Mobilization Versus Manipulation for the Treatment of Cervicogenic Headaches
关键词
抽象
描述
Cervicogenic headaches are classified as secondary headaches and typically rise from a musculoskeletal, cervical spine, disc, or soft tissue elements and are accompanied by neck pain. Dominant features of cervicogenic headache include unilateral head pain, external pressure over the ipsilateral upper neck, limited cervical range of motion, and trigger attacks by various neck motions. Cervicogenic headaches typically originate from the atlanto-occipital and upper 3 segments of the cervical spine and can radiate to the head or face region. Physical therapist have for some time been treating cervicogenic headaches with a variety of different treatment techniques ranging from conservative therapy, passive and active range of motion, stretching for cervical, strengthening exercises for the upper extremity, and manual therapy. However, little is known about the effects of thrust and non-thrust manipulative physical therapy treatments along with exercises to help reduce cervicogenic headaches. The purpose of this study is to assess the effectiveness of physical therapy in treating headaches using non-thrust to the upper 3 segments of the cervical spine or thrust mobilizations to the upper 3 segments, plus the addition of postural corrective exercises in treating cervicogenic headaches.
日期
| 最后验证: | 03/31/2020 |
| 首次提交: | 04/11/2019 |
| 提交的预估入学人数: | 04/14/2019 |
| 首次发布: | 04/17/2019 |
| 上次提交的更新: | 04/25/2020 |
| 最近更新发布: | 04/27/2020 |
| 实际学习开始日期: | 04/30/2019 |
| 预计主要完成日期: | 04/13/2020 |
| 预计完成日期: | 04/13/2020 |
状况或疾病
干预/治疗
Other: Cervical Thrust Mobilizations
Other: Cervical Non-Thrust Mobilizations
相
手臂组
| 臂 | 干预/治疗 |
|---|---|
| Experimental: Cervical Thrust Mobilizations Once therapist has assessed subject and has found the patients most comparable sign they will be performing a high velocity thrust at the end of the patients available range, as described by Maitland's Approach. The thrust will be performed only once. The therapist will perform either a localized cervical rotation thrust which primary movement is rotation or a longitudinal cephalad C1 and C2 thrust, both targeting the upper cervical spine. | Other: Cervical Thrust Mobilizations Once therapist has assessed subject and has found the patients most comparable sign they will be performing a high velocity thrust at the end of the patients available range, as described by Maitland's Approach. The thrust will be performed only once. The therapist will perform either a localized cervical rotation thrust which primary movement is rotation or a longitudinal cephalad C1 and C2 thrust, both targeting the upper cervical spine |
| Active Comparator: Cervical Non-Thrust Mobilizations Therapists will perform unilateral posterior to anterior mobilization (UPA) or central posterior to anterior (CPA) mobilizations grades I-IV as described above by Maitland concepts at levels C0-C3 which reproduce the patient's most comparable sign. Therapists will be instructed to perform 3x 30 second bouts of mobilizations at that level. | Other: Cervical Non-Thrust Mobilizations Therapists will perform unilateral posterior to anterior mobilization (UPA) or central posterior to anterior (CPA) mobilizations grades I-IV as described above by Maitland concepts at levels C0-C3 which reproduce the patient's most comparable sign. Therapists will be instructed to perform 3x 30 second bouts of mobilizations at that level. |
资格标准
| 有资格学习的年龄 | 18 Years 至 18 Years |
| 有资格学习的性别 | All |
| 接受健康志愿者 | 是 |
| 标准 | Inclusion Criteria: 1. Patient must be English-speaking and have appropriate medical literacy to participate in the study 2. The physical examination must yield a reproducible familiar/concordant neck, head, jaw symptom or dysfunction 3. Pain reports of at least 2/10 for a headache or neck pain intensity 4. Neck Disability reports of at least a 20% or greater impact 5. Patients that report having at least two headaches within one month Exclusion Criteria: 1. The presence of any know red flags (i.e., tumor, metabolic diseases, RA, osteoporosis, prolonged history of steroid use, etc.) 2. Patients who exhibit any red flag symptoms: positive upper or lower motor neuron testing. Signs or symptoms consistent cervical myelopathy or radiculopathy with nerve root compression (muscle weakness involving a major muscle group of the upper extremity, diminished upper extremity muscle stretch reflex, or diminished or absent sensation to pinprick in any upper extremity dermatome 3. Patients who exhibit any red flag symptoms of cervical instability tests, or have a positive VBI or CAD testing, showing signs of the 5 D's (dizziness, drop attacks, dysarthria, dysphagia, diplopia) or patient who have signs of 3 N's (Nystagmus, nausea, other neurological symptoms). 4. Prior surgery to the cervical spine or head (including cerebral shunts) 5. Women who are pregnant in their third trimester |
结果
主要结果指标
1. Neck Disability Index [Baseline, 4-weeks and 1-month follow-up]
次要成果指标
1. Numeric Pain Rating scale [Baseline, 1 hour, 48 hours, 4-weeks and 1-month follow-up]
2. Headache Impact Test [Baseline, 4-weeks and 1-month follow-up]
3. Global Rating of Change Scale [48 hours, 4-weeks and 1-month follow-up]
4. Patient Acceptable Symptom State [4-weeks and 1-month follow-up]
5. Active cervical range of motion [Baseline, 1 hour, 48 hours, 4-weeks]
