The effectiveness of chiropractic adjustments with ischemic compression or ultrasound on active ...

154 Pages·2014·4.33 MB·English

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How to cite this thesis
Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/
M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved
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THE EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENTS WITH
ISCHEMIC COMPRESSION OR ULTRASOUND ON ACTIVE LEVATOR
SCAPULAE TRIGGER POINTS IN PHYSICALLY ACTIVE PEOPLE

A research dissertation presented to the Faculty of Health Sciences, University of
Johannesburg, as partial fulfilment for the Master’s degree in Technology, Chiropractic by

Leonie Bosch
820401275

Supervisor: _________________________ Date:_________________________
Dr. M. Moodley

i
DECLARATION

I, Leonie Bosch, declare that this dissertation is my own, unaided work. It is being
submitted as partial fulfilment for the Master’s Degree of Technology, in the program of
Chiropractic, at the University of Johannesburg. It has not been submitted before for any
degree or examination in any other Technikon or University.

____________________________________
LEONIE BOSCH

On this day of _______________ of the month of ______________________2014

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AFFIDAVIT

AFFIDAVIT: MASTER’S AND DOCTORAL STUDENTS

TO WHOM IT MAY CONCERN

This serves to confirm that I LEONIE BOSCH

ID number 8509020109080

Student number 820401275 enrolled student for the

Qualification MTech Chiropractic

Faculty of Health Sciences

Herewith declare that my academic work is in line with the Plagiarism Policy of the
University of Johannesburg. I further declare that the work presented in the:

THE EFFECTIVENESS OF CHIROPRACTIC ADJUSTMENTS WITH
ISCHEMIC COMPRESSION OR ULTRASOUND ON ACTIVE LEVATOR
SCAPULAE TRIGGER POINTS IN PHYSICALLY ACTIVE PEOPLE

(minor dissertation) is authentic and original, and that there is no copyright infringement
in the work. I declare that no unethical research practices were used or material gained
through dishonesty. I understand that plagiarism is a serious offence.

Signed at________________________on this ______day of _____________2014

_______________________________ ______________________________
Signature Print name

STAMP COMMISSIONER OF OATHS
Affidavit certified by a Commissioner of Oaths
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ABSTRACT

Purpose: The aim of the study was to compare the efficacy of treating the active levator
scapulae trigger point (TP1) with either chiropractic adjustments combined with ischemic
compression or chiropractic adjustments combined with ultrasound therapy in physically
active people in order to determine which of the two treatment protocols was superior.
Method: This study was a comparative study consisting of two groups of fifteen
participants each. Participants were between the ages of eighteen and forty-five and there
was an equal male to female ratio. Prior to becoming a participant in this study individuals
were assessed according to the inclusion and exclusion criteria. The International Physical
Activity Questionnaire, a clinical case history, full physical examination, a cervical regional
examination and examination of the levator scapulae muscle for an active central trigger
point (TP1) were completed. The method of treatment for each participant was determined
by random group allocation. Group 1 received cervical spine chiropractic adjustments
combined with ischemic compression to the active levator scapulae trigger point. Group 2
received cervical spine chiropractic adjustments combined with ultrasound therapy to the
active levator scapulae trigger point. Subjective and objective readings were based on the
above treatment protocols.
Procedure: Treatment consisted of seven consultation sessions over a three week period.
There were six treatment visits with the seventh visit used only for data collection. There
were two treatments each week with at least two days in between visits. The third week
consisted of three visits with the last visit used only for data collection. Subjective data was
collected from the Vernon-Mior Neck Pain and Disability Index Questionnaire and the
Numerical Pain Rating Scale. Objective data was collected from the pressure algometer
readings. Subjective and objective data was collected before treatment on the first and
fourth visits and on the seventh final data collection visit. Analysis of the data collected was
done by a statistician. The chiropractic adjustments used were based on motion palpation
findings on the treatment visits and re-assessed on each visit.
Results: Clinically significant improvements regarding neck pain and disability and trigger
point severity were seen in both Group 1 and Group 2 over the three week period. Group 2
showed greater improvements in all subjective and objective readings over the three
weeks compared to Group 1.
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Conclusion: Based on the results of this study, it can be concluded that both cervical
spine chiropractic adjustments combined with ischemic compression and cervical spine
chiropractic adjustments combined with ultrasound therapy are effective in treating active
levator scapulae trigger points. Although both treatment protocols have shown to be
effective, the group receiving cervical spine chiropractic adjustments combined with
ultrasound therapy showed to be statistically and clinically more effective in treating the
active levator scapulae trigger point and was proved to be preferential.

v
DEDICATION
I dedicate this dissertation to my parents, Ronnie and Elsa. Thank you for your
unconditional love, patience and support through my many years of studying. The
sacrifices you have made to give me this opportunity are greatly appreciated. Thank you
for celebrating through the good times and for your guidance through the trying and
disappointing times. You have taught me so much. It’s been a long road but I hope I have
made you proud. You are the best role models any child can ask for. I love you both very
much. To my sister, Nicolette, thank you for your love and support throughout the years.
To my loving partner, Viaan Kamfer, thank you for the love, support and endless patience
with me on this journey. You have motivated me beyond measure to exceed my own
expectations. Even though it was tough at times you never left my side. Nothing was ever
too much. Thank you for believing in me every step of the way and for inspiring me to be
the best I can possibly be. I love you very much.
To my friends and family, thank you for showing interest through my years of studying and
for your unconditional love and encouragement.
To my good friend and study partner, Nicole Edwards, I don’t know how I would have made
it through all these years without you. Thank you for celebrating with me through the good
times and standing by me through the difficult times. What a journey it has been. Those
late night study sessions have eventually paid off. We have learnt from the bad and trying
times and will cherish the good times. Thank you for your continued love, support,
encouragement and motivation. I couldn’t have asked for a better friend.

“but those who hope in the Lord will renew their strength. They will soar on wings like
eagles; they will run and not grow weary, they will walk and not be faint”.
Isaiah 40:31

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ACKNOWLEDGEMENTS

To my supervisor Dr. Malany Moodley, thank you for your guidance and patience and the
energy you have spent to get my through this process. The long, almost endless days of
revising and correcting my work is invaluable and greatly appreciated.

Thank you to Dr. Chris Yelverton for giving me the opportunity to follow my dream and
passion. You have inspired me to be the best chiropractor I can possibly be. It has been a
long hard road but I sincerely hope that I have made you proud.

To Juliana van Staden at Statkon for your assistance and time in the statistical analyses of
my study. A big thank you to Dr. Jurgen Becker at Statkon for the hours spent revising and
correcting my work and for your guidance through my moments of confusion. Your help is
greatly appreciated.

Thank you to all the participants who took part in the study. Without you the study would
not have been possible.

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TABLE OF CONTENTS
DECLARATION…………………………………………………………………………... ii
AFFIDAVIT………………………………………………………………………………... iii
ABSTRACT……………………………………………………………………………….. iv
DEDICATIONS……………………………………………………………….…………… vi
ACKNOWLEDGEMENTS……………………………………………………..………… vii
TABLE OF CONTENTS………………………………………………………….……… viii
LIST OF APPENDICES………………………………………………………………..… xii
LIST OF FIGURES……………………………………………………………………..… xiii
LIST OF TABLES………………………………………………………………………… xvi

CHAPTER 1 - INTRODUCTION………………………………………………………... 1
1.1 PROBLEM AND ITS SETTING………………………………………………… 1
1.2 AIM OF THE STUDY……………………………………………………………. 1
1.3 POSSIBLE OUTCOMES OF THE STUDY…………………………………… 2

CHAPTER 2 - LITERATURE REVIEW………………………………………………… 3
2.1 INTRODUCTION………………………………………………………………… 3
2.2 SKELETAL MUSCLE…………………………………………………………… 3
2.2.1 Skeletal Muscle Structure…………………………………………… 3
2.2.2 The Muscle Spindle………………………………………………….. 7
2.2.3 The Golgi Tendon Organ……………………………………………. 7
2.3 THE LEVATOR SCAPULAE MUSCLE……………………………………….. 9
2.3.1 The anatomy and function of the levator scapulae muscle……… 9
2.3.2 Myofascial trigger points of the levator scapulae muscle……...… 11
2.3.3 Functional unit……………………………………………………...… 12
2.3.4 Referral pattern of the levator scapulae muscle……………...…... 13
2.3.5 Symptoms of levator scapulae trigger points……………...…....... 14
2.3.6 Activation and perpetuation of levator scapulae trigger points..... 14
2.3.7 Palpation of the levator scapulae muscle..................................... 14
2.3.8 Stretching the levator scapulae muscle........................................ 15
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2.4 MYOFSCIAL PAIN SYNDROME………………………………………………. 16
2.4.1 Introduction……………………………………………………...……. 16
2.4.2 Myofascial trigger points…………………………………...……….. 17
2.4.3 Aetiology…………………………………...…………………………. 18
2.5 THE CERVICAL SPINE………………………………………………………… 22
2.5.1 Osteology of the cervical spine………...…………………………... 22
2.5.2 Intervertebral disc……………………...…………………………….. 28
2.5.3 Ligaments of the cervical spine………...…………………………... 30
2.5.4 Neuroanatomy of the cervical spine…...…………………………... 33
2.6 JOINTS AND BIOMECHANICS OF THE CERVICAL SPINE................ 38
2.6.1 Atlanto-occipital joint……………………………………………. 38
2.6.2 Atlanto-axial joints……………………………………………….. 39
2.6.3 Joints in the lower cervical spine………………………………. 40
2.7 THE VERTEBRAL SUBLUXATION COMPLEX…………………………. 42
2.8 CERVICAL FACET DYSFUNCTION……………………………………… 43
2.9 CHIROPRACTIC ADJUSTMENT…………………………………………. 44
2.10 JOINT RANGE OF MOTION………………………………………………. 45
2.11 REFLEXOGENIC EFFECTS OF THE CHIROPRACTIC 46
ADJUSTMENT……………………………………………………………….
2.12 THERAPEUTIC ULTRASOUND…………………………………………... 46
2.13 ISCHEMIC COMPRESSION………………………………………………. 48
2.14 CONCLUSION………………………………………………………………. 49

CHAPTER 3 – METHODOLOGY……………………………………………………. 50
3.1 INTRODUCTION……………………………………………………………. 50
3.2 STUDY DESIGN……………………………………………………………. 50
3.2.1 Sample size and selection……………………………………… 50
3.2.2 Inclusion criteria………………………………………………… 51
3.2.3 Exclusion criteria………………………………………………… 51
3.2.4 Allocation………………………………………………………… 51
3.3 TREATMENT APPROACH………………………………………………… 52
3.3.1 First and follow-up visits………………………………………… 52
ix