<0,001), ali i kod operativno lečenih (FSFS=490,721 i p<0,001; FSMS=72,055 i p<0,001) značajno su se menjale u toku ispitivanja. Vrednosti SFS kod neoperativno lečenih pacijenata (početak tretmana, 3 meseca, 6 meseci): 35,5 / 44,7 / 50,8; kod operativno lečenih: 28,8 / 42,8 / 49,2. Vrednosti SMS kod neoperativno lečenih pacijenata: 40,6 / 44,8 / 52,6; kod operativno lečenih: 37,8 / 45,2 / 52,5.Najveće poboljšanje SFS, kod obe grupe pacijenata, je registrovano u prva tri meseca od početka rehabilitacionog tretmana, dok je najveći napredak SMS registrovan u prva tri meseca od početka rehabilitacionog tretmana kod druge grupe pacijenata.Vrednosti skora Osvestri indeksa nesposobnosti (ODI), i kod pacijenata prve grupe (F=432,810 i p<0,001), ali i kod pacijenata druge grupe (F=1341,180 i p<0,001) značajno su se menjale u toku ispitivanja. Vrednosti ODI kod neoperativno lečenih pacijenata su: 51,5% / 36% / 22,5%; a kod pacijenata druge grupe: 56,1% / 38,9% / 23,7%. Najveće poboljšanje je registrovano u prva tri meseca od početka rehabilitacionog tretmana kod druge grupe pacijenata. Postoje statistički značajne korelacije glavnih sumarnih skorova i domena SF-36 (SFS i SMS) i ODI skorova.Zaključak: Kvalitet života i funkcionalni status i neoperativno i operativno lečenih pacijenata je značajno bolji u komparaciji stanja, na 3 meseca i na 6 meseci u odnosu na početak rehabilitacije, kao i na 6 meseci u odnosu na stanje na 3 meseca.
Introduction: The syndrome of lumbar radiculopathy involves dysfunction of nerve roots of the lumbar spine, caused by compression, resulting due to herniation (protrusion, prolapse) intervertebral disc, or due to inflammatory and degenerative changes (usually osteophytes) in foraminal opening. Quality of life is the modern concept of observing the outcome of disease and therapeutic procedures in performance in all areas of medicine, as well as the problems of lumbar radiculopathy.Aim: Assess the quality of life for surgically and conservatively treated patients with lumbar radiculopathy at initiation of treatment and 3 months, and 6 months after conducting medical rehabilitation.Methods: The study is a prospective clinical study, which analyzed the quality of life of patients with lumbar radiculopathy. Also included is randomized and stratified sample of patients with lumbar radiculopathy of discal genesis aged 20 to 65 years, of both sexes (n=100) treated at the Special Hospital for progressive muscular and neuromuscular diseases Novi Pazar. One group of patients (n=50) were treated exclusively non-surgical methods, while the second group of patients (n=50) treated with surgical and non-surgical methods. In all patients was conducted by applying the conservative treatment of physical procedures, kinesitherapy procedures, ergonomic education. Medication treatment is at all were identical. To assess the condition of patients, quality of life and the effect of rehabilitation treatment used two standardized questionnaires: a general health questionnaire Medical Outcomes Study Short Form 36 (SF 36) and disease-specific questionnaire The Oswestry Disability Index (ODI).Results: Values SF-36 questionnaire presented summary physical (SFS) and mental (SMS) scores, with non-surgical treated subjects (FSFS=450.221, p<0.001; FSMS=106.543, p<0.001), but also at surgical treated (FSFS=490.721, p<0.001; FSMS=72.055, p<0.001) were significantly changed during the study. Values at SFS non-surgical treated patients (beginning of treatment, 3 months, 6 months): 35.5 / 44.7 / 50.8; at surgical treated: 28.8 / 42.8 / 49.2. Values SMS with the non-surgical treated patients: 40.6 / 44.8 / 52.6; with surgical treated: 37.8 / 45.2 / 52.5. The biggest improvement of SFS, in both groups of patients were registered in the first three months of the start of the rehabilitation treatment, while the biggest progress SMS is registered in the first three months of the start of treatment in other patient groups. The Oswestry Disability Index (ODI) values score, in patients of the first group (F=432.810, p<0.001), and in second group of patients (F=1341.180, p<0.001) were significantly changed during the study. ODI values at non-surgical treated patients were: 51.5% / 36% / 22.5%; the second group of patients: 56.1% / 38.9% / 23.7%. The bigest improvement was registered in the first three months of the start of treatment in second group patients. There are statistically significant correlations main summary scores and SF-36 domains (SFS and SMS) and ODI scores.Conclusion: The quality of life and functional status of both groups patients was significantly better in comparison to the situation, at 3 months and 6 months compared to the beginning of rehabilitation, as well as at 6 months compared to 3 months.

M. Tech.
Low back pain is experienced by approximately 60-90% of the population and is one of the most expensive public health problems today (Shin and Slipman, 2005). Lumbar facet joint syndrome is a common condition, involving about 79% of patients suffering from low back pain (Schleifer, et al., 1994). The aim of this study was to determine the effectiveness of treatment for lumbar facet syndrome with the homeopathic injectable Discus compositum® by using the pressure algometer, Helbig and Lee scorecard system and the Oswestry low back pain questionnaire. This double-blind placebo-control trial, with matched pairs, was conducted at the University of Johannesburg and participants were recruited with posters and by word of mouth. Thirty-two participants that met the inclusion criteria, and were not outside of treatment parameters, were included in the study. These participants were then randomly divided into two groups: Group A was treated with Discus compositum® injectables and Group B was treated with placebo injectables. In addition, participants were matched according to activity levels of more than 3 times per week and activity levels of less than 3 times per week. Participants in both groups were treated four times over a period of two weeks; two treatments per week. A one month post-injection follow-up consultation was carried out in order to determine if the treatment had a lasting effect. The subjective and objective data was analysed by using non-parametric tests in order to establish statistical significance between visits and between groups. The subjective data was obtained by using the Oswestry low back pain and disability questionnaire. The objective data was gathered by using the Helbig and Lee scorecard system as well as the algometer readings. The two sample groups did exhibit statistical differences. The results showed that there was a significant decrease in the pain experienced by the participants, as well as a significant change in the participant’s pain pressure threshold, for both groups. With regards to the diagnostic criteria a higher percentage of participants that were treated with Discus compositum® injections were no longer diagnosed with lumbar facet syndrome according to the Helbig and Lee scorecard system, than those participants that were treated with the placebo injections. In addition, it was determined that a combination of Discus compositum® injections and activity levels of more than 3 times per week proved to be beneficial. Based on the results of this study, one can determine that Discus compositum® is effective in the treatment of lumbar facet syndrome.

M.Tech.
OBJECTIVE: The aim of this study was to determine the electromyographic effect of flexion distraction therapy of the lumbar spine on the Erector Spinae muscles in participants with lumbar facet dysfunction. STUDY DESIGN: Thirty participants with lumbar facet dysfunction underwent 6 flexion distraction therapy treatments on alternate days over a 2-week period (excluding weekends) to test the electromyographic effect on the Erector Spinae muscle. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: Thirty participants with lumbar facet dysfunction participated in this study. The participants were divided into two groups of fifteen participants each and matched according to age and gender. Group 1, the study group, received flexion distraction therapy to the restricted segments in the lumbar spine. Group 2, the control group, did not receive any flexion distraction therapy and rested during the duration of the treatment. METHODS: Lumbar Erector Spinae muscle electrical activity was tested before and after treatment one, three and six using surface electromyography (sEMG). One pair of bipolar electrodes was placed bilaterally over the Erector Spinae muscles at the level of L3. Participants were asked to lie down in a prone position with their arms next to their sides. They were then instructed to perform five maximum voluntary lower back extension exercises by lifting their chests and shoulders as high off the plinth as possible. Each contraction lasted five seconds, with a rest period of ten seconds between each contraction. The average rest and work surface electromyography readings were recorded, analysed and compared for reference. Information regarding the intensity of the pain experienced by the vii subjects was also collected at the start of treatment one, three and five using the Numerical Pain Rating Scale. RESULTS: Comparison of the results indicated a statistically significant difference between the two groups and their responses to the treatments. Subjectively, a statistically significant improvement was observed in Group 1 between the third and the sixth treatments and the first and the sixth treatments, with an overall 80% improvement in pain, thus demonstrating the medium to long term effects of flexion distraction therapy. Objectively, Group 1 demonstrated a statistically significant medium to long term improvement in the resting rate of the Erector Spinae muscles as observed between the first and sixth treatments. Statistically, the two groups responded differently over time with regards to the contraction ability of the Erector Spinae muscle. A statistically significant and immediate improvement was observed in the sixth treatment in Group 1, thus further supporting the long term effects and benefits of flexion distraction therapy. CONCLUSION: In light of these findings it can be concluded that flexion distraction therapy, as represented by Group 1, demonstrated favourable treatment results in terms of the pain experienced by the subjects, the resting rate and contraction ability of the Erector Spinae muscles. The trends observed in this study should be used and tested in future research studies of a similar nature incorporating larger sample groups.

M.Tech.
This unblinded, randomised pilot study was performed to determine and compare the effect of innervation specific lumbar spine adjustments and stretching on the flexibility of the rectus femoris muscles in asymptomatic subjects. Twelve asymptomatic subjects between the ages of 20 and 30 years were recruited by the use of advertisements placed around the University of Johannesburg, Doornfontein Campus. The inclusion criteria required that the patient had decreased rectus femoris muscle flexibility (testing positive on the rectus femoris contracture test) and no history of, or any current osteoarthritis or pathology of the hips or knees. The patients were randomly placed into one of three groups by drawing a group number from a closed bag. Group 1 consisted of four subjects receiving a single lumbar spine adjustment per treatment relating to the most restricted segment in the L2-L4 area as well as bilateral proprioceptive neuromuscular facilitation (PNF) of the rectus femoris muscles; Group 2 consisted of four subjects receiving bilateral rectus femoris muscle stretches (PNF); and Group 3 consisted of four subjects who received a single lumbar spine adjustment at the L2-L4 area to the most restricted segment found. One adjustment per treatment was performed. With the subject in the rectus femoris contracture test position, a goniometer was used to measure the knee range of motion bilaterally before and after treatments. These measurements were used as objective data. Each subject was treated twelve times over a four to six week period. The objective results indicated that there was a statistically significant improvement in rectus femoris muscle flexibility in both Group 1 and Group 3. In conclusion, it was shown that specific adjustments at the spinal level of the nerve innervation for the rectus femoris muscle resulted in an improvement of the flexibility of the rectus femoris muscle and with a greater effect on the leg ipsilateral to the side of the spinal adjustment. This gives support for the effectiveness of innervation specific spinal adjustments.

A dissertation submitted in partial compliance with the requirements for the Masters Diploma in Technology: Chiropractic at Technikon Natal, 1996.
Lower back pain due to mechanical dysfunction is a common cause of pain and disability in mankind. Lumbar spine facet syndrome is a major aetiology in mechanical lower back pain
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M. Tech.
Abstract Purpose: The purpose of this study was to assess the effects of Diversified Chiropractic adjustments versus Flexion-Distraction Technique in the management and treatment of chronic Lumbar Facet Syndrome. Method: This study consisted of two groups, Group A and Group B, each consisting of 15 participants with chronic Lumbar Facet Syndrome. The participants were between the ages of 20 and 45 years. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Group A received Diversified Chiropractic Adjustments and Group B received Flexion-Distraction Technique to the lumbar facets. Procedure: Each participant was treated eight times over a period of four weeks. Before the commencement of treatment one, four and eight, the participants completed the Oswestry Low Back Pain and Disability Index questionnaire and the Visual Analogue Scale. A Digital Inclinometer was used to measure lumbar spine ranges of motion. Diversified Chiropractic adjustments were then administered to Group A based on the restrictions obtained during motion palpation. Flexion-Distraction Technique was administered to Group B based also on the restrictions that were obtained during motion palpation. Results: Objective statistically significant differences were noted on flexion and left lateral flexion ranges of motion before treatment, and clinically significant differences we noted on flexion and right lateral flexion after treatment, in favour of Group A. Subjective readings also showed statistically significant differences with regards to Oswestry Low Back Pain and Disability Index and Visual Analogue Scale in favour of both Group A and Group B. Conclusion: The results of the study indicate that both Diversified Chiropractic adjustments and Flexion-Distraction Technique have a positive effect on patients suffering from chronic Lumbar Facet Syndrome. However, Diversified Chiropractic adjustments proved to have a greater overall benefit compared to Flexion-Distraction Technique in the management and treatment of Lumbar Facet Syndrome.

M.Tech. (Chiropractic)
OBJECTIVE: The aim of this study was to determine the effectiveness of a single treatment approach of flexion distraction or diversified lumbar adjustments, compared to the combined treatment of flexion distraction in conjunction with diversified lumbar adjustments. STUDY DESIGN: A total of 30 participants were used, they all presented with chronic low back pain (LBP) of mechanical origin. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: The participants were divided randomly into one of 3 groups: Group 1 was treated with diversified lumbar adjustments. Group 2 was treated with flexion distraction directed at the lumbar spine. Group 3 was treated with a combination of diversified lumbar adjustments and flexion distraction. Each participant was treated 6 times over a 3 week period, with a 7th consultation where subjective and objective measurements were taken with no treatment. METHODS: Group 1 was adjusted on a chiropractic table in a seated or side lying posture. Group 2 was treated lying prone on the Cox Flexion Distraction Table. Group 3 was treated with a combination of the above treatments. Flexion distraction was applied to all participants in group 2. It was applied over the segments that were found to be restricted during motion palpation. One set of 10 repetitions was performed under distraction in each range of motion (ROM). Mobilisation of the restricted joints was executed until full and complete ROM was detected. To ensure that the participant was comfortable and received the best treatment possible Velcro straps were used to secure them onto the flexion distraction table. Diversified chiropractic adjustments were done on the flexion distraction bed or the chiropractic tables in the University of Johannesburg Chiropractic Day Clinic. Spinous Hook (Pull), Thigh-Transverso-Deltoid, Transverso-Deltoid and Push-Pull Technique were the names of the adjustments used to treat participants in group 1 or group 3. PROCEDURE: Subjective data was collected using the Oswestry Low Back Pain and Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS), which were completed by the participants prior to the 1st and 4th consultations and then again on the 7th consultation. Objective data was collected using the Digital Inclinometer. The ROMs measured were forward flexion, extension, left lateral flexion, right lateral flexion left rotation and right rotation of the lumbar spine. This data was collected by the researcher prior to the 1st and 4th consultations and then again on the 7th consultation. RESULTS: This study was done to try and establish the most effective approach in the management of chronic mechanical LBP using the different treatment approaches. When comparing the results obtained from the study it can be seen that all 3 groups were effective at reducing pain levels using the NPRS. There was a significant change that occurred on the 7th consultation when looking at the NPRS values. The statistics were then further analysed and a statistically significant difference was shown to have occurred between groups 1 and 3. This indicates that the chiropractic adjustment used alone, was the best treatment protocol compared to groups 2 and 3. The ODQ values showed that the treatments for all 3 groups were effective at getting the participants back to normal activities of daily living over the treatment protocol, with no preference between any of the treatment protocols. Statistically significant changes were found to have occurred in only some ranges of motion of the lumbar spine within certain groups. Clinical improvements regarding ROM were evident in group 1 concerning flexion, left rotation and right rotation. A clinical decrease was found in extension, left and right lateral flexion with group 1. Clinical improvements concerning group 2 were found in extension, left rotation and right rotation. Flexion showed a clinical decrease in ROM values of group 2. Statistically significant improvements were found with left and right lateral flexion in group 2. Group 3 showed positive clinical results with left and right rotation. Flexion and left and right lateral flexion ROM showed decreased values clinically in group in group 3. Extension showed a statistically significant decrease in group 3. These results indicate that chiropractic adjustments used alone, were the best treatment protocol compared to group 2 and 3 when using the NPRS. The ODQ values showed that there was no preference between either of the treatment protocols with regards to normal activities of daily living.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2017.
Radiographs are the most commonly used modalities for the purpose of diagnosing skeletal disorders. Radiographs are important for chiropractors to exclude any contra-indications prior to spinal manipulative therapy. If contra-indications are found treatment is modified to what best suits each patient. There is a gap in the literature regarding chiropractors reading the same set of radiographs and agreeing on findings. Objectives The study investigated inter- and intra-examiner reliability of lumbar spine radiograph analysis by chiropractors and its impact on clinical management. Methods Inter- and intra-examiner examination of radiographs occurred in two rounds separated by two weeks. Six chiropractors read the same 30 radiographs and clinical history was only available in the second round. Results Inter-observer agreement for categorisation for Round One was 96.78% and Round Two 89.49%. Inter-observer agreement in management was 96.45% in round one and 96.00% in Round two. Agreement between chiropractors had no statistically significant difference. Identification average improved from 0.09 to 0.89 kappa. Overall specificity was relatively high and sensitivity was relatively low. Conclusion Reliability/Agreement between chiropractors was strong in both rounds. Categorising of the diagnosis improved from poor to substantial from Round One to Round Two. Case history improved the accuracy of interpreting the radiographs although this change was not statistically significant.
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M.Tech. (Chiropractic)
The purpose of this study is to evaluate whether action potential simulation (APS) therapy is more effective than placebo therapy in terms of pain relief and improvement in lumbar spine range of motion when treating chronic lumbar spine pain. The comparison of the two therapies was accomplished by objective and subjective assessments. The study was conducted by means of a double blind clinical trial with two experimental groups. Thirty subjects eighteen years of age and older who suffered from chronic lumbar spine pain were chosen from the general population who responded to the advertisements and from Tarentaal Home for the Aged. The researcher examined each of these subjects in order to be accepted into the study. Each subject was treated ten times over a two-week period and underwent a one-month follow-up consultation to be re-examined. Subjects in both groups received therapy for eight minutes at an amplitude of 1-2mA. Only the APS group received the electric current and the placebo group did not receive the electric current. The objective assessment was by means of measurement of the lumbar spine ranges of motion using an inclinometer. The subjective assessment was measured by means of two questionnaires, which are widely accepted in the research community namely: a) Oswestry Low Back Pain and Disability Questionnaire b) McGill Pain Questionnaire. The results, which were obtained, were statistically analyzed using the Mann-Whitney Rank Sum test (inter-group comparison) and the Wilcoxon Signed Rank test (intra-group comparison). Graphs were created using the actual values of each patient in each group and using the medians obtained. The study concluded that both the APS and the placebo group improved in terms of lumbar spine range of motion and pain relief even though not all the results were statistically significant. The graphs representing the mean values at the first, final and one-month follow-up consultations of each group showed the apparent improvement in terms of range of motion in the lumbar spine and pain relief. The APS group's mean values, at the above mentioned consultations, showed a greater improvement in range of motion and pain relief when being compared to the placebo group's mean values that are represented on the respective graphs.

M.Tech. (Chiropractic)
Purpose: Low back pain affects the general population worldwide. Low back pain is a multi-factorial problem with debate as to the exact aetiology of low back pain. Thus, this study examines the relationship between lumbar spine lordosis, body fat percentage, physical activity level, lumbar spine range of motion and the incidence of low back pain. Method: There was a total of one hundred female participants between and including eighteen and thirty-five years of age. These females were symptomatic or asymptomatic of mechanical low back pain. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Participants were evaluated once. No treatment was administered. Procedure: Subjective responses were acquired through the Visual Analog Scale, the International Physical Activity Questionnaire and an Oswestry Low Back Pain and Disability Questionnaire. The objective evaluation included a physical examination and a lumbar spine regional examination. The participant’s height was measured using a stadiometer. The Bioelectrical Impedance Analysis (BIA) measured the participant’s weight, water content, lean tissue mass and body fat percentage. BMI was calculated from the weight and height recordings. Range of motion of the lumbar spine was measured with a Digital Inclinometer. A flexi curve ruler molded the lumbar spine lordosis of each participant, which was then traced onto a piece of paper to measure the magnitude of lumbar spine lordosis. Results: A clinical relationship did not exist between a hyperlordotic lumbar spine posture, the incidence of low back pain, body fat percentage and lumbar spine range of motion. A clinical relationship was evident between a hyperlordotic lumbar spine posture and the level of physical activity. Conclusion: Given that a clinical relationship exists between a hyperlordotic lumbar spine posture and the level of physical activity, physical activity specifically exercise to strengthen the abdominal muscles should be included in a treatment protocol to reduce the degree of lumbar spine lordosis if the degree is excessive.

M.Tech.
Purpose: To determine what effects flexion distraction will have on males with chronic lumbar facet syndrome, in reference to intersegmental range of motion and pain. Method: Thirty male participants with chronic lumbar facet syndrome received flexion distraction technique. The trail consisted of seven visits over two to three weeks. Treatment was performed on the first to sixth visit, readings and questionnaires were completed on the first, fourth and seventh visits. Data collection was concluded before treatment on the mentioned visits. Subjective data consisted of the Oswestry Disability Index (ODI) and the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). Objective data included global lumbar range of motion measurements using the Baseline Digital Inclinometer, and segmental lumbar range of motion by means of the Radiographical Midplane Angle method. Results: Objectively, clinical significance of the intersegmental lumbar range of motion increased from the L1/L2 to the L4/L5 level (2.2% - 17.7%), but showed no statistical significance. In relation to the maximal motion possible at these levels, the increase in motion escalated from 0.8% at the L1/L2 segment to 9.2% at the L4/L5 segment. The global lumbar range of motion showed clinical significant increase in all of the ranges except for extension, however statistical significance was found in right lateral flexion only (p = 0.045). The greatest increase in motion was observed in left lateral flexion (15.72%) and a decrease in extension (3.72%) was illustrated. Subjectively, the group showed statistical significant improvement in both the SF-MPQ-2 (p = 0.000) and ODI (p = 0.000). Clinical meaningful change was noted throughout the subjective data, which resultantly showed a 66% and a 67% change in pain respectively. Conclusion: Flexion distraction has shown to have clinical significant effects on segmental and thus global range of motion, and great clinical meaningful change in pain levels and pain perception. Thus specific segmental mobilisation does affect the segmental motion.

M.Tech.
According to the “Lovett Reactor” as explained by Walther (2000), the Atlas and the 5th lumbar vertebrae rotate in the same direction when a person walks. This relationship continues throughout the spinal column as 3rd cervical vertebrae (C3) rotates in the same direction as 3rd lumbar vertebrae (L3). From this point the movement changes to counter-rotation as 4th cervical vertebrae (C4) counter-rotates to 2nd lumbar vertebrae (L2) and 5th cervical vertebrae (C5) to 1st lumbar vertebrae (L1). According to Inman, Ralston and Todd (1981) this correlation extends as the Sacrum reacts with the Occiput. Thus, there is clinical verification demonstrating that the Lovett Reactor vertebrae are often interrelated to primary and compensatory subluxations. The aim of this study was to determine the effect of Chiropractic Occipital adjustments versus Chiropractic Sacroiliac adjustments in the treatment of chronic Lumbar Sacral pain.

Dissertation in partial compliance with requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010.
The aim of this study was establish if Leander versus Static traction was useful for the treatment of facet syndrome, a common type of mechanical lower back pain seen by chiropractors. Two groups of fifteen participants were chosen on the basis of the inclusion and exclusion criteria. The first objective was to determine if Static linear traction was effective for the treatment of lumbar facet syndrome in terms of subjective and objective findings. The second objective was to determine if Leander traction was effective for the treatment of lumbar facet syndrome in terms of subjective and objective clinical findings. Lastly the third objective was to compare the subjective and objective clinical findings for both groups. Design: A randomised, two group parallel controlled clinical trial was carried out between the two sample groups. Participants had to have had chronic lower back pain (> 3months). Thirty symptomatic volunteer participants between 25 and 55 were randomly divided into two equal groups – group A (Leander traction) received 5 treatments over a 2 week period. Similarly, group B (Static linear traction) also received 5 treatments over a 2 week period. Algometer readings, Numerical Pain Rating Scale (NRS101), Pain Severity Scale (PSS) and Oswestery Disabilty Index (ODI) were used as v assessment tools. Subjective and objective clinical findings were taken on the first and second visits (i.e. 48 hours) prior to treatment and immediately after treatment. Another set of subjective and objective readings were taken one week after the fifth treatment in order to gauge the long term effects of both treatments. No treatment was given on the sixth visit. Pressure tolerance measurements using an algometer were taken at the end ranges of motion in Kemp’s test and spinal extension. Outcome measures: SPSS version 15 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis of data. A p value of <0.05 was considered as statistically significant. The two groups were compared at baseline in terms of demographics variables and location using Pearson’s chi square tests and ttests as appropriate. Intra-group comparisons were made between all time points. A significant time effect indicated successful treatment intervention. Inter-group comparisons were achieved using repeated measures ANOVA tests for each outcome measured separately. A significant time group interaction effect indicated a significant treatment effect. Profile plots were used to assess the trend and direction of the treatment effect. Results: The results of the study showed that Leander traction and Static linear traction were both effective for treating chronic lumbar facet syndrome and no statistically significant difference was found between subjective and objective clinical findings between the two groups.

Submitted in partial compliance with the requirements for the Masters’ Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2014.
Background: Spinal manipulation has been shown to result in neurophysiological changes, most often noted in the paraspinal muscles. These effects have been associated with an increase in paraspinal muscle contractibility; it is unclear if this leads to an increase in paraspinal muscle endurance. Objectives: To determine the effect of sacroiliac joint (SIJ) manipulation compared to a placebo treatment of the SIJ on lumbar extensor muscle endurance time. Method: A randomised, placebo-controlled pre-test post-test experimental trial, involving 40 asymptomatic male participants divided into an intervention group receiving SIJ manipulation using an impulse adjusting instrument and a placebo group receiving a pre-load force without the delivery of an impulse thrust. Outcome measures were lumbar extensor muscle endurance time, surface electromyographic (SEMG) readings, lumbar spinal range of motion, paraspinal muscle length assessment and a subjective pain measurement. Results: There was a significant difference between the groups (p=0.004) with the SIJ manipulation group showing an increase in endurance time compared to the placebo group which showed a decrease. SEMG readings increased for both groups with no statistically significant difference between the groups (p>0.05). Only extension lumbar spinal range of motion significantly improved in both groups (p=˂0.001) with no significant differences between groups (p=0.876). Only one participant reported pain during the research procedure. Conclusions: SIJ manipulation may enhance the endurance of the paraspinal muscles. This study should be conducted in a larger sample to validate the findings.