Posts tagged spinal manipulation
What Are The Most Effective Treatments For Tension Headaches?

Tension-type headaches are headaches related to muscle trigger points or muscle tenderness in the head and neck and are the most common type of headache in adults. In our Boulder physical therapy practice, we utilize hands-on techniques addressing muscles and joints of the upper cervical region for headaches. A recent systematic review and meta-analysis (Jiang et al, Medicine 2019) concluded that the combination of upper cervical spinal manipulation and soft-tissue treatment techniques were more effective for short-term pain reduction than soft tissue work alone.

It is important to note that postural impairments and upper cervical muscle atrophy have also been correlated with headache and the effect of exercise to change these contributing factors was not addressed in this study.

Please contact the headache experts at Mend to determine what combination of spinal manipulation, soft tissue mobilization and exercise is right to address your specific headache complaint.

Physical Therapy Headache Solutions

Headaches remain a significant source of pain and disability for patients in our country costing over $30 billion dollars each year. Symptoms can be driven by different types of headache including tension, migraine, and cervicogenic (driven from the neck). Cervicogenic headaches can be found in 4% of the general population, 20% of all patients with headaches, and up to 50% of patients with headaches after a whiplash mechanism of injury.

The upper neck vertebrae are most commonly associated with these symptoms with the 2nd and 3rd vertebral joint driving 70% of headaches. The clinical diagnosis can be made based on the following criteria

  1. Pain that originates in the neck and radiates to the frontal and temporal regions

  2. Unilateral symptoms (may be bilateral but never together)

  3. Radiates to ipsilateral shoulder and arm

  4. Provocation of symptoms with neck movement

  5. History of neck pain

Physical Therapy remains a first line treatment for cervicogenic headaches. Researchers advocate for a mulitimodal approach including spinal manipulation, neck and upper back strengthening (see videos). These interventions have received the highest grade (A) of evidence for treatment of this condition. Specifically, evidence supports the use of manual therapy and exercise over primary care management, manual therapy or exercise alone in patients with neck pain and headache. These benefits are sustained at 1 and 2 year follow up time periods. Finally, the number needed to treat (NNT) is 2 for patients with neck pain treated with manual physical therapy and exercise to achieve one additional successful outcome than would have occurred if patients received an alternative treatment.

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Benefits Of Manipulation For Patients With Neck And Arm Pain

Thoracic manipulation by Physical Therapists has previously been shown to improve pain and function in patients with elbow, shoulder, and neck pain. Authors continue to research the mechanisms behind its’ effectiveness including a beneficial cascade of events in the peripheral and central nervous system, as well as, a possible biomechanical change in the spinal joints. Clinically, thoracic manipulation is also utilized in patients with neck and arm pain (cervical radicular pain or cervical radiculopathy). This painful condition is secondary to encroachment of the spinal nerves in the neck as they pass through their respective vertebrae. Patient’s with this condition can experience pain, numbness, and/or pins and needles into their shoulder blade, arm, and hand. If left untreated patients may also notice weakness in their hands. Physical Therapy treatments including manual therapy and exercise aim to improve spacing within the bony neck canals that contain the neck nerves, as well as, optimize movement in the body regions adjacent to the neck to reduce the demands in the affected neck vertebrae. A new recent study highlights the benefits of thoracic manipulation in this patient population.

A randomized controlled trial in the Journal of Orthopedic and Sports Physical Therapy was conducted by Young and colleagues to determine the effectiveness of thoracic manipulation in patients with neck and arm pain (2019). Authors randomized patients to one of two treatment groups including a single session of thoracic manipulation or sham (placebo) manipulation. They assessed immediate and short term (48-72 hours) changes in pain, pain location (centralization), function, neck range of motion and strength. As expected, patients provided with thoracic manipulation reported decreased pain, improved function, and demonstrated improved range of motion at both time points compared to the sham manipulation group.

Click Here to learn more on how spinal manipulation can reduce your symptoms.

Utilizing Spinal Manipulation for Chronic Low Back Pain

The Journal of the American Medical Association recently reviewed the evidence on the utilization of spinal manipulation for patients with acute back pain.  Authors reported moderate evidence to support its' use to both decrease pain and improve function.  The majority of research on spinal manipulation is currently being performed by Physical Therapists to determine best practice patterns for its' utilization, as well as, the mechanisms behind its' effectiveness.  A recent review article was published on spinal manipulation's effects on patient's with more persistent low back pain.

Coulter and colleagues pooled the data of 9 trials including over 1100 patients with persistent low back pain (The Spine Journal. 2018).  The authors reported spinal manipulation significantly reduced low back pain and disability.  In addition, spinal mobilization was found to also reduce pain within patients with low back pain.  The authors found spinal manipulation produced a larger effect on these treatment outcomes than spinal mobilization.  In our Boulder Physical Therapy practice we find spinal manipulation to be effective in the short term to reduce pain and disability allowing a rapid transition to advanced exercise programs.  Long term relief of low back pain is best achieved using core, upper and lower body strengthening programs. 

Contact the Boulder Physical Therapy Experts at MEND to learn more about solving your low back pain.

Impact of Manipulation Direction on Outcomes in Patients with Neck Pain

Neck pain is a common problem affecting up to 70% of the population in their lifetime.  Cervical and thoracic manipulation remains an effective Physical Therapy treatment to restore mobility and decrease pain in patients with neck pain.  Recent research has shown no difference between one manipulation technique over another with both showing equal benefits for patients.  More importantly, the research supports choosing the right patient for the manipulation versus the right manipulation technique.  A recent study examined the impact of a Physical Therapy manipulation either matched or unmatched to a patient's restriction of motion.  

Karas and colleagues in the Journal of Manual and Manipulative Therapy examined the impact of directional specific thoracic spine manipulation in patients with neck pain (2018).  69 patients with neck pain were randomized to either a thoracic manipulation either matched or unmatched to their direction of mobility loss.  For example, patients with pain and difficulty looking toward the ceiling (cervical extension) were either manipulated to improve this direction or the opposite direction.  Consistent with our previous research, the authors reported both groups pain, range of motion, and disability improved but there was no significant difference with the matched or unmatched manipulation direction.  

This study highlights the importance of patient and clinician comfort during a manipulation technique versus a manipulation in the direction of movement loss.  


Effectiveness of Physical Therapy for Sacroiliac (SI) Dysfunction

There are few areas of Physical Therapy practice more controversial than the SI Joint.  Disagreements exist among clinicians and researchers on the diagnosis and treatment of this joint.  Many commonly used clinical examination and even medical diagnostic procedures' false positive and negative rates make accurate diagnosis difficult.  Conversely, clusters of examination findings remain the clinical standard for diagnosis and more research continues to become available on effective treatments for this condition.  

A review on the available research on SI joint dysfunction interventions was published in the Journal of Physical Therapy Science (Al-Subahi et al. 2017).  Authors identified the effectiveness of Physical Therapy interventions to treat the pain and lost function found in patients with SI joint pain.  The authors concluded Physical Therapy treatments including spinal manipulation and exercise were effective in both reducing pain and lost activity/function in patients with sacroiliac dysfunction.  Specifically, manipulation by Physical Therapists was found to be the most effective intervention for this patient population.