Short- and medium-term effects of manual therapy on the upper cervical spine combined with exercise vs isolated exercise in patients with cervicogenic headache. A randomized controlled trial

BackgroundCervicogenic headache is defined as a unilateral headache associated with a lack of range of motion. The effect of manual therapy applied to the upper cervical spine combined with cervical exercises in this patient population is currently unknown.ObjectiveTo determine if adding manual therapy to an exercise and home-exercise program is more effective by reducing symptoms and improving function in the short- and mid-term than just applying exercises in patients with cervicogenic headache.MethodsRandomized controlled trial. 40 participants with cervicogenic headache were recruited (20 = Manual Therapy + Exercise and 20 = Exercise). Each group received four 20-min sessions weekly and a home exercise regime. Upper cervical flexion and flexion-rotation test, HIT-6, headache intensity, craniocervical flexion test, pain pressure thresholds, GROC-scale, and adherence to self-treatment were measured at the beginning and end of the intervention, and again at 3-(short-term) and 6-month (mid-term) follow-ups.ResultsThe Manual Therapy + Exercise group showed a statistically significant improvement in all short- and mid-term variables (p < .05) compared to the exercise group except for the variable pain pressure thresholds first metacarpal joint right and left short-term and adherence to self-treatment short-term.ConclusionFour 20-min sessions of manual therapy and an exercise protocol along with a home exercise regime is more effective in the short and mid-term than an exercise protocol and a home exercise regime for patients with cervicogenic headache.     

Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial

Background Context

The optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown.

Using the concept of ideomotor therapy in the treatment of a patient with chronic neck pain: A single system research design

BackgroundA contemporary understanding of pain neurophysiology describes the experience of pain as a multi-system output mechanism in which the perception and localisation of pain sensations cannot be separated from concurrent motor output responses generated to resolve a perceived threat to tissues. It has been suggested that the resolution of pain is dependant on an appropriate motor response, and that such a response should proceed as the result of instinctive, in-built mechanisms. Ideomotor movements constitute the prevailing expression of instinctive movement response in humans. The enhancement of corrective ideomotor movement expression may lead to improvements in pain intensity and disability in symptomatic patients whose instinctive responses have been suppressed. A manual technique can be employed therapeutically to elicit fuller expression of ideomotor movement in patients suffering pain.ObjectivesTo document the outcome of short-term pain and disability in a patient with chronic neck and shoulder girdle pain treated with ideomotor-based manual therapy and self-management exercise using a single system experimental design.MethodsA prospective A–B–C single system experimental design consisting of a 3-week baseline data collection phase (A), a 3-week treatment and self-management phase (B), and a 3-week self-management phase (C). Treatment and self-management were provided using a light touch technique based on ideomotor principles. Five validated outcome measures were recorded weekly and displayed graphically for visual inspection and analysis.ResultsVisual analysis of the plotted outcome measures as a function of time indicated a reduction in pain intensity and perceived disability concurrent with the introduction of treatment (Phase B). These changes appear to be clinically relevant.ConclusionsThe results imply a relationship between the introduction of ideomotor-based manual therapy and self-management, and clinically relevant reductions in pain intensity and perceived disability in a patient suffering severe chronic neck and shoulder girdle pain. It is hoped that this study will provoke further interest in this concept and draw attention to a possible mechanism and explanation for some of the effects of commonly used indirect manual therapy techniques.     

颈椎Key-hole技术与颈前路Zero-P系统治疗神经根型颈椎病的病例对照研究

目的:探讨脊柱内镜下颈后路开窗减压髓核摘除术(Key-hole)和颈前路零切迹椎间植骨融合内固定系统(zero profile intervertebral fusion system,Zero-P)治疗单节段神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的短期临床疗效....