Abstract
M.Tech. (Chiropractic)
Background: In sporting activity, especially rugby, soccer, cricket and hockey, re-occurring hamstring injuries are a common sight that suggests that there is an opening for an improvement in the treatment and management of these injuries. This can be debilitating to any sportsman as it results in recurrent time away from his/her sporting activity. A study by Fyfer, Yelverton and Sher (2005), found that sacroiliac manipulation alone had a positive effect in the treatment of recurrent hamstring injuries. Cibuklka, Rose, Delitto and Sinacore (1986), proposed a possible link between hamstring muscle injuries and sacroiliac joint dysfunction. A study conducted by Donahue, Docherty and Schrader (2010), on the effects of Graston technique on pressure pain threshold, revealed a significant improvement in the patient’s pain threshold due to the fact that the instrument assisted technique effectively broke down scar tissue and correct fascial restrictions. The FAKTR approach to soft tissue dysfunction combines instrument-assisted soft tissue mobilization (Graston Technique) with proprioceptive (functional) techniques to reduce pain and return to function (Hyde and Doerr, 2012).
Objective: This blinded, randomised pilot study was done to investigate the effects of sacroiliac joint manipulative therapy versus functional and kinetic treatment with rehabilitation on hamstring flexibility in previously injured hamstring muscle.
Design: The study consisted of 30 participants recruited from the University of Johannesburg by word of mouth and posters, which met the inclusion criteria. They were equally and randomly divided into 2 groups. Group 1 received chiropractic therapy of the sacroiliac joint. Group 2 received functional and kinetic treatment with rehabilitation.
Objective measurements consisted of digital inclinometer which measured the flexibility and range of motion of the hamstring muscle. The pressure algometry was used to measure pain pressure threshold.
Procedure: Both group participants hamstring flexibility and ranges of motion were tested. Group 1 participants were motion palpated to determine sacroiliac joint dysfunction and treated with a high velocity, low amplitude trust to restricted segment, group 2 received functional and kinetic treatment with rehabilitation.
Results: The statistical results should be viewed with regards that this study only represent a small group of thirty participants and therefore no assumption can be made with respect to whole population.
The p-value was set at 0.05 and represents the level of significance of the results. If the p-value was less or equal to 0.05 (p≤0.05) there was a statistical significance finding. If the p-value is greater than 0.05 (p>0.05)
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there was no statistical finding. Statistical significance only means that a given result is unlikely to have occurred by chance.
Analysis included demographic data analysis of age and gender. Objective data were collected using Digital Inclinometer and Pressure Algometry. Intra-group and inter-group analysis was done on straight leg raise, passive knee extension, hip extension, lateral rotation of the hip and medial rotation of the hip.
The Shapiro-Wilk test was performed to determine normality. As normality could not be assumed, non-parametric testing were used to do intra-group analysis. The Non-parametric Friedman test was used to determine if a change occurred over time. As change did occur over time the Wilcoxon Signed Rank Test was use to determined where the change within each group occurred. The Mann-Whitney U test was also used to determine if any difference between the groups were present at any given time.
At the end of the study both test groups showed significant clinical as well as statistical improvement over the three week course of the study.
Conclusion: The FAKTR treatment did clinically have the greatest improvement, however the changes seen was not statistically superior to those seen with the sacroiliac joint manipulation treatment. A statistical significant improvement was seen in both treatment protocols, concluding that both the spinal manipulative therapy and the functional and kinetic treatment with rehabilitation could be proficient protocols in treating hamstring flexibility.