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Satpute K, Bedekar N, Hall T. Mulligan manual therapy added to exercise improves headache frequency, intensity and disability more than exercise alone in people with cervicogenic headache: a randomised trial. J Physiother 2024; 70:224-233. [PMID: 38902195 DOI: 10.1016/j.jphys.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024] Open
Abstract
QUESTION What is the effect of a 4-week regimen of Mulligan manual therapy (MMT) plus exercise compared with exercise alone for managing cervicogenic headache? Is MMT plus exercise more effective than sham MMT plus exercise? Are any benefits maintained at 26 weeks of follow-up? DESIGN A three-armed, parallel-group, randomised clinical trial with concealed allocation, blinded assessment of some outcomes and intention-to-treat analysis. PARTICIPANTS Ninety-nine people with cervicogenic headache as per International Classification of Headache Disorders (ICHD-3). INTERVENTIONS Participants were randomly allocated to 4 weeks of: MMT with exercise, sham MMT with exercise or exercise alone. OUTCOME MEASURES The primary outcome was headache frequency. Secondary outcomes were headache intensity, headache duration, medication intake, headache-related disability, upper cervical rotation range of motion, pressure pain thresholds and patient satisfaction. Outcome measures were collected at baseline and at 4, 13 and 26 weeks. RESULTS MMT plus exercise reduced headache frequency more than exercise alone immediately after the intervention (MD between groups in change from baseline: 2 days/month, 95% CI 2 to 3) and this effect was still evident at 26 weeks (MD 4 days, 95% CI 3 to 4). There were also benefits across all time points in several secondary outcomes: headache intensity, headache duration, headache-related disability, upper cervical rotation and patient satisfaction. Pressure pain thresholds showed benefits at all time points at the zygapophyseal joint and suboccipital areas but not at the upper trapezius. The outcomes in the sham MMT with exercise group were very similar to those of the exercise alone group. CONCLUSIONS In people with cervicogenic headache, adding MMT to exercise improved: headache frequency, intensity and duration; headache-related disability; upper cervical rotation; and patient satisfaction. These benefits were not due to placebo effects. TRIAL REGISTRATION CTRI/2019/06/019506.
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Affiliation(s)
- Kiran Satpute
- Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Pune, India.
| | - Nilima Bedekar
- Sancheti Institute College of Physiotherapy, Pune, India
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Uzun M, İkidağ MA, Ekmekyapar Fırat Y, Ergun N, Akbayrak T. The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:852. [PMID: 38929469 PMCID: PMC11205762 DOI: 10.3390/medicina60060852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Physiotherapy approaches are used to eliminate the problems caused by cervicogenic headache (CHA), known as secondary headache associated with the structures of the upper cervical region. This study aimed to investigate the effects of cervical mobilization (CM) with clinical Pilates exercises (CPE) on pain, muscle stiffness and head-neck blood flow in CGH. Materials and Methods: A total of 25 patients participated in this randomized controlled study and were randomized into either the CM group or the CM+CPE group. All treatment methods were applied 3 days a week for 6 weeks. The outcome measure was headache intensity and frequency, the number of analgesics, muscle stiffness and vertebral artery (VA) and internal carotid artery (ICA) blood flow. Headache intensity was measured by a visual analogue scale, muscle stiffness by a myotonometer and blood flow by Doppler US. Evaluations were repeated after 6 weeks of treatment. Within-group comparisons were made by the Wilcoxon signed rank test, and between-group comparisons were made by the Mann-Whitney U test. Results: After treatments in the two groups, headache intensity and frequency and the number of analgesics decreased, the muscle stiffness of the suboccipital, upper trapezius and sternocleidomastoid (SCM) muscles decreased, and the blood flow of the ICA and VA increased (p < 0.05). There was a significant difference between the groups in terms of headache intensity (p = 0.025) and muscle stiffness in SKM (p = 0.044) in favor of the CM+CPE group. Conclusions: Non-pharmacological treatment approaches have an important role in CHA related to the upper cervical region. This study suggests that it would be beneficial to add CM in combination with CPE to the non-pharmacological treatment of patients with CHA.
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Affiliation(s)
- Meltem Uzun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, 27090 Gaziantep, Turkey;
| | - Mehmet Ali İkidağ
- Department of Radiology, SANKO University Hospital, 27090 Gaziantep, Turkey;
| | | | - Nevin Ergun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, 27090 Gaziantep, Turkey;
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Ankara, Turkey;
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Patil DS, Tikhile P, Gangwani N. Effectiveness of Nonpharmacological Measures on Improving Headache Score, Strength, Pain, and Quality of Life in Cervicogenic Headaches: A Systematic Review. Cureus 2024; 16:e57361. [PMID: 38699082 PMCID: PMC11063809 DOI: 10.7759/cureus.57361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/31/2024] [Indexed: 05/05/2024] Open
Abstract
Cervicogenic headache (CGH) is a common condition affecting a significant portion of the population and is effectively managed through various interventions, including nonpharmacological approaches. Physical therapy plays a crucial role in CGH management, with numerous studies supporting its effectiveness. This systematic review aimed to evaluate the effectiveness of specific nonpharmacological physical therapy interventions for CGH. A comprehensive search was conducted across various databases (PubMed, Medline, PEDro, and Cochrane Library) for randomized controlled trials (RCTs) published between January 2017 and January 2023 investigating the effectiveness of specific nonpharmacological physical therapy interventions for CGH. We employed manual searches to capture potentially missed studies. Independent reviewers screened all studies based on predefined eligibility criteria. Extracted data included methodology, specific interventions, outcome measures (headache score, strength, pain, and quality of life (QOL)), and study conclusions. Eight RCTs were identified as meeting all inclusion criteria and were thus included in the data synthesis. The findings from these trials revealed a diverse range of nonpharmacological physical therapy interventions, including but not limited to manual therapy, exercise therapy, and multimodal approaches. Specifically, the interventions demonstrated significant improvements in headache scores, strength, pain levels, and overall QOL among individuals with CGH. These results underscore the multifaceted benefits of physical therapy in managing CGH and highlight its potential as a comprehensive treatment option. This review identified eight relevant RCTs investigating nonpharmacological interventions for CGH. Despite the promising findings, this review acknowledges several limitations, including the limited sample size and the heterogeneity of interventions across studies. These limitations emphasize the necessity for further research to elucidate optimal intervention strategies and refine treatment protocols. Nevertheless, the comprehensive analysis presented herein reinforces the pivotal role of physical therapy in not only alleviating pain but also enhancing function and improving the QOL for individuals suffering from CGH.
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Affiliation(s)
- Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Priya Tikhile
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Gangwani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Carrasco-Uribarren A, Mamud-Meroni L, Tarcaya GE, Jiménez-Del-Barrio S, Cabanillas-Barea S, Ceballos-Laita L. Clinical Effectiveness of Craniosacral Therapy in Patients with Headache Disorders: A Systematic Review and Meta-analysis. Pain Manag Nurs 2024; 25:e21-e28. [PMID: 37709558 DOI: 10.1016/j.pmn.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/29/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To analyze the effectiveness of craniosacral therapy in improving pain and disability among patients with headache disorders. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases were searched in March 2023. REVIEW METHODS Two independent reviewers searched the databases and extracted data from randomized controlled trials comparing craniosacral therapy with control or sham interventions. The same reviewers assessed the methodological quality and the risk of bias using the PEDro scale and the Cochrane Collaboration tool, respectively. Grading of recommendations, assessment, development, and evaluations was used to rate the certainty of the evidence. Meta-analyses were conducted using random effects models using RevMan 5.4 software. RESULTS The searches retrieved 735 studies, and four studies were finally included. The craniosacral therapy provided statistically significant but clinically unimportant change on pain intensity (Mean difference = -1.10; 95% CI: -1.85, -0.35; I2: 44%), and no change on disability or headache effect (Standardized Mean Difference = -0.34; 95% CI -0.70, 0.01; I2: 26%). The certainty of the evidence was downgraded to very low. CONCLUSION Very low certainty of evidence suggests that craniosacral therapy produces clinically unimportant effects on pain intensity, whereas no significant effects were observed in disability or headache effect.
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Affiliation(s)
| | - Lucas Mamud-Meroni
- Flores University, Department of Kinesiology and Physiotherapy, Comahue, Argentina
| | - Germán E Tarcaya
- Flores University, Department of Kinesiology and Physiotherapy, Comahue, Argentina
| | - Sandra Jiménez-Del-Barrio
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, Soria, Spain
| | - Sara Cabanillas-Barea
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - Luis Ceballos-Laita
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, Soria, Spain.
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Demoulin C, Timmermans A, Grosdent S, Danneels L. Comments on "Effectiveness of sustained natural apophyseal glides in females with cervicogenic headache: A randomized controlled trial". J Back Musculoskelet Rehabil 2024; 37:1097-1098. [PMID: 38393889 DOI: 10.3233/bmr-230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
| | - Annick Timmermans
- Belgian Back Society, Liege, Belgium
- Hasselt University, Hasselt, Belgium
| | | | - Lieven Danneels
- Belgian Back Society, Liege, Belgium
- Ghent University, Ghent, Belgium
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Khachatryan Z, Hambartsoumian T, Tatintsyan L, Burnazyan S, Hakobyan G. Efficacy of the transcutaneous electrostimulation in treatment dysfunctions of the TMJ associated with occlusion distortions. BMC Oral Health 2023; 23:937. [PMID: 38017420 PMCID: PMC10683287 DOI: 10.1186/s12903-023-03662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The study evaluation of the effectiveness the method of electrostimulation in treatment TMJ associated with occlusion disorders with the use of a patches by the company "Aganyan''. METHODS The study included 54 patients with temporomandibular dysfunction syndrome who had previously undergone endodontic dental treatment. In patients temporomandibular disorders (TMD) determined on the basis of Diagnostic criteria for temporomandibular disorders(DC/TMD).All patients had occlusion disorders due to errors after dental filling restoration. To diagnose the TMJ, a CT scan was used. The complex therapy also included therapy and with the use of a patches by the company "Aganyan''. The wearable patch includes a flexible substrate, a binder an adhesive layer, with an electrode foil attached to it. Patients applied one patch behind each TMJ. The patches were applied for eight hours every third day for three months. All the patients were given full-fledged endodontic treatment and restoration of the crown part, taking into account anatomical features. RESULTS The dynamics of the complex treatment of patients diagnosed with TMJ dysfunction syndrome showed that after treatment, the clinical symptoms gradually decreased and disappeared at the end of treatment. CT scan a year after treatment showed a normal ratio of TMJ elements. Сomplex treatment was effective in 87% of patients, after 3-5 months gradually decreased pain, noise in the joints, restriction of opening and closing of the mouth disappeared. Patients recovered their chewing functions, psycho-emotional state. CONCLUSION The results of the studies revealed a positive effects for the complex treatment dysfunctions syndrome TMJ the using the patches by the company "Aganyan" through electrical stimulation with low intensity.
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Affiliation(s)
- Zhanna Khachatryan
- Dept. of Therapeutic Stomatology, Yerevan State Medical University after M. Heratsi, Dental Clinic Pail, Yerevan, Armenia
| | - Tsovinar Hambartsoumian
- Dept. of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Lyudmila Tatintsyan
- MC ArtMed, Yerevan, Armenia
- Dept. of Therapeutic Stomatology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Seda Burnazyan
- Dept. Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, 0028 Kievyan str. 10 ap. 65, Yerevan, Armenia
| | - Gagik Hakobyan
- Dept. Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, 0028 Kievyan str. 10 ap. 65, Yerevan, Armenia.
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Thoomes E, Tilborghs G, Heneghan NR, Falla D, de Graaf M. Effectiveness of thoracic spine manipulation for upper quadrant musculoskeletal disorders: protocol for a systematic review. BMJ Open 2023; 13:e076143. [PMID: 37714676 PMCID: PMC10510929 DOI: 10.1136/bmjopen-2023-076143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Upper quadrant musculoskeletal disorders (UQMD), comprising of cranial, cervical, shoulder and upper extremity disorders, are among the most frequently reported disorders in clinical practice. Thoracic high velocity low amplitude thrust (Tx-HVLAT) manipulation is a form of conservative management recommended in systematic reviews as an effective treatment option for aspects of UQMD disorders such headache, shoulder pain and lateral elbow pain. However, no recent systematic reviews have assessed the effectiveness across UQMD. Therefore, this systematic review aims to update the current evidence on the effectiveness of Tx-HVLAT for patients with UQMD on (1) patient-reported outcomes, (2) performance measures or (3) psychosocial outcomes. METHODS AND ANALYSIS The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PEDro and Index to Chiropractic Literature will be searched from inception using Medical Subject Headings (MeSH), Thesaurus and/or free-text words. Combinations will be made based on localisation, disorder, intervention and design. Following guidelines as advised by the Cochrane Back Review Group, published randomised controlled trials will be included. Two review authors will independently assess the risk of bias (ROB) using the Cochrane Back Review Group's recommended ROB2 tool and will independently extract the data using a standardised data extraction form. Overall quality of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. For continuous data, we will calculate standardised mean differences with 95% CIs. For dichotomous outcomes, relative risks and 95% CIs will be calculated. Where possible we will present a subgroup analysis by disorder. For pooling, a random-effects model will be used. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review. The study findings will be submitted to a relevant peer-reviewed journal for dissemination and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42023429996.
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Affiliation(s)
- Erik Thoomes
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
- Research Department, Fysio-Experts, Hazerswoude, The Netherlands
| | - Gus Tilborghs
- Department of Manual Therapy, Breederode College, Rotterdam, The Netherlands
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
| | - Marloes de Graaf
- Research Department, Fysio-Experts, Hazerswoude, The Netherlands
- Department of Manual Therapy, Breederode College, Rotterdam, The Netherlands
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Daher A, Dar G. Stretching and muscle-performance exercises for chronic nonspecific neck pain: who may benefit most? Physiother Theory Pract 2023:1-14. [PMID: 37133358 DOI: 10.1080/09593985.2023.2207103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Although exercise is the mainstay of treatment for neck pain (NP), uncertainty remains over optimal decision-making concerning who may benefit most from such, particularly in the long term. OBJECTIVE To identify the subgroup of patients with nonspecific NP most likely to benefit from stretching and muscle-performance exercises. METHODS This was a secondary analysis of treatment outcomes of 70 patients (10 of whom dropped out) with a primary complaint of nonspecific NP in one treatment arm of a prospective, randomized, controlled trial. All patients performed the exercises, twice weekly for 6 weeks, and a home exercise program. Blinded outcome measurements were collected at baseline, after the 6-week program, and at a 6-month follow-up. Patients rated their perceived recovery on a 15-point global rating of change scale; a rating of "quite a bit better" (+5) or higher was defined as a successful outcome. Clinical predictor variables were developed via logistic regression analysis to classify patients with NP that may benefit from exercise-based treatment. RESULTS NP duration since onset≤6 months, no cervicogenic headache, and shoulder protraction were independent predictor variables. The pretest probability of success was 47% after the 6-week intervention and 40% at the 6-month follow-up. The corresponding posttest probabilities of success for participants with all three variables were 86% and 71%, respectively; such participants were likely to recover. CONCLUSION The clinical predictor variables developed in this study may identify patients with nonspecific NP likely to benefit most from stretching and muscle-performance exercises in the short and long terms.
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Affiliation(s)
- Amira Daher
- Department of Physical Therapy, Faculty of Health Studies, Zefat Academic College, Safed, Israel
- Department of Health Systems Administration, Max Stern Academic College of Emek Yezreel, Emek Yezreel, Israel
| | - Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Israel
- Physical Therapy Clinic, The Ribstein Center for Sport Medicine Sciences and Research, Wingate Institute, Netanya, Israel
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