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Vertigo—Cervical Vertigo/Cervicogenic Dizziness
Published in Charles Theisler, Adjuvant Medical Care, 2023
Manual Techniques: Several studies have reported that approximately 75% of patients improve with conservative treatment of the neck, such as gentle spinal mobilization, exercise, and instruction in proper posture and use of the neck.2,3,4
Osteoporotic thoracolumbar fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Once pain from the acute fracture is manageable, it is important for the patient to start mobilizing with a formal rehabilitation exercise program (7). Prolonged bed rest is associated with bone density reduction and increased bone turnover (78), which may worsen bone fragility, expose the patient to the adverse effects of physical inactivity (79), and possibly lead to the development of pressure sores. The goals of rehabilitation are prevention of falls and subsequent fractures, reduction of kyphosis, enhanced axial muscle strength, and correct spinal alignment to improve posture. However, there is no consensus on what to include or how best to deliver this form of rehabilitation exercise program. Trials so far have been limited to small randomized studies of varied interventional programs delivered in the community to generally less-frail patients with vertebral fragility fracture (80). Programs varied in duration from 10 weeks to 2 years and were delivered in either the participants’ home or as part of group exercise. Exercise programs ranged from ones that focused only on back strengthening exercises, to programs incorporating manual spinal mobilization and postural taping, to multicomponent exercise programs, and they had varying levels of supervision (77,81–87). Findings have not been consistent, with no conclusive reduction in pain, improvement in markers of quality of life, and improvement in levels of disability (80,88,89). However, there was a clear increase in muscle strength as part of the prescribed exercise programs (80).
Cervicogenic Headache
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
A few published, randomized, controlled trials exist analyzing the effectiveness of spinal manipulation and/or mobilization for TTH, migraine, or CeH in which methodological quality of the studies is low (114). For the prophylactic treatment of CeH, there is evidence that both neck exercise (low-endurance training) and spinal manipulation are effective in the short and long term when compared to no treatment. There is also evidence that spinal manipulation is effective in the short term when compared to massage or placebo spinal manipulation, and weaker evidence when compared to spinal mobilization (115).
Effectiveness of spinal mobilization and postural correction exercises in the management of cervicogenic headache: A randomized controlled trial
Published in Physiotherapy Theory and Practice, 2023
The most common cause of CGH is musculoskeletal impairment of the upper three cervical segments, especially the articular and muscular impairment (Hall, Briffa, and Hopper, 2008). Musculoskeletal impairment in CGH is characterized as a reduced cervical extension, painful upper cervical joint dysfunction, and impaired muscle function (Getsoian et al., 2020) as well as restricted range of motion. The loss of active motion is often accompanied by the presence of palpable painful cervical joints especially the upper three cervical segments. The lower cervical joints do not exhibit any substantial dysfunction in the CGH (Jull et al., 2007). This was also postulated by a cross-sectional study that patients suffering from CGH have decreased range of motion (ROM) and a higher incidence of painful upper cervical joint dysfunction as compared to patients suffering from other types of headaches (Zito, Jull, and Story, 2006). Another study postulated that the upper cervical spine plays a role in the development of headaches. Decreased mobility of the cervical spine, especially the right atlano-axial joint causes positional fault, which results in dural tension and contributes to CGH (Sillevis and Swanick, 2021). Recently, it has been established that upper cervical synovial joints are the most frequent source of pain in CGH (Govind and Bogduk, 2021). Therefore, working on these articular imbalances through spinal mobilization (SM) may affect CGH because mobilization helps in relieving pain and increasing range of motion (Maitland, Hengeveld, Banks, and English, 2001)
Treatment of non-sports related concussion in adolescents following an irritability algorithmic approach: a case series
Published in Physiotherapy Theory and Practice, 2022
Kelly Hardesty, Zachary Walston, Lindsay Walston, Dale Yake, Tye Marr
Manual therapy interventions were patient-specific and individualized to address subjective and objective impairments in cervical and thoracic mobility, pain, and to facilitate postural reeducation utilizing techniques such as thoracic manipulation, spinal mobilization, and soft tissue mobilization. Spinal mobilization, cervical manipulation, and thoracic manipulation have demonstrated efficacy in the management of neck pain and cervicogenic dizziness when combined with exercise intervention, compared to manual therapy alone (Bier et al., 2018; Blanpied et al., 2017; Chaibi and Russell, 2014; Hidalgo et al., 2017; Lystad, Bell, Bonnevie-Svendsen, and Carter, 2011; Page, 2011; Yaseen et al., 2018). Manual therapy interventions were discontinued upon restoration of equal bilateral cervical and thoracic mobility with no subjective complaints of symptom provocation throughout the available range of motion or at end range. The patients, all presenting with cervicogenic symptoms in the moderate irritability classification initially, performed 1–3 sets of 15–20 repetitions or greater than 30 second isometric, low level eccentric, and multi-joint upper quarter exercises to improve motor control and motor recruitment to proximal postural musculature. Exercise interventions were progressed once all exercises could be performed at appropriate intensity without symptom exacerbation, and regressed with increased pain, decreased cervical mobility, or exacerbation of concussion symptoms greater than 4/10 NPRS.
What do we know about spinal manual therapy for people with osteoporosis? A narrative review
Published in Physical Therapy Reviews, 2021
Caitlin McArthur, Christina Ziebart, Judi Laprade
All identified studies included manual therapy as part of a multifaceted intervention for people with osteoporosis. One case study [31] and two randomized controlled trial [32,34] conducted PA mobilizations to the thoracic spine in prone, with the case study performing unilateral Grade II to III pressure [31], one RCT performing Grade II to III central pressure [32] and one RCT performing Grade II to IV central pressure [34]. One RCT conducted spinal mobilization in seated, combining extension with lateral flexion and/or rotation [33]. However, this study did not identify the grade of mobilization. One study had therapists perform 10 to 15 passive movements [33], while another had therapists perform two sets of five repetitions at each level starting at T1 down to two segments below the most painful vertebral region [32]. Sran [31] and Barker et al. [34] described the dose of manual therapy as individualized. Provision of services ranged from 7 to 18 sessions over 10–12 weeks. Other intervention components included postural taping, education, postural exercises, and general exercise.