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Nambi G, Alghadier M, Eltayeb MM, Aldhafian OR, Saleh AK, Alsanousi N, Albarakati AJA, Omar MA, Ibrahim MNA, Attallah AA, Ismail MA, Elfeshawy M. Comparative effectiveness of cervical vs thoracic spinal-thrust manipulation for care of cervicogenic headache: A randomized controlled trial. PLoS One 2024; 19:e0300737. [PMID: 38551917 PMCID: PMC10980233 DOI: 10.1371/journal.pone.0300737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND There is ample evidence supporting the use of different manipulative therapy techniques for Cervicogenic Headache (CgH). However, no technique can be singled as the best available treatment for patients with CgH. Therefore, the objective of the study is to find and compare the clinical effects of cervical spine over thoracic spine manipulation and conventional physiotherapy in patients with CgH. DESIGN, SETTING, AND PARTICIPANTS It is a prospective, randomized controlled study conducted between July 2020 and January 2023 at the University hospital. N = 96 eligible patients with CgH were selected based on selection criteria and they were divided into cervical spine manipulation (CSM; n = 32), thoracic spine manipulation (TSM; n = 32) and conventional physiotherapy (CPT; n = 32) groups, and received the respective treatment for four weeks. Primary (CgH frequency) and secondary CgH pain intensity, CgH disability, neck pain frequency, neck pain intensity, neck pain threshold, cervical flexion rotation test (CFRT), neck disability index (NDI) and quality of life (QoL) scores were measured. The effects of treatment at various intervals were analyzed using a 3 × 4 linear mixed model analysis (LMM), with treatment group (cervical spine manipulation, thoracic spine manipulation, and conventional physiotherapy) and time intervals (baseline, 4 weeks, 8 weeks, and 6 months), and the statistical significance level was set at P < 0.05. RESULTS The reports of the CSM, TSM and CPT groups were compared between the groups. Four weeks following treatment CSM group showed more significant changes in primary (CgH frequency) and secondary (CgH pain intensity, CgH disability, neck pain frequency, pain intensity, pain threshold, CFRT, NDI and QoL) than the TSM and CPT groups (p = 0.001). The same gradual improvement was seen in the CSM group when compared to TSM and CPT groups (p = 0.001) in the above variables at 8 weeks and 6 months follow-up. CONCLUSION The reports of the current randomized clinical study found that CSM resulted in significantly better improvements in pain parameters (intensity, frequency and threshold) functional disability and quality of life in patients with CgH than thoracic spine manipulation and conventional physiotherapy. TRIAL REGISTRATION Clinical trial registration: CTRI/2020/06/026092 trial was registered prospectively on 24/06/2020.
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Affiliation(s)
- Gopal Nambi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mudathir Mohamedahmed Eltayeb
- Department of Nursing, College of Applied Medical Sciences, University, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Osama R. Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | - Nesreen Alsanousi
- Department of Biochemistry, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Alaa Jameel A. Albarakati
- Department of Surgery, College of Medicine, Umm Al-Qura University, Al-Qunfudah Branch, Makkah, Saudi Arabia
| | - Mohamed A. Omar
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | | | - Abdehamid A. Attallah
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Elfeshawy
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
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Comparative Effects of Mulligan's Mobilization, Spinal Manipulation, and Conventional Massage Therapy in Cervicogenic Headache-A Prospective, Randomized, Controlled Trial. Healthcare (Basel) 2022; 11:healthcare11010107. [PMID: 36611567 PMCID: PMC9819355 DOI: 10.3390/healthcare11010107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
Background: There is ample evidence supporting the use of manual therapy techniques for the treatment of cervicogenic headache (CGH). Objective: The objective of this study was to find and compare the effects of different manual therapy approaches to cervicogenic headache. Methods: A randomized, controlled study was conducted on 84 CGH participants at the university hospital. The participants were divided into a Mulligan mobilization therapy group (MMT; n = 28), a spinal manipulation therapy group (SMT; n = 28), and a control group (Control; n = 28); they received the respective treatments for four weeks. The primary outcome (CGH frequency) and secondary outcomes (CGH pain intensity, CGH disability, neck pain frequency, pain intensity, pain threshold, flexion rotation (right and left), neck disability index, and quality of life scores) were measured at baseline, after 4 weeks, after 8 weeks, and at a 6-month follow-up. The one-way ANOVA test and repeated measures analysis of variance (rANOVA) test were performed to find the difference between the inter- and intra-treatment group effects. Results: Four weeks following training, the MMT group showed a statistically significant difference in the primary (CGH frequency) and secondary (CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, flexion rotation test, neck disability index, and quality of life) scores than those of the SMT and control groups (p < 0.001). The same difference was seen in the above variables at 8 weeks and at the 6-month follow-up. At the same time, the neck pain threshold level did not show any difference at the 4-week and the 8-week follow-up (p ≥ 0.05) but showed statistical difference at the 6-month follow-up. Conclusion: The study concluded that Mulligan’s mobilization therapy provided better outcomes in cervicogenic headache than those of spinal manipulation therapy and conventional massage therapy.
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González-Rueda V, Hidalgo-García C, Rodríguez-Sanz J, Bueno-Gracia E, Pérez-Bellmunt A, Rodríguez-Rubio PR, López-de-Celis C. Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8334. [PMID: 33187167 PMCID: PMC7697824 DOI: 10.3390/ijerph17228334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion-rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion-rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion-rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion-rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion-rotation test in the short- and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion.
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Affiliation(s)
- Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (V.G.-R.); (J.R.-S.); (A.P.-B.); (P.R.R.-R.); (C.L.-d.-C.)
- Fundació Institut Universitari per a la recerca a l’Atenció Primaria de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - César Hidalgo-García
- Facultad de Ciencias de la Salud, Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (V.G.-R.); (J.R.-S.); (A.P.-B.); (P.R.R.-R.); (C.L.-d.-C.)
| | - Elena Bueno-Gracia
- Facultad de Ciencias de la Salud, Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (V.G.-R.); (J.R.-S.); (A.P.-B.); (P.R.R.-R.); (C.L.-d.-C.)
| | - Pere Ramón Rodríguez-Rubio
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (V.G.-R.); (J.R.-S.); (A.P.-B.); (P.R.R.-R.); (C.L.-d.-C.)
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (V.G.-R.); (J.R.-S.); (A.P.-B.); (P.R.R.-R.); (C.L.-d.-C.)
- Fundació Institut Universitari per a la recerca a l’Atenció Primaria de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Carroll K, Yiu EM, Ryan MM, Kennedy RA, de Valle K. The effects of calf massage in boys with Duchenne muscular dystrophy: a prospective interventional study. Disabil Rehabil 2020; 43:3803-3809. [PMID: 32356505 DOI: 10.1080/09638288.2020.1753829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: We explored the effects of standardized calf massage in ambulant boys with Duchenne muscular dystrophy (DMD) using a prospective study design.Materials and Methods: Twenty boys completed two study visits, 1 week apart. At both visits, each leg received a 10-min calf massage (intervention) and a 10-min control rest period (placebo) in randomized order. Muscle length of calf and hamstrings and gastrocnemius stiffness were measured by a blinded assessor before and after intervention and placebo. Measures of gait function (timed 10-m walk/run and spatio-temporal gait parameters); gastrocnemius muscle ultrasound findings; participant perception of leg pain, stiffness and effort of walking and general psychological well-being were also collected.Results: Consistent significant small increases in muscle length of soleus, gastrocnemius and hamstrings were recorded post-massage, and gastrocnemius stiffness decreased. Small changes in gastrocnemius and soleus length only were also recorded following the control rest period. Gait function and general well-being remained stable throughout. Measurement across both study visits suggested that gains in muscle length may be cumulative with repeated massage.Conclusions: Calf massage is safe and associated with benefits to muscle length and stiffness for ambulant boys with DMD.Implications for RehabilitationIn a small sample of boys with Duchenne muscular dystrophy, calf massage was found to be safe, well-tolerated and associated with increased muscle length and decreased stiffness.The use of massage may assist in managing muscle length in boys with Duchenne muscular dystrophy.
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Affiliation(s)
- Kate Carroll
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Eppie M Yiu
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Monique M Ryan
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Rachel A Kennedy
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Katy de Valle
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Spratt HG, Levine D, Bage J, Giles DK, Collier AG. Topical lotions utilized in outpatient rehabilitation clinics as a potential source of bacterial contamination. Physiother Theory Pract 2018; 35:163-170. [PMID: 29482428 DOI: 10.1080/09593985.2018.1441935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Soft tissue mobilization and massage requiring lotions or creams are commonly used interventions in outpatient rehabilitation clinics. For at least 50 years hand creams used in healthcare settings have been found to be contaminated by bacteria. The purpose of this study was to determine the current state of bacterial contamination of lotions used in clinics and to determine the efficacy of lotion preservatives to kill bacteria. Unopened containers of lotions were studied, along with 81 lotion containers used in 22 outpatient clinics in southeast Tennessee and northwest Georgia. Three sites on each container were sampled using sterile swabs. At a microbiology lab, bacterial growth media was inoculated and incubated. Of the 81 containers sampled, 16 supported bacterial growth (19.8%). Container threads displayed the highest contamination compared with other container locations (p < 0.01). No bacteria were found in unopened lotion containers, although when challenged with live bacterial cultures lotion preservatives did not kill bacteria tested. Enrichment cultures using lotions studied here supported the growth of several bacterial species. These findings suggest the need for standardized protocols to help reduce potential healthcare-associated infections due to use of lotions. Improved efficacy of preservatives added to lotions should be a priority.
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Affiliation(s)
- Henry G Spratt
- a Department of Biology, Geology, and Environmental Science , University of Tennessee at Chattanooga , Chattanooga , TN , USA
| | - David Levine
- b Department of Physical Therapy , University of Tennessee at Chattanooga , Chattanooga , TN , USA
| | - Julie Bage
- b Department of Physical Therapy , University of Tennessee at Chattanooga , Chattanooga , TN , USA
| | - David K Giles
- a Department of Biology, Geology, and Environmental Science , University of Tennessee at Chattanooga , Chattanooga , TN , USA
| | - A Grace Collier
- a Department of Biology, Geology, and Environmental Science , University of Tennessee at Chattanooga , Chattanooga , TN , USA
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Schäfer A, Lüdtke K, Breuel F, Gerloff N, Knust M, Kollitsch C, Laukart A, Matej L, Müller A, Schöttker-Königer T, Hall T. Validity of eyeball estimation for range of motion during the cervical flexion rotation test compared to an ultrasound-based movement analysis system. Physiother Theory Pract 2018; 34:622-628. [DOI: 10.1080/09593985.2017.1423523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Axel Schäfer
- University of Applied Sciences Bremen, Faculty of Social Science, Degree course Applied Sciences Speech and Language Therapy and Physiotherapy, Bremen, Germany
| | - Kerstin Lüdtke
- University Hospital Hamburg (UKE), Institute for Neuroscience, Hamburg, Germany
| | - Franziska Breuel
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Nikolas Gerloff
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Maren Knust
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Christian Kollitsch
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Alex Laukart
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Laura Matej
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Antje Müller
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Thomas Schöttker-Königer
- University of Applied Sciences and Arts Hildesheim, Faculty of Social Work and, Degree course Physiotherapy Health, Hildesheim, Germany
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Abstract
STUDY DESIGN Case report. BACKGROUND Neck-tongue syndrome (NTS) is defined as neck and/or head pain accompanied by ipsilateral dysesthesia of the tongue with sudden rotation of the head. Proposed causes include compression or irritation of the C2 nerve root as it courses behind the atlantoaxial joint or hypertrophy of the inferior oblique muscle. The primary purpose of this case report was to describe the conservative physical therapy treatment of a patient with uncomplicated NTS. CASE DESCRIPTION The patient was a 13-year-old girl who reported insidious onset of sharp pain in the neck, numbness/tingling of the ipsilateral tongue/face, and tinnitus with cervical rotation. Symptoms occurred several times a week for approximately 10 seconds. Examination revealed impaired function, increased forward head posture, decreased cervical range of motion, and positive neurodynamic assessment. The patient's treatment included manual therapy and exercise for postural stabilization. OUTCOMES Following 8 visits, pain of the neck and tongue numbness had resolved. Score on the Patient-Specific Functional Scale (PSFS), cervical range of motion, and posture had also improved. At the 22-month follow-up, infrequent, momentary symptoms in the neck and dysesthesia of the tongue were reported. The PSFS remained the same. Objective measures were normal. DISCUSSION This case report describes the physical therapy management of an individual with NTS. The management strategy followed a protocol similar to that used for cervicogenic headaches, due to the involvement of the upper cervical spine with both NTS and cervicogenic headache and the lack of evidence for the treatment of NTS. Level of Evidence Therapy, level 4.
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Is there a difference in head posture and cervical spine movement in children with and without pediatric headache? Eur J Pediatr 2013; 172:1349-56. [PMID: 23708260 DOI: 10.1007/s00431-013-2046-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT. Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001). In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.
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