Cervical Spine Dysfunction Research Articles

Effectiveness of cervical spine manipulation and prescribed exercise in reduction of cervicogenic headache pain and frequency: A single case study experimental design

Introduction Patients commonly present to osteopaths with a complaint of headache. There is a clear rationale for osteopathic manipulative treatment in management of headaches that involve cervical spine dysfunction such as cervicogenic headache. Recent evidence suggests that deficits in muscle performance of the deep neck flexor muscles may be linked to cervicogenic headache, and that specific exercise prescription may play an important treatment role. Evidence also suggests that combining both manipulative treatment and specific exercise may be an effective treatment approach. Methods A prospective case study utilising an A–B–C design was used to evaluate the effectiveness of osteopathic treatment and specific exercise of the deep cervical flexor muscles in reducing cervicogenic headache pain and frequency in a 26-year-old female, with a 16-year history of cervicogenic headache. The diagnosis of cervicogenic headache was based upon clinical examination, medical history and fulfilment of cervicogenic headache diagnostic criteria. The study consisted of a three-week baseline data collection phase, a three-week osteopathic manipulative treatment phase and a three-week home based exercise phase. Outcome measures included the quadruple visual analogue scale, a headache diary, and data recorded from a pressure biofeedback device. Osteopathic treatment involved high velocity low amplitude (HVLA) thrust techniques and a low load exercise programme targeting the deep cervical flexor musculature. Results Visual analysis of plotted outcome measure data indicated a reduction in both intensity of headache pain and frequency. Conclusions The findings of this single case study are limited in their generalisability, but are consistent with the results of other similar studies investigating cervicogenic headache using similar interventions.

Pain Descriptors Used by Headache Patients Presenting for Physiotherapy

Summary Background and purpose Physiotherapists are often involved in the management of patients with headache when cervical spine dysfunction is a likely cause or contributing factor. Knowing the nature of the pain experienced by headache sufferers may help in the diagnostic process. The main purpose of this study was to investigate the characteristics of headache pain experienced by patients presenting to physiotherapy clinics. Secondary aims were to determine whether an exploratory factor analysis could identify different headache types among patients presenting for physiotherapy, based on pain descriptors found in the McGill pain questionnaire, and whether any of the sub-types were associated with the characteristics of cervicogenic headache. Methods A modified version of the short-form McGill pain questionnaire was completed by 112 patients presenting to private physiotherapy practices for treatment of headache. Data were analysed by principal components analysis with Varimax rotation. Results Five distinct factors were extracted of which the first three were clearly interpretable, and were labelled ‘tension-type headache’, ‘migraine’ and ‘neuralgic headache’. The fourth factor may have been associated with a mixed headache type while descriptors loading on the fifth factor (hot, tight, tender) were significantly associated with the subjective criteria for cervicogenic headache (p Conclusions Physiotherapists are likely to be treating a variety of headache types. There may be a central component to cervicogenic headache as the descriptors found to be associated with this headache type are not typically associated with somatic referred pain.

Inter-examiner reliability in detecting cervical spine dysfunction: A short review

Manual diagnosis of the cervical spine is widely used in those professions using manual therapy to detect somatic dysfunction that may be contributing to a patient's presenting complaint. Inter-examiner reliability in detecting cervical spine dysfunction is poor to excellent depending on factors such as examiner experience, incorporation of a patient's subjective report of tenderness and the motion palpation tests employed. Continued research into this area is necessary as the diagnostic methods taught to manual therapists are often based on tradition rather than good quality evidence. The current literature in this area is promising and there are a number of research avenues open to investigation.

A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction

Objective: To determine the relative effect of instrument-delivered thrust cervical manipulations in comparison with traditional manual-delivered thrust cervical manipulations in the treatment of cervical spine dysfunction. Design: Prospective, randomized, comparative clinical trial. Setting: Outpatient chiropractic clinic, Technikon Natal, South Africa. Patients: Thirty patients diagnosed with neck pain and restricted cervical spine range of motion without complicating pathosis for at least 1 month were included in the study. Interventions: The patients were randomized into 2 groups. Those in one group received mechanical force, manually assisted (MFMA) manipulation to the cervical spine, delivered by means of a hand-held instrument (Activator II Adjusting Instrument). Those in the other group received specific contact high-velocity, low-amplitude (HVLA) manipulation consisting of standard Diversified rotary/lateral break techniques to the cervical spine. Each group received only the specific therapeutic intervention, no other treatment modalities or interventions (including medication) being used, until asymptomatic status was achieved or a maximum of 8 treatments had been received. Main Outcome Measures: Both treatment groups were assessed through use of subjective (Numerical Pain Rating Scale 101, McGill Short-Form Pain Questionnaire, and Neck Disability Index) and objective (goniometer cervical range of motion) measurement parameters at specific intervals during the treatment period and at 1-month follow-up. The data were assessed through use of 2-tailed nonparametric paired and unpaired analysis, descriptive statistics, and power analysis of the data. Results: The results indicate that both treatment methods had a positive effect on the subjective and objective clinical outcome measures, no significant difference being observed between the 2 groups (P <.025). The subjective data from all 3 questionnaires showed statistically significant changes from initial to final consultations as well as from initial consultation to 1-month follow-up (P <.025). The objective range of motion measures showed statistically significant changes in the MFMA group for left and right rotation and left and right lateral flexion from initial consultation to final consultations and for right rotation and right lateral flexion from initial consultation to 1-month follow-up. The HVLA group showed only the change in left rotation from initial to final consultations and from initial consultation to 1-month follow-up to be statistically significant. Conclusions: The results of this clinical trial indicate that both instrumental (MFMA) manipulation and manual (HVLA) manipulation have beneficial effects associated with reducing pain and disability and improving cervical range of motion in this patient population. A randomized, controlled clinical trial in a similar patient base with a larger sample size is necessary to verify the clinical relevance of these findings. (J Manipulative Physiol Ther 2001;24:260-71)

A possible cervical cause of low back pain: pelvic distortion

Abstract Objective: to discuss the diagnosis and treatment of pelvic distortion related to cervical spine dysfunction in a patient with low back pain, as well as presenting a theoretical etiology. Clinical features: pelvic distortion is a disorder in which the ilia become counter-rotated on the sacrum. Our clinical experience suggests that it can arise from dysfunction in the cervical spine. It can produce low back pain, as occurred in the presented case. The sacroiliac (SI) joint is often determined to be the primary pain generator, although there may or may not be joint dysfunction detected in this joint. In the presented case the primary pain generator was initially felt to be the T12–L1 joint, as well as trigger points in the iliocostalis muscle. When the pain returned, and normal findings were noted in these structures, the patient was examined for the presence of pelvic distortion. This was found, as was painful joint dysfunction in the cervical spine. It was suspected that the pelvic distortion may have occurred secondary to cervical joint dysfunction. Intervention and outcome: treatment that was limited to manipulative therapy to the cervical spine successfully relieved the low back pain in this case. Conclusion: pelvic distortion secondary to cervical joint dysfunction may be a common cause of low back pain. Further research is needed to identify the prevalence, etiology, mechanism and ideal treatment of pelvic distortion.

Assessing audiological, pathophysiological, and psychological variables in chronic tinnitus: a study of reliability and search for prognostic factors.

The development and course of chronic tinnitus are determined by both biological and psychological factors. To combine these different sources of data, we developed a standardized interview to assess tinnitus history, summarize audiological findings, screen for etiological conditions, and explore tinnitus-related psychological complaints (Structured Tinnitus Interview). The results of a test-retest study with 65 tinnitus inpatients show that most of these components can be assessed with acceptable or high reliability. Further data based on 166 patients demonstrate that tinnitus annoyance was to some extent different from patterns of general psychological complaints, although there were medium intercorrelations with depression. Significant predictors of tinnitus annoyance were (a) continuous tinnitus without intervals, (b) hearing loss, (c) increasing tinnitus loudness over time, (d) poor maskability, (e) history of sudden hearing loss, and (f) associated craniomandibular disorder. Psychological distress was not significantly increased in patients whose tinnitus was associated to vascular disorder, cervical spine dysfunction, acoustic trauma, Menihre's disease, or neurological disorder.

Cervicogenic headache Part 1: An anatomic and clinical overview (awarded the OPTP Award for Excellence in a Published review of the Literature ** )

Cervicogenic headache is a headache arising from painful dysfunction of the upper cervical spine. This paper reviews current literature on the anatomy, etiology, clinical presentation and differential diagnosis of cervicogenic headache. Lower cervical spine levels and cervical soft tissue components will be incorporated where they have a direct influence on the upper three segments.

Vertigo in patients with cervical spine dysfunction.

To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed with dysfunctions of the upper cervical spine. Nineteen patients, hereinafter referred to as group B, did not show signs of dysfunction. Cervical spine dysfunctions were documented as published by Bischoff. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervical spine motion segment was affected. Dysfunctions were treated and resolved with mobilising and manipulative techniques of manual medicine. Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients (26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population.

Determination of manipulative physiotherapy treatment outcome in headache patients

SUMMARY. Although physiotherapists are frequently involved in the treatment of headache when cervical spine dysfunction is thought to be a cause or contributing factor there does not appear to be a consistent definition of treatment success. This study analysed treatment outcome in a population of 112 headache patients presenting for manipulative physiotherapy. Two months after the initial consultation, statistically significant improvements were observed in mean scores for each of headache frequency ( P < 0.001), duration ( P < 0.05) and intensity ( P < 0.001). When a combination of patient estimate of treatment effect and a headache index incorporating scores for frequency, intensity and duration was used to classify treatment outcome, 51 of the 91 subjects analysed at follow-up were deemed to have had a positive response to treatment. This method of classification of treatment outcome appeared to be sensitive to cases where the patient's headaches were improved by factors other than the physiotherapy treatment. However the classification used was less sensitive when the patient's headaches were aggravated by other factors or where there was not consistent improvement or deterioration in the measures of headache frequency, intensity and duration.

Cervicogenic Headache Part 1: An Anatomic and Clinical Overview

Cervicogenic headache is a headache arising from painful dysfunction of the upper cervical spine. This paper reviews current literature on the anatomy, etiology, clinical presentation and differential diagnosis of cervicogenic headache. Lower cervical spine levels and cervical soft tissue components will be incorporated where they have a direct influence on the upper three segments.

Are "cervicogenic" headaches due to myofascial pain and cervical spine dysfunction?

The purpose of this investigation was to evaluate whether the pain of cervicogenic headache could be due to referred symptoms from myofascial trigger points. The presence or absence of cervical spine dysfunction was also of interest. Eleven patients with cervicogenic headaches were systematically examined for myofascial trigger points and cervical spine dysfunction. All patients had at least three myofascial trigger points on the symptomatic side. In eight of these patients, trigger point palpation clearly reproduced their headache. There were 70 myofascial trigger points (35 "very tender", 35 "tender") and 17 non-myofascial tender points on the symptomatic side, compared to 22 myofascial trigger points (one "very tender", 21 "tender") and 19 non-myofascial tender points on the asymptomatic side. These differences were statistically significant [chi-square (2df) = 22.04, p less than 0.0001]. All patients had some evidence of cervical dysfunction. Ten patients (91%) had specific segmental dysfunction of occiput on atlas and/or atlas on axis. Five patients were entered into a non-invasive, interdisciplinary pain management program designed to treat cervical spine dysfunction and myofascial pain. Treated patients reported a significant decrease in the frequency and intensity of their headaches during a median two-year follow-up. It is concluded that myofascial trigger points may be an important pain producing mechanism in cervicogenic headache and that segmental cervical dysfunction is a common feature in such patients. Conservative, non-surgical treatment appears to be effective in reducing the frequency and intensity of cervicogenic headache. These data suggest that surgical approaches should be reserved only for those patients who fail conservative therapy.

Are "Cervicogenic" Headaches Due to Myofascial Pain and Cervical Spine Dysfunction?

Are "Cervicogenic" Headaches Due to Myofascial Pain and Cervical Spine Dysfunction?

A Multidisciplinary Approach to the Evaluation and Treatment of Temporomandibular Joint and Cervical Spine Dysfunction

This article presents a multidisciplinary approach to the management of temporomandibular joint (TMJ) and cervical spine dysfunction in a heterogeneous population of patients. A methodology for the systematic evaluation and treatment of patients is outlined; case histories are used to illustrate the workings of the model. A study to assess the efficacy of treatment was performed on 27 female and three male adult patients. Results indicated that patients achieved an 87% recovery rate at discharge with an 83% success rate six months after discharge. A control study was undertaken using 16 female and three male adults to establish indications for TMJ occlusal splint therapy in patients who present with questionable TM dysfunction. The multidisciplinary model presented in this article provides a system of patient evaluation and treatment that can be easily adopted by clinicians involved in a team approach to TMJ and cervical spine dysfunction.