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BMC Musculoskelet Disord. 2016 Feb 6;17:64. doi: 10.1186/s12891-016-0912-3.

Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial.

Author information

1
Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. jamesdunning@hotmail.com.
2
Nova Southeastern University, Ft. Lauderdale, FL, USA. jamesdunning@hotmail.com.
3
AAMT Fellowship in Orthopaedic Manual Physical Therapy, Columbia, SC, USA. jamesdunning@hotmail.com.
4
Research Physical Therapy Specialists, Columbia, SC, USA. buttsraymond@yahoo.com.
5
Universidad Rey Juan Carlos, Alcorcón, Spain. firas.mourad@me.com.
6
Spine and Sport, Savannah, GA, USA. youngian@spinesport.org.
7
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain. cesarfdlp@yahoo.es.
8
Department of Physical Therapy, Long Island University, Brooklyn, NY, USA. marshall.hagins@liu.edu.
9
Back to Health, Brooklyn, NY, USA. thomas.stanislawski@gmail.com.
10
Research Physical Therapy Specialists, Columbia, SC, USA. jonathan.donley@palmettohealth.org.
11
Cutting Edge Orthopedics, Gilbert, AZ, USA. dustinbuck@hotmail.com.
12
Champion Sports Medicine, Birmingham, AL, USA. trhooks@hotmail.com.
13
Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA. joshcleland@comcast.net.

Abstract

BACKGROUND:

Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH.

METHODS:

One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable.

RESULTS:

The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001).

CONCLUSIONS:

Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.

TRIAL REGISTRATION:

NCT01580280 April 16, 2012.

PMID:
26852024
PMCID:
PMC4744384
DOI:
10.1186/s12891-016-0912-3
[Indexed for MEDLINE]
Free PMC Article

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