the effect of the activator adjusting instrument in the treatment of chronic sacroiliac joint syndrome

181 Pages·2014·3.63 MB·English

THE EFFECT OF THE ACTIVATOR
ADJUSTING INSTRUMENT IN THE
TREATMENT OF CHRONIC
SACROILIAC JOINT SYNDROME
By
Natasha Coetzee

Dissertation submitted in partial compliance with the requirements for
the Master’s Degree in Technology: Chiropractic at the Durban
University of Technology.

I, Natasha Coetzee, do declare that this dissertation is representative of
my own work in both conception and execution.

N. Coetzee D a t e :

APPROVED FOR FINAL EXAMINATION

Supervisors:

Dr. H. White D a t e :
M. Tech: Chiropractic

Dr. R. Phillips D a t e :
DC PhD

i
DEDICATION

I dedicate this research to my late dad, Johann, and my mom, Cynthia,
as well as my life-partner, Leigh-Ann. My parents always encouraged
me to follow my dreams, and never to give up. This valuable life lesson
is what kept me going, even when I wanted to give up. Leigh-Ann has
been my rock for the past 8 years, and without her none of this would
have been possible. Her patience and commitment has been flawless.
Thank you to my family and friends for always believing in me, and for
your ongoing encouragement. I love you all very much.

To my Heavenly Father, thank you for carrying me every step of this
journey. Without your Grace and guidance I would have been lost. I
hope that I have made you and my family proud.

ii
ACKNOWLEDGEMENTS

To my brothers, Johann and Eric, thank you for all your love and
support. I am very proud to be your sister.
To my best friend Terry-Ann. Thank you for your love and support over
the years. Without you, life would not be the same.
To my other close friend, Belinda. You have been such a fantastic
mentor. Thank you for all your encouragement and support.
To my life-partner, Leigh-Ann, thank you for being you; for being the best
partner I could have wished for. Your ongoing patience and commitment
amazes me.
To my supervisor, Dr. H. White, you have been my mentor and
inspiration to be the best chiropractor I can be. Thank you for always
being willing to teach and inspire the students.
To my mentor, Dr C Korporaal, a very big thank you for spending many
long hours and weekends helping me get through this process. Without
you this would not have been possible. I can never express the extent of
my gratitude to you!
Thank you to all my lecturers at the Durban University of Technology for
your support and the knowledge that you shared over the years.
Many thanks to all the clinicians for sharing your experiences and
knowledge over the years.
To Pat and Linda, thank you for all the support and laughter.

iii
To all my classmates over the years, thank you for your support through
some really tough times. Thank you for keeping me young, and for
making me the person I am today. I wish everyone of you all the success
in the world.
To Tonya Esterhuizen, my statistician, thank you for all your patience
and participation in this study.
Then, a very big thank you to all the patients who were willing to
participate in my research, and who sacrificed their time for me. Without
you this research would definitely not have been completed.
iv
ABSTRACT

Objective:
Low back pain (LBP), and in particular sacroiliac joint syndrome, is a
significant health concern for both patient and their chiropractor with
regards to quality of life and work related musculoskeletal disorders.
Therefore, chiropractors often utilise mechanical aids to reduce the
impact on the chiropractor’s health. It is, however, important to establish
whether these mechanical aids are indeed clinically effective, therefore,
this study evaluated the Activator Adjusting Instrument (AAI) against an
AAI placebo to determine whether this adjusting instrument is an
effective aid for both the chiropractor and the patient.

Method:
This randomised, placebo controlled clinical trial consisted of 40 patients
(20 per group), screened by stringent inclusion criteria assessed through
a telephonic and clinical assessment screen. Post receipt of informed
consent from the patients, measurements (NRS, Revised Oswestry
Disability Questionnaire, algometer) were taken at baseline, prior to
consultation three and at the follow consultation. This procedure
occurred with four interventions over a two week period.

Results:
The AAI group showed clinical significance for all clinical measures as
compared to the AAI placebo group which attained clinical significance
only for the Revised Oswestry Disability Questionnaire. By comparison
iv
there was only a statistically significant difference between the groups in
terms of the algometer readings (p= 0.037).

Conclusion:
Therefore, it is evident that the AAI seems to have clinical benefit
beyond a placebo. However this is not reflected in the statistical
analysis. It is, therefore, suggested that this study be repeated with a
larger sample size in order to verify the effect on the statistical analysis
outcomes.

Keywords:
Sacroiliac joint syndrome
Low back pain
Activator Adjusting Instrument

v
TABLE OF CONTENTS
Page
DEDICATION ii
ACKNOWLEDGEMENTS iii
ABSTRACT iv
TABLE OF CONTENTS v
LIST OF TABLES ix
LIST OF FIGURES x
LIST OF APPENDICES xi
DEFINITION OF TERMS xii
LIST OF ABBREVIATIONS xiv

1 CHAPTER ONE INTRODUCTION 1
1.1 Introduction 1
1.2 Aims of the study 6
1.3 Objectives of the study 6
1.4 Rationale 7
1.5 Benefits of the study 8
1.6 Conclusion 9

2 CHAPTER TWO LITERATURE REVIEW 10
2.1 Introduction 10
2.2 Anatomy of the sacroiliac joint 10
2.2.1 Structure 10
2.2.2 Ligaments 12
2.2.3 Muscles as a base of support 15
2.2.4 Sacroiliac joint movement/motion 17
2.2.5 Innervation 19
2.3 Definition of low back pain (LBP) and the context of sacroiliac 20
joint syndrome
2.4 Low back pain 21
2.4.1 Incidence and prevalence of low back pain 21
2.4.2 Causative factors (aetiology) of sacroiliac joint 24
syndrome
2.4.3 Signs and symptoms of sacroiliac joint syndrome 31
2.4.4 Associated clinical signs of sacroiliac joint 33
syndrome
vi
2.4.5 Diagnostic testing (provocative testing) for 35
sacroiliac joint syndrome
2.4.6 Differential diagnoses 37
2.5 Treatment of sacroiliac joint syndrome 38
2.6 Instrument manipulation with particular emphasis on the 40
Activator Adjusting Instrument (AAI)
2.7 The Placebo effect/ The Hawthorne effect/ Observer effect 42
2.8 Conclusion 43

3 CHAPTER THREE MATERIALS AND METHODS 44
3.1 Introduction 44
3.2 Advertising 44
3.3 Sampling 45
3.3.1 Size 45
3.3.2 Allocation 45
3.3.3 Method 45
3.4 Inclusion criteria 47
3.5 Exclusion criteria 51
3.6 Intervention/Treatment types 52
3.7 Intervention frequency 55
3.8 Data collection 56
3.8.1 Data collection instruments 56
3.8.1.1 Subjective data 56
3.8.1.2 Objective data 57
3.9 Statistical Methodology 58
3.10 Conclusion 59

4 CHAPTER FOUR RESULTS AND DISCUSSION 60
4.1 Introduction 60
4.2 Data 60
4.2.1 Primary data 60
4.2.2 Secondary data 61
4.3 Abbreviations 61
4.4 Patient flow as per Consort diagram 63
4.4.1 Discussion of the Consort diagram 64
4.5 Results 65
4.5.1 Baseline results 65
4.5.1.1 Gender 65
vii
4.5.1.2 Age 66
4.5.1.3 Occupation 66
4.5.2 Discussion of baseline results 67
4.5.3 Intra and Inter group analyses 71
4.5.3.1 Numerical Pain Rating Scale 71
4.5.3.2 Algometer Pain/Pressure Meter 72
4.5.3.3 Revised Oswestry Disability 74
Questionnaire
4.5.4 Discussion of Intra and Inter group analyses 76
4.5.5 Correlation between changes over time in 83
outcomes
4.5.6 Discussion of the correlation between changes 84
over time in outcomes
4.5.7 Review of the objectives and hypotheses 84
4.6 Summary and conclusion 85

5 CHAPTER FIVE CONCLUSION AND 87
RECOMMENDATIONS
5.1 Conclusion 87
5.2 Recommendations 88
5.2.1 Methodological suggestions 88
5.2.2 Future studies 89
5.2.3 Practical recommendations 89

REFERENCES 90
APPENDICES

viii
LIST OF TABLES

Chapter One
Table 1.1: Research studies involving AAI
Chapter Two
Table 2.1a: Muscles of the low back and pelvic region
Table 2.1b: Muscles of the low back and pelvic region (cont)
Table 2.2: Review of the epidemiology of LBP
Table 2.3: The relative and absolute contraindications for manipulative
therapy
Chapter Three
Table 3.1: Telephonic Questionnaire
Table 3.2: Treatment and Measurement Protocols
Chapter Four
Table 4.1: Cross correlations for gender between the groups
Table 4.2: Chi-Square Tests
Table 4.3: Group Statistics
Table 4.4: Intergroup comparisons of Occupation
Table 4.5: Effect of Time and Time/Group: NRS
Table 4.6: Tests of Between-Subjects Effects: NRS
Table 4.7: Multivariate Tests: Algometer
Table 4.8: Tests of Between-Subjects Effects: Algometer
Table 4.9: Multivariate Tests: Oswestry
Table 4.10: Tests of Between-Subjects Effects: Oswestry
ix