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The Effect of Cervico-Thoracic Adjustments On THE EFFECT OF CERVICO-THORACIC ADJUSTMENTS ON THE ACTIVITY OF THE LATTISIMUS DORSI MUSCLE AND ITS TRIGGER POINTS USING ELECTROMYOGRAPHY AND ALGOMETER READINGS RESPECTIVELY. A dissertation submitted to the Faculty of Health Sciences, University of Johannesburg, in partial fulfilment of the requirements for the Master's Degree in Technology: Chiropractic. By Nico Goosen (Student number 802013714) SUPERVISOR: oS og DR. M. MOODLEY DATE (M. Tech. Chiropractic (Natal)) DECLARATION I, Nico Goosen, do hereby declare that this dissertation is my own, unaided work except where otherwise indicated in the text. It is being submitted for the Degree of Master of Technology at the University of Johannesburg, Johannesburg. It has not been submitted before for any degree or examination at any other Technikon or University. Signature of Candidate: Date: °7 i&S—/Ok Signature of Supervisor: n/■,e■I'■-c•c>U2_s--k Date: S Dr. M. Moodley M.Tech. Chiropractic (Natal) ii DEDICATION This work is dedicated to my parents, Braam and Beneta Goosen, two extraordinary people whose love and support made everything possible. I am truly blessed to be your son and love you with all my heart. And To my wife, Terina Goosen, an amazing woman whose kindness and love is an example for us all. Thank you for all your support. Thank you for all the sacrifices you have made for me to reach my goals. You are a wonderful wife and friend. iii ACKNOWLEDGEMENTS First and foremost, praise and glory to our Lord and Saviour, Jesus Christ, through whom all things are possible. To Dr. Moodley, my supervisor, for her support and constant enthusiasm throughout this study. Her assistance in this study is greatly appreciated and her ongoing motivation made the world of difference. To my friends and family for their unwaving love and support, especially my wife and parents, for their constant guidance and prayers. And finally, a special thanks to all the patients who participated in this study. iv ABSTRACT OBJECTIVE: To determine and compare the effect of Spinal Manipulative Therapy (SMT) to the cervico-thoracic junction on the activity of the ipsilateral latissimus dorsi with regards to muscle activity measured by electromyography and activity of the trigger points measured by the algometer. STUDY DESIGN: Fourty subjects with lower cervical spine pain and dysfunction underwent six spinal manipulative treatments on alternative days over a 3 week period (excluding weekends) to test the changes in activity of the ipsi-lateral Latissimus Dorsi muscle. SETTING: Chiropractic Day Clinic at the University of Johannesburg, Johannesburg, South Africa. SUBJECTS: Forty subjects with lower cervical spine pain participated in this study. Each of the subjects was randomly assigned to one of two groups. Group A consisted of 20 subjects receiving SMT to the cervico thoracic junction. Group B consisted of 20 subjects receiving de-tuned ultra-sound to the area of cervical spine pain. METHODS: Latissimus Dorsi muscle activity and its trigger point activity were tested before and after the first consultation using electromyography and the algometer respectively. After consultations two, four and six readings were taken. For the electromyography readings subjects were asked to lie down in a prone position with their arms next to their sides. They were then instructed to lie as still as possible for three minutes. The mean, peak and minimum values from the surface electromyographic meter were recorded, analysed and compared for reference. For the algometer readings, the researcher grasped the Latissimus Dorsi muscle along the free border at the posterior axillary fold of the midscapular level. The algometer was then pushed into this point and candidates had to indicate when they started to feel pain. This measurement was then recorded. RESULTS: Data was analysed using the T-test for independent samples to compare the two individual groups. Repeated measures ANOVA was useful to investigate changes over time. If one considers Group A as the superior group, no statistical significant difference were noted between Group A and Group B regarding the electromyographic readings. With regards to the algometer readings no statistically significant differences were identified between the two groups except for the last consultation (treatment 4) of Group A where the p-value = 0.035<0.05. CONCLUSION: In light of these findings, it can be concluded that there were no statistically significant differences between Group A and Group B, regarding the electromyographic readings. Group A showed the most favourable treatment efficacy in terms of the algometer readings. The trends shown in this study should be used and tested in future similar research studies incorporating larger sample groups. vi TABLE OF CONTENTS DECLARATION ii DEDICATION iii ACKNOLEDGMENTS iv ABSTRACT TABLE OF CONTENTS vii LIST OF APPENDICES xii LIST OF FIGURES xiii LIST OF TABLES xiv CHAPTER ONE — INTRODUCTION 1.1 Introduction 1 1.2 Statement of the problem 2 1.3 Objectives 2 1.4 Benefits of the study 2 vii CHAPTER TWO — LITERATURE REVIEW 4 2.1 Anatomy 4 2.1.1 Anatomy of aTypical Cervical Vertebra 4 2.1.2 Anatomy of the Seventh Cervical Vertebra 4 2.1.3 Anatomy of a Typical Thoracic Vertebra 6 2.1.4 Anatomy of the First Thoracic Vertebra 6 2.1.5 Anatomy of the Sacro-iliac Joint 7 2.1.6 Anatomy of the Latissimus Dorsi Muscle 7 2.1.7 Anatomy of the Gluteus Maximus Muscle 8 2.2 Biomechanics of the Cervico-thoracic Junction 10 2.3 Functional Anatomy 11 2.4 Stability vs. Instability of the Sacro-iliac Joint 13 2.5 The Self-locking Mechanism 14 2.5.1 Form Closure 14 2.5.2 Force Closure 16 2.6 The Vertebral Subluxation Complex (VSC) 17 2.6.1 The Kinesiological Component 19 2.6.2 The Neurological Component 20 2.6.3 The Connective Tissue Component 20 2.6.4 The Myologic Component 21 2.7 Effects of Chiropractic Adjustive Technique 21 2.8 Surface Electromyography 23 2.9 Algometry 24 viii CHAPTER 3 — MATERIALS AND METHODS 25 3.1 Introduction 25 3.2 Study Design 25 3.2.1 Patient Selection 25 3.2.2 Patient Consent 26 3.2.3 Patient Sampling 27 3.3 Interventions 27 3.3.1 Chiropractic Motion Palpation 27 3.3.2 Spinal Manipulative Therapy 28 3.4 Measurements 29 3.4.1 Objective Measurements 29 3.4.1.1 Surface Electromyography 29 3.4.1.2 Algometer 30 3.5 Data Analysis 30 CHAPTER 4 — RESULTS 31 4.1 Introduction 31 4.1.1 Graphical Representation of Data 31 4.2 Demographic Data 32 ix 4.3 Objective Measurements 33 4.3.1 The Mean Surface Electromyographic Readings 33 4.3.1.1 Column statistics for the improvement in the average sEMG readings of the ipsi-lateral Lattissimus Dorsi muscle for group A and group B from data collected on the initial, second, fourth and final consultation 35 4.3.2 The Peak Surface Electromyographic Readings 36 4.3.2.1 Column statistics for the improvement in the peak sEMG readings of the ipsi-lateral Lattissimus Dorsi muscle for group A and group B from data collected on the initial, second, fourth and final consultation 38 4.3.3 The Minimum Surface Electromyographic Readings 39 4.3.3.1 Column statistics for the improvement in the minimum sEMG readings of the ipsi-lateral Lattissimus Dorsi muscle for group A and group B from data collected on the initial, second, fourth and final consultation 41 4.3.4 Algometer Readings 42 4.3.4.1 Column statistics for the improvement in the algometer readings of the ipsi-lateral Lattissimus Dorsi muscle for group A and group B from data collected on the initial second, fourth and final consultation 44 4.4 Non-Parametric Tests 45 CHAPTER 5 — DISCUSSION 47 5.1 Introduction 47 5.2 Demographic Data 47 5.2.1 Mean Age at Onset of Treatment 47 5.2.2 Gender 47 5.3 Objective Data 48 5.3.1 Electromyographic Readings 48 5.3.2 Algometer Readings 50 CHAPTER 6 — CONCLUSION AND RECOMMENDATIONS 52 6.1 Conclusion 52 6.2 Recommendations 53 REFERENCES 55 xi LIST OF APPENDICES Appendix A: Advertisement 60 Appendix B: Contra-indications to Spinal Manipulative Therapy 61 Appendix C: Consent Form 63 Appendix D: Illustration of Adjustment 64 Appendix E: Case History 65 Appendix F: Physical Examination 70 Appendix G: Cervical Spine Regional Examination 80 xii LIST OF FIGURES Figure 2.1: A Comparison between a typical cervical vertebrae and an atypical cervical vertebrae 6 Figure 2.2: Location'of the Lattissimus Dorsi muscle and the Gluteus Maximus muscle in relation to the thoracolumbar fascia 9 Figure 2.3: Model of the self-locking mechanism: To illustrate the combination of form and force closure to establish stability in the sacro-iliac joint 13 Figure 2.4: Form closure: decreasing sacroiliac joint shear through the "keystone in a Roman arch" effect, with the sacrum being "trapped" vertically 16 Figure 2.5: The posterior oblique sling 17 Figure 2.6: A Model of the Vertebral Subluxation Complex 18 Figure 4.1: Intra- and inter-group comparison of the mean improvement in the average sEMG readings of the ipsi- lateral Lattissimus Dorsi muscle for both groups using data collected on the initial, second, fourth and final consultations 34 Figure 4.2: Intra- and inter-group comparison of the improvement in the peak sEMG readings of the ipsi-lateral Lattissimus dorsi muscle for both groups using data collected on the initial, second, fourth and final consultations 37 Figure 4.3: Intra- and inter-group comparison of the improvement in the minimum sEMG readings of the ipsi-lateral Lattissimus Dorsi muscle for both groups using data collected on the initial,
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