369- The Effectiveness of Spinal Manipulation on Cervicogenic Headaches

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we're talking research. This is all around headaches and the effectiveness of manual and exercise therapy. This is a systematic review. It came out in 2022 and it is great. I'm going to drop a link down below. The full title is the Effectiveness of Manual and Exercise Therapy on Headache Intensity and Frequency among Patients with Cervicogenic Headache Among A Systematic Review and meta analysis. Great study. Lots of clinical pearls, lots of nuggets for patient communication. We're going to get into all that and much more on today's episode. But before we get started, I'll say a few words about patient Pilot and the smart Chiropractor. If you are looking at 2023 and you're saying, how do I make this my best year, you need to stop ignoring your email list. Patient Pilot automated email campaigns can help you maximize your email list, which is the most valuable asset you have in your practice to generate more new patients, better retention and more reactivation. We'll hook you up with a 3x ROI guarantee. Head over to the smartchiropractor.com, book a demo. That's going to give you access to best pricing as well as some bonuses. The Smart Chiropractor.com, book a demo Again, the Smart Chiropractor.com book a demo. See how we can help you. 3x ROI guarantee. No reason not to go over there and learn more. But as I said at the top, today we're talking research. We're talking about manual and exercise therapy on headache intensity. The this study. There was 20 studies included in this review and a total of a little bit less than 1,500 patients. And there were a couple common interventions that they noticed. Spinal manipulation being one trigger point therapy being another, spinal mobilization, they broke those apart. Scapulothoracic and craniocervical exercises were included as well. So let's take a step back, talk cervicogenic headache. Then we can get into what they found. Cervicogenic headache is a secondary headache. Keep in mind and it prevalence is 1 to 4% among people experiencing headaches. So over the course of, you know, a state, a city, a country or the world, 1 to 4% adds up to A lot. So this is not something that affects 99% of people every single day, but it is a big deal. And people that struggle with cervicogenic headache, the other thing I just want to point out, my experience has been these are like daily struggles. And a lot of it we know as chiropractors. Well, cervicogenic headache, much of it has to do with ergonomics and posture, joint mobility. So this is the type of headache I find that patients are like, every day at noon, I get a headache, right, because they're getting back in the same posture, doing the same job function, and after four to five hours in a day, bang, they start to get that headache. And when you suffer with daily headaches, especially cervicogenic headaches, you're tight, you got stiffness, you got lack of mobility. These things are pretty debilitating. So I know we think of migraines as being the ultimate debilitating headache, but cervicogenic headaches, especially when they're chronic, can be a really, really big deal. So manual therapy is one of the most common treatment choices, and specifically in Australia, Europe and the United States. And it's provided to about 33, about a third, 33% of patients in headache type clinics, as they say. So guidelines do suggest the management of sericogenic headache using things like exercise therapy, spinal manipulation, specifically to reduce intensity, frequency and disability. And they highlight in this study that based upon the current literature, eight to 10 sessions of manual or exercise therapy over six weeks are recommended if that's kind of done in isolation. So there's no magic number, right? Everybody's different, they're presenting with different goals, you're seeing different findings, but sort of what they're saying are out in the guidelines. I think this is important. I'll highlight this again. It never gets old to me to, to see in recent studies saying, hey, guidelines support the use of spinal manipulation to reduce cervicogenic headache, pain intensity, frequency and disability. I mean, what more can you ask for? That's literally everybody that has a cervical genetic headache minus red flags should probably be exploring this. And that is a lot of people. And when the research continues to say this, I know there is a delay with the application of how the consumer is making choices and how other providers in your community are making referrals. But that's exactly why you listen to this podcast and use tools like the smart chiropractor and the evidence based chiropractor is because the onus is on us to get out there and build the relationships with our community and with other healthcare providers so that we get the referrals that we deserve. So, cervicogenic characteristics, let's talk a few characteristics there. Usually it's unilateral pain. It is usually pain beginning in the neck, then radiating to the occipital, temporal, frontal or orbital regions, moderate to severe intensity. So these aren't usually mild. I mean, these are for real non throbbing and non lancinating pain. And the duration can be variable. And a lot of this is based upon the fact that much of it's postural pain may be constant or intermittent, and it's usually triggered or worsened by neck movements or external pressure. And it's normally accompanied by restricted motion and pain in the shoulder blade area. These are all things that are really big deals. And we think about that cascade from acute to chronic. And if somebody's doing the same thing every day, they get older every day, gravity is one day more on their spine and neuromusculoskeletal system. They're doing the same repetitive motion as many of us do in our jobs. That's why it's our job five days a week. We're doing something with repetition. And man, now you start to talk about restricted range of motion, you get a headache, you notice one, the next day you're not doing anything for it. This is compounding factors that become real deal issues for millions of people out there and probably tens of millions, if not hundreds when you look at it at a global scale. So this systematic review had a broader scope than previous research and it was comparing the effectiveness of interventions commonly used in manual therapy to other conservative interventions, as well as sham or no sham. So it was really taking a deep dive and trying to understand what's going on. So from an intervention standpoint, manual therapy does have a specific definition and is defined as any techniques administered manually by a trained provider for therapeutic reasons. Now, underneath that there's a pretty broad scope. Manual therapy techniques include things like massage, trigger point therapy, kinesio taping, manipulation, mobilization, acupuncture, and any combination. Now they break that off from exercise therapy, which is really prescribed to correct impairments, restore muscular and skeletal function and or maintain a state of well being, as they say. So therapeutic exercise would include things like endurance training, resistance training, whether isotonic, isometric or isokinetic, flexibility training, static and dynamic stretching exercises. All of those things fall under the therapeutic exercise realm. So this study was trying to splinter those apart a little bit and get a really good understanding as far as what goes on with people with cervical Genica headache when they go through some of these different treatment modalities. And what they found with spinal manipulation was pretty darn good news if you're a chiropractor listening to this. Overall, eight trials assessed the effectiveness of spinal manipulation. And two of the trials compared spinal manipulation alone to sham treatment and found statistically significant. We love to hear those words in the literature. Not just significant, statistically significant changes in favor of spinal manipulation. And drum roll on this one at the short and long term, which is awesome because that is a common criticism of people who don't know what they're talking about, is they'll say, well, spinal manipulation is a sham. Well, no. And we've seen this in multiple studies that it outperforms placebo time and time again. The sec, which I have nothing against placebo, by the way, but the second component is, oh, it's so short term. I'm actually surprised at how long the results last. When we see time and time again in the literature that somebody can undergo chiropractic care, chiropractic manipulation, spinal adjustments, however you want to define it. And in the midterm, in the long term, one year later, six months later, 12 weeks afterward. And my assumption is, when it's that far after the care and treatment, they probably went back to doing the same thing. Think about how powerful the adjustment that you deliver is when somebody goes back to doing the same thing. And it could be years before the pain comes back. I'm surprised it actually doesn't come back sooner based upon the fact that 23 hours and 45 minutes a day, if they're not in your practice, they're probably doing the thing that's causing the issue. That is a big, big deal. And I often believe that we shortchange ourselves as chiropractors. That is huge. That what we do with our hands can make an impact not only now, but for the foreseeable future in many cases. That is such a. Such a big deal. And spinal manipulation was also found to be more effective than spinal mobilization. Important there. And craniocervical flexion exercises. So all good news in this research study as far as helping cervical people with cervicogenic headache or. Now, I know a lot of docs and students listening to this are interested in kinesio taping. And they found kinesio taping was compared to sham taping and to home rehabilitation. And clinical improvements at 4 and 8 weeks were reported. So I'm gonna call that more short term. Four to eight weeks. Not short and long. Long is usually six months to a year in the literature, so short term. But that's interesting. I've seen a lot of back and forth, shall we say, on kinesio taping. What does it help, what doesn't it help? How does it work? There's a lot that we're still learning about that every day, all day. That's totally cool. This has a really interesting study, and I wouldn't normally think about it. I think about kinesio taping from an extremity standpoint most of the time. So to see it in realm of cervicogenic headache and provide clinical improvements at four to eight weeks compared to a sham taping, it's interesting. And I thought I'd pull that out as something that would be of interest to many people listening to this podcast. Additionally, Graston mobilization plus therapeutic exercise to exercise alone found differences in favor of Graston mobilization for headache intensity and frequency at four weeks. So if you're a Graston practitioner, utilize that technique. It's a good one for headaches, as we see here, Headache intensity and frequency at four weeks, a positive association with reductions in those. That's a weird way to say it, but Graston is a good, solid technique in the literature, according to this systematic review. So comparing the results of this review to the clinical indications proposed in other studies and guidelines, everything seems right. And they're saying especially regarding spinal manipulation and mobilization. In fact, 10 of the 11 included trials of spinal manipulation and mobilization reported clinical and statistical superior effects for the experimental groups compared to the controls. Let me say that one more time. There's a lot of recommendations out there that are reinforcing the idea that manual therapy and spinal manipulation is a really good idea for neuromusculoskeletal issues. Duh. But what we're seeing now in the literature is that just compounding. And that compounding is very important because every time we see a study, that's just another drop. It's just another drop. And that matters. One study in the sea of studies is, quite frankly, irrelevant. But when we start to have the preponderance of evidence, that is a powerful thing. We've seen it in our clinics and now we see it in the literature. The literature is typically, I'm gonna say, often behind, but that's okay. And we're seeing it catch up now. So I wanna read that one more time. Typically, 10 of the 11 included trials of spinal manipulation and mobilization reported clinically and statistically superior results for the experimental group compared to the controls. So that is absolutely powerful. It's a big take home message. And if we drive forward to the conclusions in this study, the researchers found manual therapy, with or without exercise therapy, appears to be a safe and effective intervention for cervicogenic headache and should be considered in the management of this condition. As already opposed by the latest guidelines. Main body evidence favors the use of spinal manipulation to reduce headache intensity, frequency and disability. But other forms of manual therapy and exercise therapy were found to be beneficial as well. The relevance for clinical practice is considerable, as they say, as reflected by the amount of clinical guidelines proposing some form of manual physical therapy in the management of headaches and the large number of patients seeking this type of intervention to manage their headache symptoms. That final line of this study is the take home message and it is powerful. Clinical guidelines recommend who we are and what we do with the hands on care we provide as being safe, effective in the short term and the long term. We see a reduction in intensity, a reduction in frequency or a reduction in disability. If we just had one of those things, if it was just short term and just intensity, it would be of value. The fact that it's short, medium and long term intensity, frequency and duration, you're hard pressed to get better than that in any meaningful way. So I love this study. I hope you're able to find some great clinical pearls to take home. And it just reinforces as you're taking care of people today, tomorrow in practice, in student clinic, in your practice, wherever you're gonna be taking care of patients, it reinforces the fact that what you're doing is absolutely the right thing and the best thing thing to do with the movement based hands on care you provide. In the absence of red flags, of course. So this is a great study. Again, I'll drop that link down below. Before we wrap up, let me say a few words about powerstep Orthotics. If you have not picked up a free sample pair of PowerStep orthotics, you're blowing it. Head over to pro.powerstep.com sample pro.powerstep.com sample I'll drop the link in the show notes, use the code EBC evidence based Chiropractor. Of course they are going to send you and hook you up with a totally free complimentary pair of orthotics. They're what I use, what my dad uses. I cannot recommend them enough. Additionally, I just want to give a quick shout out to World Spine care. You know, 50 chiropractors volunteering around the world internationally and this is a really really big deal. A billion people worldwide experience low back and neck pain and most of them don't have access to spine care. But but you can be part of the solution world. SpineCare is an awesome organization and you can make a tax deductible donation@worldspinecare.org EBCPodcast WorldSpineCare.org EBCPodcast I'll drop that link down below. And finally before we wrap, Chiro Matchmakers if you're looking for a change in your career, we have over 100 jobs available, 85k plus starting salaries. If you're looking to hire a new CA or DC, do not go on gut and go it alone. You're gonna end up with wasting a lot of time, effort and energy and money and you're gonna be super frustrated. It's hard to hire people the right way. That's why we take a assessment based approach. We'll do all the heavy lifting and hard work for you and hook you up and find great associates that match the culture of your practice so you don't have to siphon through and work through a variety of false starts which cost your practice a ton of time. We like to say finding the right person can add seven figures to your practice. Hiring the wrong person can be a six figure mistake and anybody out there that's made a few hires in their life I'm certain can attest to thank you so much for tuning in Listening to this podcast. I am super excited at what we're gonna be putting out this year on the Evidence Based Chiropractor podcast. If you have not left us a review. If you're listening on your phone, you wanna scroll on down, tap how many stars, leave a few words of encouragement. That'd be super appreciated. Helps more and more docs find out about this podcast. Thank you for being a chiropractor. Have an awesome day and I'll talk to you soon.

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