SMT-2

Question 1

Moser et al (2019) did a crossover randomized controlled trial of cervical hemodynamics following manipulation and maximal cervical rotation and found what?

Answer 1

Rotation and manipulation result in changes to hemodynamics of the neck but not to cerebral blood flow or perfusion.

Question 2

Kranenburg et al (2019) completed a systematic review of 31 studies with 2254 participants to investigate hemodynamic changes with craniocervical positions and found what?

Answer 2

For the majority of people, most positions and movements of the craniocervical region do not affect blood flow.

Question 3

Young et al (2019) showed that thoracic manipulation for cervical radiculopathy improved patients on which outcomes?

Answer 3

Neck pain, UE pain, cervical ROM, disability, and DNF endurance with moderate to large effect sizes.

Question 4

What reliability, responsiveness, and construct validity did Young et al (2018) conclude the NDI and NPRS have for cervicogenic HA?

Answer 4

NDI: excellent reliability (ICC=0.92)
NPRS: moderate reliability (ICC=0.72)

Both: adequate responsiveness (0.78-0.93) adequate construct validity (p<0.001)

Question 5

What were the MDC, MCID, sensitivity, and specificity calculated by Young et al (2018) for the NDI and NPRS for mechanical neck pain?

Answer 5

NDI: MDC=6.9, MCID=5.5, Sn=0.83, Sp=0.79
NPRS: MDC=2.6, MCID=1.5, Sn=0.93, Sp=0.64

Question 6

What did Butts et al (2017) conclude was the best treatment for TMJ supported in the literature?

Answer 6

Dry needling to pterygoids and manipulation of upper cervical spine and TMJ joint capsule

Question 7

What did Walker (2008) show when comparing exercise and manual therapy to Advice, ROM and sham US?

Answer 7

Exercise + MT has significantly less pain, disability and GRC at 3 wks, 6 wks, and 1 year

Question 8

What did Leaver (2010) find in comparing time to recovery, pain, disability, and pt perception between those who received thrust vs. Non-thrust techniques for 4 tx over 2 weeks?

Answer 8

No significant differences

Question 9

Griswold et al found what difference between thrust and non-thrust mobilization for neck pain?

Answer 9

None

Question 10

Young et al (2009) compared exercise and manual therapy with and without traction and found what?

Answer 10

Similar improvements regardless of group—traction did not add to improvement

Question 11

Rodine & Vernon (2012) did a review of cervical radiculopathy Tx and found what?

Answer 11

Very limited evidence for cervical HVLAT—most studies didn’t review it. Concluded SMT May be cautiously considered as a therapeutic option for pts with radiculopathy.

Question 12

What did Austin et al (2010) find when studying arterial microdamage in repeated strain?

Answer 12

1000 cycles of simulated SMT (6% strain) to C/S did not result in any microdamage

Question 13

The Vaga study of headache epidemiology found what prevalence of cervicogenic HA?

Answer 13

4.1% prevalence, 1/3 most common type of recurrent HA

Question 14

Ogince et al (2007) calculated what Sn, Sp, (-) LR, and (+) LR for the diagnostic validity of flexion rotation test in C1-2 CGH?

Answer 14

Sn=91.3%
Sp=91.4%
(+) LR=10.65
(-) LR=0.095

Question 15

In the study by Ogince (2007), normal subjects had 40 deg on flexion rotation test, whereas those with CGH had _____.

Answer 15

20 deg on the symptomatic side, p<0.001

Question 16

Hall et al (2010) found that the flexion rotation test can differentiate between CGH vs. migraine with what cutoff degree for Dx?

Answer 16

Accuracy 85%
Cutoff ROM 30 deg

Predictor variables: neck mvmt/pos provokes HA and/or precede HA

Question 17

Hall et al (2008) found what reliability and validity of flexion-rotation test for experienced examiners?

Answer 17

ICC=0.94
Sn=90%
Sp=85-90%
+LR=6-9
-LR=0.11-0.12

Question 18

Hall et al concluded what degree loss indicates a positive flexion-rotation test? What is the MDC?

Answer 18

> 10 deg restriction is positive
MDC=7

Question 19

What degree is the cutoff for lower cervical vs. Upper cervical pain in the flexion rotation test? With what Sp and +LR?

Answer 19

32 degrees or greater is indicative of lower cervical pain.
Sp=0.92
+LR=9.4

Question 20

What are the norms for the craniocervical flexion test and neck flexion endurance test?

Answer 20

26-28 mmHg, 10s holds x 10

Head 2 in off table w/ chin tucked x25s (males) or 20 s (females)

Question 21

Multiple studies (Lluch 2014, Jull 2002) have compared manual Tx (mobs or manips) to exercise for neck pain. What are their conclusions?

Answer 21

No significant difference between ex and MT.

Question 22

Epsi-López (2014) found improvements in pain and HA frequency for tension type headaches with which manual treatment approaches?

Answer 22

HVLA to OA joint with or without SO release improved pain intensity, HLVA w/ SO release only reduced HA frequency

Question 23

Nelson (1998) found that SMT had what effect on migraine headache at 8 weeks of treatment?

Answer 23

SMT with or without meds resulted in less pain than meds alone at 8 weeks—SMT pain reduction maintained at 12 weeks but less robust than medications by that point (meds more effective only after 12 weeks)

Question 24

Bronfort (2005) found in their Cochrane review that that SMT can treat which types of headaches?

Answer 24

Migraine (similar to amytriptyline) and CGH (combined with low intensity endurance training)

Question 25

Jull et al (2002) compared SMT, Ex, SMT+Ex, and no Tx for CGH and found what effects for neck pain and intensity, duration, and frequency of HAs?

Answer 25

No difference between treatment groups at any time point; no difference vs. no Tx at 12 month f/u

Question 26

Haas et al (2004) found what effect on headaches regarding SMT dosage when comparing 1, 3, and 4x/week Tx for a three week Tx?

Answer 26

Significant improvement in headache pain for 4x/week vs 1x/week, improvement in disability for 3-4x/week vs 1x/week at 12 week f/u

Question 27

Haas (2010) found what effect when comparing 16 SMT Tx, 8 SMT, 8 light massage, or 16 light massage for headache pain and frequency?

Answer 27

Significant effects for pain with 16 SMT and for frequency with 8 or 16 SMT

Question 28

What are the 7 cervicogenic HA international study group criteria?

Answer 28

1. Unilateral w/o sideshift, starting posterior/occipital and spreading temporally
2. Pain triggered by neck mvmt and sustained positions
3. Reduced cervical ROM
4. Pain elicited by pressure to at least one upper cervical joint
5. Moderate to severe non-throbbing pain
6. Headache frequency of at least 1x/week for at least 3 months
7. Minimum 2/10 on NPRS and 20% disability

Question 29

Dunning’s study on cervicogenic headache compared thrust and non-thrust mobilization w/ exercise. What were the results and effect sizes for disability and intensity, frequency, duration of HAs, at 1, 4, and 12 weeks?

Answer 29

Thrust manipulation resulted in reduced headache intensity, HA frequency, and disability at all time points.
Intensity: 67.1% reduction (vs. 30.5%); d=2.5
4.6 times more likely to achieve 50% or greater improvement in HA intensity.

Disability: 65.7% decrease (vs. 30.1%), d=1.7

Frequency: 2.74 day reduction per week (vs. 1.35 days) d=1.8

Duration: 74% w/ 0-5 hours/week vs. 36.5% — 5x more likely than non-thrust, d=1.2

Question 30

In the cervicogenic HA study by Dunning et al, what where the differences between thrust and non-thrust mobilization for GROC and medication intake at 3 months?

Answer 30

89.7% had a rating of 4+ or better (vs. 36.5%)
56.9% discontinued meds entirely, and patients were 4x more likely to have completely stopped HA meds vs control

Question 31

Cleland et al (2005) found what effect for manipulation vs sham in cervical radiculopathy?

Answer 31

Immediate reduction in pain on VAS score

Question 32

Dunning’s RCT on thoracic manipulation for cervical radiculopathy showed significant improvements in which parameters at 48-72 hour f/u? What was the NNT?

Answer 32

Neck and upper extremity pain
NDI
DNF
GRC
Centralization

NNT: 2.2 neck pain, 3.1 arm pain

Question 33

Boyle (1999) wrote a case study of 2nd rib syndrome presenting as impingement. What 4 signs were present to indicate shoulder impingement?

Answer 33

1. Pain with abd AROM
2. • Hawkins-Kennedy
3. Long head of biceps TTP
4. Rotator cuff mm weak and painful

Question 34

Dunning (2015) evaluated shoulder pain and disability after thrust manipulation for 2nd and 3rd rib syndrome. What degree of pain reduction occurred post-manipulation?

Answer 34

62% reduction within 48 hours, avg NPRS <1 and GROC 6.8 after 4 days continuing into 3 month f/u