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THE EFFECT OF CHIROPRACTIC MANIPULATION OF THE HIP AND SACROILIAC JOINT ON ACCELERATION AND SPRINTING TIME OF MALE RUGBY PLAYERS THAT PRESENT WITH A POSITIVE MODIFIED THOMAS TEST A dissertation submitted to the Faculty of Health Sciences, University of Johannesburg, in partial fulfillment of the requirements for the degree Master of Technology: Chiropractic by TONY KENNETH BLEEKERS Supervisor: ___________________________ Date: _______________ Dr D. M Landman DECLARATION I, Tony Bleekers, declare that this dissertation is my own, unaided work. It is being submitted in partial fulfillment for the Master’s degree in Technology, in the programme of Chiropractic, at the University of Johannesburg. It has not been submitted before for any degree in any other Technikon or University. _________________________________ Tony Bleekers On this day the ______ of the month of _______________2015 i DEDICATIONS This is dedicated to my mother and father for all their support, time and belief in me. Secondly I would like to thank all my chiropractic class mates for all their support, advice and help. Thirdly to my supervisor who tirelessly gave me time and effort and without whom this would not have been possible. iii ACKNOWLEDGEMENTS To Dr. Landman, my supervisor, thank you for helping me complete this dissertation. You were always available and gave your advice and time freely. To all the participants that took part in my research, I thank you from the bottom of my heart for giving up your time and showing patience when necessary. Without you this would not have been possible. To all my fellow chiropractic students thanks for the all the support and friendship over the years. iv ABSTRACT Objective The objective of this study was to determine the effect of chiropractic manipulative therapy of the sacroiliac and hip joint on performance indicators (acceleration, sprint times, Modified Thomas Test and hip range of motion) that was performed on rugby players. Tight hip flexors are a cause of limited hip extension. Limited hip extension has been proposed as a means of limiting running performance by decreasing the length of stride an athlete can achieve. Another method an athlete can use to improve sprint speed is by increasing stride frequency. This means increasing the amount of strides taken which is controlled by the nervous system. Chiropractic manipulative therapy aims to improve biomechanics and in doing so has an effect on not only the skeletal system but also on the muscles and nervous system. Thus chiropractic manipulative therapy may have an effect on the above mentioned performance indicators through effects on the nervous system and/or by improving range of motion and/or biomechanics. Methods This study consisted of 20 male participants. They were required to have played rugby in the varying forms in the last year and were required to present at the first consultation with a positive for the Modified Thomas Test. All the participants received chiropractic manipulation aimed at the sacroiliac and hip joints. This study was based on a pre and post test model. The participant’s acceleration and sprint speed were measured pre and post treatment. The participants received six treatments. At the first and seventh consultations; acceleration, sprint speed, hip range of motion and the Modified Thomas Test were tested. The fourth consultation included only measurements of hip range of motion and the Modified Thomas Test. These v tests were used to assess acceleration and sprinting capabilities as well as hip range of motion. The data was analysed by statisticians at statkon. Results The results obtained from the statistical analysis showed that statistically significant improvements were found in both the Modified Thomas Test and in hip flexion on the left hand side. The Modified Thomas Test was 100% positive at the first consultation for all participants. At the fourth consultation 9 participants achieved a positive score and 11 achieved a negative score. At the seventh consultation 3 participants achieved a positive score and 17 achieved a negative score. This indicated an 85% improvement in the repeated testing of the Modified Thomas Test. Left Hip flexion changed from 95° at the first consultation to 97.7° at the fourth consultation and to 101.8° at the final consultation. This showed an overall improvement of 6.8°. No other statistically significant changes were noted. Acceleration changed from 2.14 seconds to 2.03 seconds and improved by 0.11 seconds. The sprint speed changed from 4.55 seconds to 4.64 seconds thus being slower by 0.09 seconds. Hip flexion on the right hand side changed from 99.5° at the first and fourth consultations and was 103.4° at the seventh consultation. This improved by 3.9° overall. Hip extension on the left hand side showed an overall improvement of 2.3° and on the right hand side of 2°. Conclusion The study showed statistically significant improvements in the performance of the modified Thomas Test and in hip flexion on the left hand side. The other tests all showed minor improvements except sprint speed which showed an increase in time and these improvements or vi changes seen were statistically insignificant. It can be deduced that chiropractic manipulation was a possible cause of the noted benefits. This could be due to the changes that occur in the biomechanics caused by correcting leg length inequalities and anterior pelvic tilt; post chiropractic manipulation. vii TABLE OF CONTENTS DECLARATION……………………………………………………………………… i AFFIDAVIT…………………………………………………………………………… ii DEDICATIONS..……………………………………………………………………... iii ACKNOWLEDGEMENTS..…………………………………………………………. iv ABSTRACT…………………………………………………………………………... v TABLE OF CONTENTS…………………………………………………………….. viii LIST OF FIGURES…………………………………………………………………… xii LIST OF TABLES……………………………………………………………………. xiii APPENDICES………………………………………………………………………… xi CHAPTER ONE - INTRODUCTION……………………………………………….. 1 1.1 Introduction………………………………………………………………………. 1 1.2 Aim of this Study………………………………………………………………… 3 1.3 Benefit of Study………………………………………………………………….. 3 CHAPTER TWO - LITERATURE REVIEW……………………………………….. 4 2.1 Introduction……………………………………………………………………….. 4 2.1.1 Definition of Chiropractic……………………………………………………… 4 2.1.2 Vertebral Subluxation Complex……………………………………………… 4 2.1.3 Subluxation…………………………………………………………………….. 5 2.1.4 The Chiropractic Manipulation……………………………………………….. 5 A. The effects of chiropractic manipulation…………………………………… 6 B. Mechanical effects…………………………………………………………… 6 C. Soft tissue effects……………………………………………………………. 6 D. Neurological effects………………………………………………………….. 6 E. Psychological effects………………………………………………………… 7 2.1.5 Chiropractic and Sport………………………………………………………... 7 2.2 Sacral and Hip Anatomy……………………………………………………….... 8 2.2.1 The Osteology of the Sacroiliac and Hip Joints…………………………….. 8 viii A. Osteology of the sacral region……………………………………………… 8 B. Osteology of the hip bone…………………………………………………… 9 2.2.2 The Joints of the Sacroiliac and Hip Joints……………………………….. 9 A. The sacroiliac joint…………………………………………………………... 9 B. The hip joint………………………………………………………………….. 10 2.2.3 Movements of the Sacroiliac and Hip Joints………………………………. 10 A. Movements of the sacroiliac joint…………………………………………. 10 B. Movements of the hip joint………………………………………………… 11 2.2.4 Ligaments of the Sacroiliac and Hip Joints………………………………… 11 A. Sacroiliac ligaments…………………………………………………………. 11 B. Hip joint ligaments……………………………………………………........... 12 2.2.5 Muscular Anatomy related to Sports………………………………………... 12 A. Musculature associated with acceleration and sprinting………………… 14 2.2.6 Innervation of the Sacroiliac and Hip Joint…………………………………. 19 A. Innervation of the sacroiliac joint…………………………………………… 19 B. Innervation of the hip joint…………………………………………………… 19 2.3 Running…………………………………………………………………………… 19 2.3.1 Phases of Running……………………………………………………………. 19 2.3.2 Running Biomechanics……………………………………………………….. 21 2.3.3 Specific Rugby Biomechanics and Common Injuries……………………… 21 2.4 Conclusion………………………………………………………………………… 23 CHAPTER THREE - METHODOLOGY…………………………………………… 24 3.1 Introduction………………………………………………………………………. 24 3.2 Study Design…………………………………………………………………….. 24 3.2.1 Aim of Study…………………………………………………………………… 24 3.2.2 Participant Recruitment………………………………………………………. 25 3.2.3 Sample Size and Selection…………………………………………………… 25 3.2.4 Inclusion Criteria………………………………………………………………. 26 3.2.5 Exclusion Criteria……………………………………………………………… 26 3.3 Treatment Approach…………………………………………………………….. 27 3.3.1 Consultation Procedure……………………………………………………….. 27 ix