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Manual Therapy Techniques

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Cervical

SUMMARY:


Manual therapy interventions for the cervical spine have been associated with improvements in pain, function and disability in individuals with mechanical neck pain (MNP), cervical radiculopathy (CR), whiplash associated disorder (WAD), cervicogenic headache (CGH), and lateral epicondylalgia (LE).

Mechanical neck pain (MNP):
When combined with therapeutic exercise, manual therapy (MT) interventions for the cervical spine results in superior short and long term clinical outcomes when compared to exercise alone, ‘usual care’ from a general practitioner or ‘minimal intervention’ including range of motion exercise and advice to remain active. Manual therapy is more effective when combined with exercise than when it is delivered as a stand-alone intervention. Thrust and non-thrust manipulation/mobilization produce similar outcomes in patients with MNP.  

Bronfort, 2001, Spine
Hoving, 2002, Ann Int Med
Hurwitx, 2005, Spine
Vernon, 2007, J Manipulative Physiol Ther
Walker, 2008, Spine
Hurwitz, 2008, Spine
Miller, 2010, Man Ther
Gross, 2010, Man Ther


Whiplash associated disorder (WAD):
When combined with early active exercise; manual therapy in the form of cervical spine mobilizations has been shown to be superior to rest and use of a soft collar in improving pain, function and range of motion in the short term.
Mealy, 1986, BMJ
Hurwitz, 2008, Spine

Cervical Radiculopathy (CR)
There are no studies that explicitly examine the effectiveness of cervical spine MT interventions in individuals with CR. Cervical spine MT has been included in multi-modal (traction, exercise, thoracic MT and cervical MT) treatment protocols associated with good outcomes in individuals with CR, however, there are no placebo-controlled trials investigating this management approach. Because of these factors, the benefit of cervical spine MT for individuals with CR is currently unknown.

Cleland, 2005, JOSPT
Cleland, 2007, JOSPT
Young, 2009, JOSPT
Leininger, 2011, Phys Med Rehabil Clin N Am


Cervicogenic headache (CEH)
MT interventions (thrust and non-thrust manipulation/mobilization) have been shown to be effective in reducing CEH frequency and intensity at short and long-term follow up (1-year) when compared to controls. When combined with therapeutic exercise interventions, MT produces superior outcomes to MT alone or exercise alone at short and long term follow up.

Jull, 2002, Spine
Bronfort, 2001, J Manipulative Physiol Ther
Castien, 2010, Cephalagia


Lateral Epicondylalgia (LE)
To date, no randomized controlled trials have assessed the long term efficacy of cervical OMT for LE.  Vicenzino and colleagues conducted a repeated measures design study and observed that a group of 15 patients with LE demonstrated greater improvements in pressure pain threshold (PPT), pain-free grip strength, upper limb neurodynamics, pain and function when treated with cervical manipulation compared to a placebo and control treatment.   Cleland and colleagues conducted a retrospective observational study on patients managed with typical PT interventions and those managed with typical PT interventions plus cervical OMT interventions.  Patients treated with cervical OMT + typical PT interventions achieved successful outcomes with less visits and time than those treated with typical PT interventions alone.  
Vicenzino, 1996, Pain
Cleland, 2004, J Orthop Phys Ther  


OTHER CLINICAL EVIDENCE:
Hall, 2010, Man Ther
Kanlayanaphotporn, 2009, Arch Phys Med Rehabil
Kanlayanaphotporn, 2010, Disabil Rehabil


OTHER RELEVANT EVIDENCE:

Fernandez-de-las-Peñas, 2007, J Orthop Sports Phys Ther
Snodgrass, 2009, J Manipulative Physiol Ther
Tuttle, 2008, Spine

 

 

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