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ABSTRACT
Background/Purpose
Headaches are among the most common complaints requiring medical care, and annual expenditures for this condition are estimated to be 14 billion US dollars. The International Headache Society (IHS) describes cervicogenic headache (CGH) as a secondary type of headache emanating from the cervical spine which may be referred to one or more regions of the head and/or face. Mechanical Diagnosis and Therapy (MDT) is an approach shown to be effective in the management of spinal musculoskeletal disorders; however, there is limited evidence as to its efficacy in the management of CGH. The purpose of this case series was to examine the MDT approach in the assessment, classification, and management of a sample of patients experiencing cervicogenic headache.
Case Description
This study was a prospective case series. Following IRB approval, 15 patients meeting the study inclusion criteria were recruited from a hospital-based outpatient physical therapy clinic. All subjects received a physical therapy examination by a Diploma trained MDT clinician which included but was not limited to patient self-report forms and the testing of repeated end range movements. The Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Index (HDI), Yellow Flag Risk Form (YFRF), Cervical Flexion Rotation Test (CFRT), and the Craniocervical Flexion Test (CCFT) were administered at the initial visit, 5th visit, and 10th visit or discharge, whichever occurred first. The NPRS, NDI, and HDI were re-administered at a 3 month follow up. Following the initial examination, patients were classified into the MDT categories of derangement, dysfunction, postural, or ‘other’ and then received intervention based on directional preference.
Outcomes
Fifteen subjects (mean age, 45.9 years; F = 11, M = 4; symptom duration, 44.3 months; average visits, 8.8) received an examination and intervention and completed follow-up outcome measures. Based on MDT classification criteria, all 15 subjects in this case series were classified as derangements. A non-parametric Friedman test of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation differences among repeated measures was conducted on all outcome measures revealing statistically significant improvements in NPRS (p < .01), NDI(p < .01), and HDI (p < .01) scores at visit 10 and 3 month follow up. The mean change scores exceeded the minimal clinical important difference (MCID) for NPRS (4.2), NDI (7.6), and HDI (28.5). CCFT scores improved significantly from the initial examination to visit 5 (p < .01) and YFRF scores improved significantly between visits 5 and 10 (p < .01).
Discussion/Conclusion
The diagnosis of CGH is difficult to determine based on pathoanatomical assessment. This case series suggests that the patient’s response to repeated end range movements may indicate a directional preference for manual procedures and exercises which may be used in management of musculoskeletal conditions such as CGH.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplementary Information
Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2217592.
Additional information
Funding
Notes on contributors
Lan Lin Pu
Lan Lin Pu graduated from the University of South Dakota with a Master of Science in Physical Therapy degree in 1996. Lin achieved her Diploma in Mechanical Diagnosis and Therapy® (MDT) in 2017. For the past 12 years, she has been a senior physical therapist in the Outpatient Rehab Therapies Department at Faith Regional Health Services in Norfolk, Nebraska where she manages cervicogenic headaches and spine conditions with the MDT system. This case series on cervicogenic headaches earned a research award at the AAOMPT conference in 2022 and was presented at the 2023 APTA Combined Sections Meeting in San Diego, California.
Eric Miller
Dr. Miller graduated from Ithaca College in 1990 with a BS in Physical Therapy. He obtained his Certification in Mechanical Diagnosis and Treatment from the McKenzie Institute in 1993. He then went on to complete his MS in General Education from Canisius College (1998) and his DSc in Orthopaedic Physical Therapy from Rocky Mountain University (2002). In 2009, he completed Daemen University’s Orthopaedic Manual Physical Therapy program and became a Fellow in the American Academy of Orthopaedic Manual Physical Therapy. He currently works as an Associate Professor at D’Youville University where has taught orthopedics and differential diagnosis since 1996. He continues to maintain clinical practice working part time in the Catholic Health System as a member of their Spine Team. Dr. Miller has been married to his wife Kelly for 28 years and has 4 adult children.
Ronald Schenk
Dr. Ronald Schenk is a Clinical Professor and serves as the musculoskeletal track coordinator in the Doctor of Physical Therapy program at Tufts University. In terms of scholarship, Dr. Schenk has published 32 peer-reviewed manuscripts and has presented 45 professional presentations. He is an invited presenter in Orthopaedic Manual Physical Therapy (OMPT) Fellowship programs and serves as a clinical mentor for physical therapy residents and fellows in training. Dr. Schenk serves as Chair of the Board of Directors of the McKenzie Institute USA and leads the McKenzie Institute USA Research Task Force. He also serves as an Associate Editor for the Journal of Manual and Manipulative Therapy and as a manuscript reviewer for Physical Therapy Journal, Physiotherapy Canada, and Musculoskeletal Physiotherapy Practice.