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CHIROPRACTIC MANIPULATIVE THERAPY COMBINED WITH KINESIO TAPE√ VERSUS ELASTIC BANDAGE IN TREATMENT OF CHRONIC LOWER BACK PAIN A research dissertation presented to the Faculty of Health Sciences, University of Johannesburg, as partial fulfillment for the Masters degree in Technology, Chiropractic by Machere Venter (du Toit) (Student number: 200700894) Supervisor: _____________________ Date: _________________________ Dr. C.Yelverton Co-supervisor: ____________________ Date: __________________________ Dr. R.Potgieter DECLARATION I Machere du Toit, declare that this dissertation is my own, unaided work. It is being submitted as partial fulfillment for the Masters Degree in 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. _______________________________________ Machere du Toit On this day the ________________ of the month of _____________________2014 i AFFIDAVIT: MASTERS AND DOCTORAL STUDENTS TO WHOM IT MAY CONCERN This serves to confirm that I Machere du Toit ID number 8811170014080, Student number 200700894 am an enrolled student for the Qualification of Masters in Technology at Chiropractic Faculty of Health Science. 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 study of chiropractic manipulative therapy combined with Kinesio tape√ versus elastic bandage in treatment of chronic lower back pain 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 ii DEDICATIONS I would like to dedicate this research to my family, especially my mother Lizette Venter and brother Juan-Pierre du Toit. Thank you for all the encouragement, support, patience and unconditional love throughout my studies. I love you all dearly and will always be thankful for the opportunity that both of you made possible to pursue a passion of helping people. To all my friends and fellow students thank you for all the great times, memories and moral support. To my dearest friend Hugo Botha, thank you for all the support and love and always showing me the lighter side of everything, making all obstacles a lot more bearable. I love you dearly. iii ACKNOWLEDGEMENTS To my supervisor, Dr. Chris Yelverton. Thank you for al your hard work, patience, guidance and knowledge. Your efforts are greatly appreciated and working with you was truly a great privilege. To my co-superviser Dr. Ross Potgieter. Thank you for your advice, motivation and work, you truly made the process a lot easier. To Dr. Gregory Duddy, thank you for sponsoring the necessary tape. iv ABSTRACT Purpose: Chronic lower back pain (LBP) is considered as one of the most prevalent conditions in our society with 70-85% of the population experiencing pain at some point in their lives and 80% having recurrent episodes. The majority of chronic LBP is treated with conservative care, with spinal manipulation being a treatment modality shown to be beneficial resulting in restoration of normal ranges of movement, decrease of muscle spasm and there is an overall biomechanical change. One of the more modern trends is combining manipulation with taping. It has been shown that with the application of Kinesio tape√ to the lumbar para-spinal muscles effectively increases lumbar range of motion and decreases pain with the relaxation of tense muscles as well as increase in proprioception as the tape increasingly stimulates cutaneous mechanoreceptors. Elastic bandage has been shown to improve proprioceptive acuity as it stimulates cutaneous mechanoreceptors, as well as providing support to joint structure. The purpose of this study was to determine the superiority of one tape versus the other as well as the efficacy of the individual tape and whether the combination treatment of spinal manipulative therapy and taping of the lumbar paraspinal muscles are possibly a more effective treatment protocol in the treatment of chronic lower back pain. Method: This clinical study was a comparative study and consisted of two groups of fifteen participants who met the inclusion and exclusion criteria. The participants were between the ages of eighteen and forty-five years of age. Group 1 was treated with lumbar spine and sacroiliac joint adjustments and the application of Kinesio tape√. Group 2 was treated with lumbar spine and sacroiliac joint adjustments and the application of elastic bandage. Treatment took place over a period of three weeks and participants were treated six times out of a total of seven consultations. Procedure: Subjective data was recorded at the first and fourth consultation prior to treatment and on the seventh consultation by means of a Numerical Pain Rating Scale and an Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was recorded at the first and fourth consultation prior to treatment and on v the seventh consultation by means of a digital inclinometer for assessing lumbar spine range of motion. Data recorded was analyzed by a statistician. Results: Clinically and statistically significant improvements were noted in both groups over the course of the study with regards to pain, disability and lumbar spine range of motion. Conclusion: The results show that both combination treatments of spinal manipulative therapy and the application of Kinesio™ tape or elastic adhesive bandage are effective treatment protocols, both clinical and statistical in decreasing pain, disability and improving lumbar range of motion in patients with chronic lower back pain. However neither treatment protocols proved to be superior over the other. vi TABLE OF CONTENTS DECLARATION ……………………………………………………………………………………..i AFFIDAVIT …………………………………………………………………………….……..……..ii DEDICATIONS…………..…………………………………………………………………….……iii ACKNOWLEDGEMENTS ………………………………………………………………………...iv ABSTRACT……….…………………………………………………………………………...….... v CHAPTER ONE – INTRODUCTION 1.1 Problem Statement………………………………... ………………………………………….1 1.2 Aim of the study………………………………………….……………………………………. 2 1.3 Benefits of the study……………………………….…………………………………………. .2 CHAPTER TWO – LITERATURE REVIEW 2.1 General anatomy of the lumbar spine………….…………………………………………. ...4 2.1.1 Lumbar vertebrae …………………………………….…………………………. ..4 2.1.2 Lumbar spine innervation……………………... ………………………………….6 2.1.3 Intervertebral ligaments………………………. ……………………….………….6 2.1.4 Joints of the vertebral body…………………... ………………….……………. ...7 2.1.5 The intervertebral disc………………………... ………………….……………. ...7 2.1.6 Joints of the vertebral arch…………………… …………….…………………. ...8 2.2 Sacrum…………………………………………… …………………………………………….8 2.3 Coccyx……………………………………………………………………………………….…..9 2.4 Sacroiliac joint…………………………………… ……………………………………………10 2.4.1 Anatomy of the sacroiliac joint………………. ………………………………….10 2.4.2 Ligaments of the sacroiliac joint……………… …………………………………10 2.4.3 Innervation of the sacroiliac joint……………. ………………………………….11 2.5 Spinal biomechanics……………………………. ……………………………………………11 2.5.1 Lumbar spine………….…..………….…………………………………………. ..11 2.5.2 Sacroiliac joint…………….…………………... ……………………….…………14 2.6 Lumbar spine muscles…..…………………………………………………………………. ..15 2.6.1 General anatomy of psoas major and minor………….………………………..15 2.6.2 General anatomy of quadratus lumborum……….……………………..………16 2.6.3 Extrinsic back muscles………………………….………………………………..17 vii 2.6.4 Intrinsic back muscles……….………………. ……………………………..…. .17 2.7 Thoracolumbar fascia……………..……………. …………………………………………. 22 2.8 Lower back pain……………………….………….…………………………………………. 23 2.8.1 Introduction and prevalence of lower back pain……………..………………. .23 2.8.2 Cause and effects of lower back pain………………………………………… .23 2.8.3 Effects of chiropractic adjustive therapy and kinesio√ tape on chronic lower back pain…………………………………………………..……………………………. 25 2.9 Integumentary system…………………………... …………………………………………. 26 2.9.1 Introduction………......………………………... ………………………….……. .26 2.9.2 Innervation of the skin………………………… ……………….………………..27 2.10 Chiropractic.…….……………………………… …………………………………………. .28 2.10.1 The Chiropractic Subluxation………………… …………..…………………...28 2.10.2 Chiropractic Manipulative Therapy defined………………. ……...…………..29 2.10.3 Effects of spinal manipulative therapy……….……………………………… ..30 2.11 Taping……………………………………….………………………………………..………37 2.11.1 MCconnel taping technique……….………. …………………….…………….37 2.11.2 White