https://orcid.org/0000-0002-1930-6208
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ABSTRACT
Objective
To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH).
Methods:
A randomized controlled crossover trial was conducted on 48 participants (mean age: 34.4 years) with CeH symptoms. Participants were randomized to 6 sessions of TSM or no treatment (Hold) and after 4-weeks, groups crossed over. Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). Outcomes were analyzed using a linear mixed-effects model with Bonferroni correction. Odds of achieving the minimal clinically important difference (MCID) on the GRC of +4 or greater were also calculated. Scores at 4 weeks represent the only timepoint where 1 group is fully treated and other group has not received any treatment.
Results:
Comparing hold to active treatment, HDI were not significantly different between groups (mean difference = 7.39, 95 CI: −4.39 to 19.18; P = 0.214) at any timepoint; the NDI was significant (mean difference = 6.90, 95 CI: 0.05 to 13.75; P = 0.048) at 4 weeks. Odds of achieving the +4 MCID on the GRC (OR = 38.0, 95 CI: 6.6 to 220.0; p < 0.001) favored TSM at 4 weeks.
Conclusion:
TSM had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Future studies are needed to examine the long-term impact of TSM in this population.
Acknowledgments
The authors would like to acknowledge individuals who contributed to the study including Paige Williams PT, DPT, and Lauren Hinrichs, PT, DPT. We would also like to thank students from the University of Colorado Physical Therapy Program who contributed to this study including, Diana Edwards, Simone Addison and anatomic illustrator Mariah Donofrio.
Disclosure statement
Drs. Cleland, Mintken and Glynn receive honorariums for teaching continuing education courses which include techniques used in this study. All other author(s) do not have conflicts of interest to report.
Grant support
This work was supported by The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) under a grant from Cardon Rehabilitation (Ontario, Canada). Neither AAOMPT nor the funding agency had a role in the study design, analysis, interpretation, or decisions about publication.
Author contributions
Drs. McDevitt, Cleland, Glynn and Mintken were involved in the conception and design of the study. Drs. McDevitt, Mintken were responsible for recruitment and data collection. Drs. McDevitt, Courtney and Altic managed the data. Drs. McDevitt, Rhon, Cleland and Mintken analyzed and interpreted the data. All authors contributed to the writing and revision of the manuscript and approved the final version of the manuscript.
Data sharing
Individual participant data that underlie the results reported in this article (text, tables and figures) are available, after deidentification, for researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author.
Patient and public involvement
The patients and the public were not involved as research partners.
Additional information
Funding
Notes on contributors
Amy W. McDevitt
Dr. Amy W. McDevitt is an Associate Professor in the Physical Medicine and Rehabilitation Department at the University of Colorado, Anschutz Medical Campus where she teaches entry-level physical therapist students. Clinically, she practices at the University of Colorado Health, CU Sports Physical Therapy and Rehabilitation. She is a board-certified Orthopaedic Clinical Specialist and a Fellow in the American Academy of Orthopaedic Manual Physical Therapists. She is currently completing her PhD in Physiotherapy through the University of Newcastle, Australia. Dr. McDevitt has an active research agenda including publications and national presentations in the areas of shoulder pain, regional interdependence, dry needling and the assessment of clinical reasoning in DPT students. She is a past recipient of the Rose Excellence in Research Award from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association.
Facebook: https://www.facebook.com/awmcdevitt
LinkedIn: https://www.linkedin.com/in/amy-mcdevitt-258711109/
Twitter: @awmcdevittDPT
Joshua A. Cleland
Dr. Joshua A. Cleland is the Director of Research and Faculty Development in the DPT program at Tufts University. He is actively involved in numerous clinical research studies investigating the effectiveness of manual physical therapy and exercise in the management of spine and extremities disorders. He has published over 280 manuscripts in peer-reviewed journals. He is an Editor for the Journal of Orthopaedic and Sports Physical Therapy. He is currently an author/editor on 4 textbooks. Dr Cleland is a well-known speaker at both the national and international level. He is the recipient of the 2008 Jack Walker Award, the 2009 Eugene Michels New Investigator Award, the 2011 Chattanooga Research Award, the 2015 Rothstein Golden Pen Award for Scientific Writing all from the American Physical Therapy Association. He also received the 2013, 2014 and 2015 Rose Excellence in Research Award from the Academy of Orthopaedic Physical Therapy. Additionally, he received both the Dorothy Baethke-Eleanor J. Carlin Award for Excellence in Academic Teaching and was also selected as a Catherine Worthingham Fellow of the American Physical Therapy Association in 2018.
Twitter: JoshClelandPT
Daniel I. Rhon
Dr. Daniel I. Rhon is a clinician and active health services researcher. He is an Associate Professor in the Department of Rehab Medicine, Uniformed Services University of Health Sciences and an Assistant professor in the Army-Baylor University, Doctoral Program in Physical Therapy. He completed a postdoc research fellowship through the University of Utah and has a strong research interest in the effectiveness of clinical care pathways for musculoskeletal disease, both at primary and specialty care levels, and the intersection of these two. He is the Primary Investigator on several CDMRP and NIH-funded multi-site trials focused on these clinical problems. He is a past recipient of the Rose Excellence in Research Award from the Orthopaedic Section of the American Physical Therapy Association and the US Army COL Mary Lipscomb Hamerick Lifetime Research Award.
LinkedIn: linkedin.com/in/danrhon
Twitter: @danrhon
Rebecca A.K. Altic
Dr. Rebecca A.K. Altic completed her Doctor of Physical Therapy degree at the University of Colorado Anschutz Medical Campus in 2019. She has been involved in orthopedic physical therapy research at the University since 2017. She practices orthopedic and pelvic health physical therapy with UCHealth in Denver, Colorado.
Facebook: Rebecca Kretschmer Altic
LinkedIn: Rebecca Altic
Drew J. Courtney
Dr. Drew J. Courtney earned his Doctor in Physical Therapy from the University of Colorado Anschutz Medical Campus and his Bachelor’s degree in Athletic Training from Colorado Mesa University. He is now the head physical therapist at DBC Fitness San Diego, a sports performance and rehabilitation facility in San Diego, California.
Facebook: Drew Courtney
LinkedIn: Drew Courtney
Twitter: @drewcourtneydpt
Paul E. Glynn
Dr. Paul E. Glynn has over 25 years experience in the PT field to include acting as the Director of Orthopedic Surgery and Rehabilitation services at Newton-Wellesley Hospital, Director of Physical Therapy for gWell Health inc., and most recently opening a private practice in Lexington, MA. He holds academic appointments at Evidence in Motion as well as the MGH Institute of Health Profession in Boston, MA. He has published research in numerous peer-reviewed journals, has authored multiple textbook chapters, and has co-authored a textbook and application. He is an active researcher and national presenter in the field, a manuscript reviewer for numerous PT journals, an item writer for the PT National Examination, and an associate member of the PT Federation Board. Dr. Glynn has served as the Chair of the Practice Committee for the Massachusetts American Physical Therapy Association and he remains active in multiple local educational groups.
Facebook: https://www.facebook.com/glynnphysicaltherapy/
Twitter: @pauleglynn
Paul E. Mintken
Dr. Paul E. Mintken is a Professor in the Physical Medicine and Rehabilitation Department at the University of Colorado, Anschutz Medical Campus. He maintains an active research agenda investigating conservative care for musculoskeletal disorders. He has over 50 peer-reviewed publications and has co-authored 3 eBooks and 7 book chapters. His awards include the Gould Excellence in Teaching Orthopaedic Physical Therapy Award from the American Physical Therapy Association (APTA), the Baethke-Carlin Award for Excellence in Academic Teaching from the APTA, the Rose Excellence in Research Award, The Journal of Orthopaedic & Sports Physical Therapy Excellence in Research Award, the Chattanooga Research Award from the Physical Therapy Journal, and the Outstanding Physical Therapist Award for the State of Colorado from the Colorado chapter of the APTA.
Facebook: Paul Mintken
Twitter: @PMintkenDPT
LinkedIn: Paul Mintken