SMT 2 - Neck (Random)

Question 1

Systematic Review of cervicogenic dizziness

Answer 1

Reid and Rivett (2005) did systematic review of cervicogenic dizziness and manual therapy. This condition is suspected if one is able to reproduce patient’s dizziness on testing active cervical movements. Methodological quality of 9 studies was “poor.” All 9 studies found a positive trend with manual therapy. There was a significant improvement in signs and symptoms of dizziness after manual therapy. Conclusion: Limited evidence (level 3) that manual therapy is beneficial for cervicogenic dizziness.

Question 2

Anatomy of cervicogenic dizziness

Answer 2

Upper cervical mechanoreceptors and proprioceptors contribute to static postural sensation or sense of balance. Dorsal roots of spinal nerves C2-C3 synapse with nucleus abducens in vestibular nuclei. Altered type I cervical articular mechanoreception and proprioception from dysfunctional joints results in loss of normal afferent input, which results in aberrant information being sent to the vestibular nuclei.

Question 3

CPR’s for neck pain

Answer 3

1. Raney (2009) has yet to be validated and only identifies those patients likely to respond to traction
2. Cleland (2007) identified those patients with neck pain likely to benefit from thoracic HVLAT and general cervical ROM exercise but was since not found to be valid (Cleland 2010).

Question 4

CPR for cervical, CTJ, and thoracic HVLAT

Answer 4

(Ssavedra-Hernandez 2011) Single arm trial that collected data for short term outcomes after 1-2 sessions of cx/CTJ/tx HVLAT. 5 variables identified:
1. Pain intensity > 4.5/10
2. Cervical extension < 46 degrees
3. Negative ULTT
4. Hypomobility at T1
5. Female
If 4/5 present then likelihood of success (+5 on GROC) increases from 61.7% to 75.4%. Strongest predictor was hypomobility at T1.

Question 5

Short term effectiveness of cervical HVLAT

Answer 5

1. Cassidy (1992)
2. Martinez-Segura (2006)
3. Fernandez-de-las-Penas (2007)
4. Gross (2010)

Question 6

Parker-Smith and Penter

Answer 6

(1998): Compared cervical HVLAT to cervical PLUS thoracic HVLAT. Found no difference in pain or disability between groups after 6 sessions.

Question 7

Herwitz

Answer 7

(2002): 336 patients with neck pain of any duration, with or without radiculopathy. Compared cervical HVLAT to mobilization. No significant difference in pain and disability between groups at 6 months. An unknown number of patients did not actually receive manipulation or mobilization to cervical spine, but instead to the thoracic spine. Included moist heat or e-stim, plus posture, strengthening, stretching, and ergonomics advice. Not sure if upper cx/tx was manipulation in anyone.

Question 8

Leaver

Answer 8

(2010) : Found patients with acute or subacute neck pain treated with cervical HVLAT vs. mob did not experience a more rapid recovery.
1. Undisclosed number of subjects also received HVLAT or mob to thoracic and lumbar
2. Randomization in some subjects occurred after several conservative treatment sessions had been completed or failed
3. 79% had concomitant UE pain
4. Technique dosage not described
5. Not known if manipulated upper cervical spine in anyone

Question 9

Puentedura

Answer 9

(2011): Randomly assigned to either 2 sessions of cervical HVLAT or thoracic HVLAT (plus 5 sessions of exercises). Found significantly greater improvements in pain and disability at short and long-term follow up when HVLAT applied to cervical spine instead of thoracic. However, mean duration of symptoms in this trial was just 15 days and sample size was very small (24 total).