PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Use of Translatoric Mobilization in a Patient With Cervicogenic Dizziness and Motion Restriction: A Case Report

Melodie Kondratek, DScPT, OMPT, Doug Creighton, DPT, OCS, FAAOMPT, John Krauss, PhD, PT, OCS, FAAOMPT

Abstract: Some physical therapists consider the report of dizziness at end-range cervical ex- tension when coupled with side-bending and rotation to the same side (coupled lower cervical rotation in extension) to be a positive sign of vertebral artery compromise. However, degen- erative changes and associated movement abnormalities in cervical motion segments may also produce dizziness. The use of mid-line translatoric joint mobilization in the presence of limited active cervical motion that is accompanied by dizziness during cervical extension, rotation, and coupled rotation in extension has not been addressed in the current literature. This case report describes the examination, evaluation, diagnosis, intervention, and outcomes for a 64-year-old woman who presented with limited cervical mobility and the complaint of dizziness during performance of these movements. Examination included a clinical differentiation process to determine the cause of the movement-related dizziness. Examination findings included increased translatoric joint play, tenderness, and reproduction of dizziness at the C4-C6 segments and decreased translatoric joint play at the C1-C4 and C7-T4 motion segments. Intervention included movement re-education and application of translatoric joint mobilization to the hypomobile segments. After 8 visits, there was complete resolution of dizziness during all active cervical movements and improved cervical mobility, as documented with the CROM. This case report demonstrates that clinical symptoms consistent with cervicogenic dizziness and limited cervical mobility may be treated safely and effectively using translatoric joint mobilization techniques. Confirmatory diagnostic ultrasound analysis of the vertebral artery revealed no compromise in flow velocity during the application of these translatoric mobilization techniques.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 3 (2006), 140-151

Effect of High-velocity Low-amplitude Manipulation on Cervical Spine Muscle Strength: A Randomized Clinical Trial

Stan Metcalfe, BSc PT, FCAMT, Hilary Reese, BSc PT, FCAMT, Robert Sydenham, BSc, DPT, FCAMT

Abstract: Clinical observation suggests that side-to-side differences in anterolateral neck flexor strength may be resolved by appropriate high-velocity low-amplitude manipulation of a dysfunctional upper cervical segment. We examined 67 patients with mechanical neck pain or cervicogenic headaches to evaluate the change in anterolateral neck flexor strength after upper cervical spine manipulation. We used the relative position of the atlas, determined by palpation, to predict the weaker side of anterolateral neck flexor strength. The subjects were randomly assigned to two groups. The control group received spinal manipulation to dysfunctional segments in the lower cervical spine only, and the treatment group received manipulation to dysfunctional segments in both the upper and lower cervical spine. Following manipulation of the upper and lower cervical spine, the predicted weak side of the treatment group showed a greater improvement in strength compared to the predicted strong side. Also, following manipulation, there was a greater increase in strength of the predicted weak side of the treatment group compared to the predicted weak side of the control group. We also studied the interrater reliability of positional palpation of the atlas and determined the re- lationship between the relative position of the atlas and anterolateral neck flexor strength.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 3 (2006), 152-158

Role of Manual Physical Therapy and Specific Exercise Intervention in the Treatment of a Patient With Cervicogenic Headaches: A Case Report

Jason Rodeghero, PT, DPT, OCS, MTC, ATC, A. Russell Smith, Jr., PT, EdD, OCS, FAAOMPT

Abstract: Headaches are a common complaint among patients seeking medical care. This case report highlights the role of physical therapy (PT) management including manual therapy and specific exercise interventions in the care of a patient with cervicogenic headaches. The patient was an 18-year-old female college student with a medical diagnosis of migraine headaches. Her history included three previous motor vehicle accidents. Treatment from her primary care physician and optometrist had had no effect on her headache intensity and fre- quency. Findings on the PT examination included upper cervical segmental restrictions and neuromuscular imbalances. The primary treatment strategy for this patient included cervical manipulation, neuromuscular retraining of deep neck flexors, and soft tissue manipulation. The patient demonstrated improvement with a total of seven treatment sessions over a five-week period. Neck Pain Disability Index score improved from a score of 38% perceived disability at initial examination to a score of 10% upon discharge. Headache frequency and intensity significantly improved as upper cervical segmental mobility and deep cervical flexor function improved to within normal limits. This case report demonstrates the potential role of manual physical therapy and specific exercise intervention in quickly improving function and impairments in a patient with cervicogenic headaches.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 3 (2006), 159 - 167

Evidence-Based Approach to the Physical Therapy Diagnosis and Management of Neck and Upper Extremity Pain using Cervical and Thoracic Spine Thrust Manipulation: A Case Report

Paul E. Glynn, DPT, OCS, Joshua A. Cleland, DPT, PhD, OCS

Abstract: Neck and upper extremity pain are common medical diagnoses for patients seeking physical therapy care. The purpose of this case report is to describe an evidence-based ap- proach to the physical therapy diagnosis and management of a 46-year-old female reporting insidious onset neck pain and bilateral upper extremity paraesthesiae of two years duration. Evaluation of examination data, based on research data with regard to diagnostic accuracy of the tests and measures used, indicated a diagnosis of cervical radiculopathy. Management was based on a treatment-based classification approach and focused on restoring mobility by way of thrust manipulations directed at the thoracic and cervical spine. At the completion of the physical therapy plan of care (8 visits), the patient rated her perceived improvement on the Global Rating of Change Scale as “a very great deal better.” The Numerical Pain Rating Score improved from 6/10 to 0/10. Patient-perceived disability, as measured by the Neck Disability Index, improved from 26% to 0%, and the patient’s score on the modified Oswes- try Disability Index improved from 30% to 0%. Bilateral upper extremity paraesthesiae also had completely resolved. These clinically meaningful improvements in pain and perceived disability were maintained six weeks after discharge. While a cause-and-effect relationship cannot be inferred from a case report, it is plausible that an orthopaedic manual physical therapy approach in the management of patients with both neck and upper extremity pain may result in decreased pain and improved function. Further clinical trials are needed to test this hypothesis.
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Physical Therapy and Manual Physical Therapy for Patients with Non-Speciic Low-Back Pain: Differences in Patient Characteristics with Implications for Diagnostic Classiication

Rob A. B. Oostendorp, PhD, PT, MT, Lonneke M. van Berkel, MSc, PT, C. D. Dorine van Ravensberg, PhD, Gwendolijne G. M. Scholten-Peeters, PhD, PT, MT, Jan J.M. Pool, BSc, PT, MT, Raymond A. H. M. Swinkels, PhD, PT, MT, Peter A. Huijbregts, PT, DPT, FAAOMPT, FCAMT

Abstract: A previous study compared socio-demographic characteristics, health problem character- istics, and primary process data between a database sample of patients referred to physical therapy (PT) versus a sample of patients referred for specific manual physical therapy (MPT) diagnosis and management. This study did not differentiate between patients based on affected body region or diagnosis. The present study is a secondary analysis of these data for patients with non-specific low-back pain (LBP). Statistical analysis indicated that the MPT patient sample was significantly (P<0.01) different from the PT database sample with regard to socio-demographic data: The MPT patients were more often male, younger, had attained a higher level of post-secondary education, and were more often gainfully employed. The MPT sample was also significantly (P<0.01) different from the PT sample with regard to health problem characteristics indicating more often acute, recurrent, non-surgical LBP of shorter duration and unknown etiology in the MPT sample. Both samples were also significantly different with regard to the most common impairments, limitations in activities, and restrictions in participation. After correction for socio-demographic differences, both samples remained significantly different for pathology, recurrence, and mechanism of injury. Diagnosis and management with MPT resulted in a significantly better outcome at discharge than PT as determined by the therapist based on patient verbal report (P=0.0000); however, data on recurrence and the unclear influence of socio-demographic data as well as the absence of more reliable, valid, and responsive outcome measures render these outcome data somewhat equivocal. Interpretation of these data with regard to their potential use in diagnostic classification of patients with non-specific LBP is discussed.
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Cervicogenic Dizziness: A Case Report Illustrating Orthopaedic Manual and Vestibular Physical Therapy Comanagement

Ron Schenk PT, PhD, OCS, FAAOMPT, Cert. MDT, Laura B Coons, DPT, Susan E. Bennett PT, EdD, NCS, Peter A. Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT,

Abstract: The diagnosis and treatment of patients with dizziness of a cervical origin may pose a challenge for orthopaedic and vestibular physical therapy specialists. A thorough exami- nation, which consists of a screening examination to rule out pathologies not amenable to sole physical therapy management and, if indicated, a physical therapy differential diagnostic process incorporating both cervical spine and vestibular tests and measures, may indicate an appropriate course of management. The treatment progression is then based on patient signs, symptoms, and response to physical therapy interventions. This case study describes the diagnosis, treatment, and outcomes of a patient with cervicogenic dizziness co-managed by a vestibular and an orthopaedic manual physical therapist.
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ABSTRACTS: AAOMPT Conference, 2006

The following abstracts are to be presented at the 12th annual meeting of the American Academy of Orthopaedic Manual Physical Therapists held in Charlotte, North Carolina from October 20-22, 2006. Pre- sentations are either by poster of platform. Inclusion of an abstract in this supplement does not constitute a peer-reviewed journal publication. The publication of abstracts alerts readers to research that is pres- ently being conducted. It is hoped that the research presented here in brief will eventually be submitted as full-length manuscripts for review and potential publication.
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