Recently I found a research paper conducted by a group of physiotherapists in America which compared the effectiveness of manipulation versus mobilisation and exercise for treatment of headache amongst a group of 110 people.
The primary outcome measured in this study was the patient’s headache intensity. Patients were asked to complete a questionnaire to indicate the average intensity of their headache pain on a scale of 1-10 at the beginning of the study in addition to their intensity at 1-week, 1-month, and 3-months following the initial treatment session. Secondary outcome measures included a disability questionnaire, headache frequency, headache duration, and medication intake.
On the initial visit patients completed all outcome measures then received the first treatment session. Patients completed 6–8 treatment sessions of either manipulation of the upper neck and upper back, or mobilization of the same areas combined with exercises over a 4 week period. The exact areas of the spine to be treated were left to the discretion of the treating therapist and it was based on the combination of patient reports and examination. The exercises given to the second group was neck flexion exercises during treatment, and 10 minutes take home resistance exercises using a resistance band within their own tolerance.
This study is the first clinical trial to directly compare the effectiveness of both neck and upper back manipulation versus mobilisation and exercise in patients with headache. The results suggest 6–8 sessions of manipulation over 4 weeks, directed mainly to both the upper neck and upper back, resulted in greater improvements in all aspects of the patients headache than the mobilisation/exercise group. This included headache intensity, disability, headache frequency, headache duration, and medication intake. Most importantly the effects of manipulation were maintained at 3 months follow-up. Additionally there were no adverse reactions to either group aside from mild discomfort either at the point of manipulation/mobilisation or post exercise, which is completely normal in clinical practice.
The underlying mechanisms as to why manipulation may have resulted in greater improvements than mobilisation plus exercise is still under investigation. In addition our current thinking about how manipulation affects patients positively in clinical practice delves into neurology far more deeply than what is possible in this column. More than likely it has something to do with joint receptors being stimulated which leads to pain reduction, greater range of motion and less muscle spasm. Fortunately in clinical practice patients will vote with their feet. Meaning that if a patient feels like they have improved they will continue to seek Chiropractic care when needed. Consequently they will continue to refer other patients to Chiropractors, telling their family and friends about the benefits they have received from care. Of course we’d all like to fully understand the precise mechanisms behind why what we do works, however it is up to researchers to investigate that process further. In clinical practice it’s up to us Chiropractors to keep providing the best service and treatment possible thereby improving clinical knowledge that drives further research and evidence. Clinical practice will always be a driver for research, not vice versa. This is a very important study and it again builds on the body of knowledge demonstrating the effectiveness and safety of spinal manipulation as a treatment for a variety of spinal related complaints, in this instance headache. It is becoming clearer that if there are any individuals, be they either members of the public or other health professionals that still doubt the validity of spinal manipulation as a treatment for spinal related disorders then I would suggest they are demonstrating that they no experience or knowledge of the topic at hand and should be ignored.
Do you or someone you know have a history of headache, if so Chiropractic care may be able to help. Chiropractors have a great deal of experience in dealing with different forms of headache and as indicated by the research, spinal manipulation, which Chiropractors specialise in, can be a very effective form of therapy for headache pain. Contact your local NT Chiropractor today.
Dunning J.R. et al. Musculoskelet Disord. Feb 6;17(1):64. 2016. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial.