499- Cervicogenic Headaches: Why Spinal Adjustments Outperform Massage and Mobilization

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 are back with more research. It is all about manual therapy and cervicogenic headaches. A fantastic brand new study. We're gonna dive deep into it, bring out the clinical pearls, evaluate how this can influence your patient communication. Of course, I'll drop a link to the study down in the show notes. Before we get started, I wanna say a few words about Leander Tables. You can still save $1,000 on a Series 50 Flexion distraction table using the code EBC 2025. You can visit Leander tables at the link down in the show notes. And a table is a great expense to write off that helps you make more money. So if you are in the market for a new table or just want to check out what the best tables look like, head over to Leander tables and again, I'll drop that link and they are going to hook you up with a big discount. Now, as I said at the top, we're talking research. This is all about stuff. Cervicogenic headaches. This is a condition that I'm sure you see each and every day in practice and one that I'm gonna say continues to spark some debate on what's the best way to approach this. So what we're gonna do is we're gonna dive into. A brand new study came out 2025, published in Frontiers in Neurology. And it's a systematic review and meta analysis evaluating spinal adjustment, spinal manipulation, mobilization and massage for managing these cervicogenic headaches. Now, not only is this study comprehensive, it included over 14 randomized controlled trials in nearly 1300 patients. But the findings also offer powerful insights that can guide all of us in terms of the hands on care that we are delivering. Now you probably are aware headaches are the third most common reason people visit a chiropractor, at least for the first time. Back pain being number one, neck pain being number two, and headaches closely following behind. So let's talk about the specifics of cervicogenic headaches and then dive deep into what was found in this study. So, cervicogenic headache, typically a secondary headache. And it originates from the neck radiating to the head. It's usually not throbbing, it's often unilateral and it's commonly mistaken for tension or migraine headaches. Clinically, you probably see these patients all the time. Limited range of motion. Ring a bell with maybe 99% of the people that walk through your front doors. Limited cervical spine range of motion, postural stress and strain, stiffness in the cervical thoracic region, and a history of prolonged neck loading and or trauma. So, you know, I'm gonna say the good news is, as you're gonna see in the findings, we can take care of these people at a super high level. That which you're already probably aware of. I'm gonna say the bad news is almost every single person that walks through your front door is probably gonna have some constellation of that symptomatology and challenge. So what makes this research compelling is I'm gonna say it kind of cuts through the noise comparing real world, you know, interventions, techniques, modalities that we use daily adjustments, mobilization and or massage to determine what actually works and how safe it is. And let's pick it up right there with some key findings and we're going to dive into what works best. And the results in this study were super, super clear. Cervical spine adjustments came out on top. Cervical spine adjustments came out on top showing the most effective short term pain and disability relief. So the cervical adjustments scored 98.9% for pain reduction and 82.2% for disability improvement. Beating mobilization, beating massage, beating exercise. So if you are adjusting those individuals who come in with the cervicogenic headaches into your practice, barring any red flags, that's a really good idea because that is the best thing you could be doing. If you are not doing that, this might be something you want to look at. Now in second place was the mobilizations, specifically those snag modal mobilizations, which is a general mobilization technique. And it demonstrated additionally significant and sustained benefits. So the VAS pain score, the mean difference was just shy of 2 on a 10 point scale. So nearly a 20% reduction. Neck disability index 8.55 improvement. And the flexion rotation test improved by over 7 degrees. Disability inventory reduced by 9 points. So mobilization was definitely effective, it just wasn't as effective as the adjustment. Now why is that? Well, there's a variety of different, I'm going to say thoughts regarding that. There's not one answer but, but we've highlighted on this podcast previous research showcasing the differences. When you deliver an adjustment, different things happen getting into that paraphysiological space specifically, what I've seen is with more of the high velocity type adjustments, something different happens than, I'm going to say, just going through the range of motion. So immobilization or mobilizing a joint is a really good idea, but adjusting that joint can really compound that benefit. Something different happens, and that's gapping facets, that's influencing the peripheral and central nervous system, that's influencing biomechanics. All of those things are happening, some of which happen with massage, some of which happen with mobilization. But it seems to take it to a new level when you get in there and deliver that adjustment. So what about massage? Massage was still deemed very helpful, but when it was stacked side by side against adjustments and mobilizations, it just kind of fell apart and underperformed. So now let's talk safety, because this is a very common thing for, I'm gonna say, on both sides of this equation, patients have safety concerns. There's no question about it. If you've been online lately, you see the topic of potential injury has come up time and time again, and there's a rash of that content going out there. Now, interestingly, on some of those reports, you click in and the headline is completely different than the actual story of what went on. That's not surprising because the headline is by definition supposed to be sensationalized, but it doesn't make you feel good if you're a chiropractor. So let's take a look at what actual research says, not what some marketer trying to get clickbait headlines wrote. So adjustments, especially in the cervical spine, are really the big question mark in this review that found found that when performed by trained providers like you and I, adverse events were extremely rare. Adjustments and mobilizations were safe, with almost zero adverse events reported. So when skill meets the strategy, when your skill meets the strategy of how you're approaching, these techniques can be super effective and super, super safe. As a matter of fact, here's a direct quote from the study. Snag mobilization and cervical spine manipulation are your best tools to reduce pain, improve function, and help patients with cervicogenic headaches get their life back. That is a massively powerful statement, so much so that I'm gonna read it one more time. Snag mobilization and cervical spine manipulation are your best tools to reduce pain, improve function, and help patients with cervicogenic headaches get their life back. So is there research to showcase if somebody's having headaches, that adjustments are a good idea? It's not only a good idea, it's actually reinforced as the best thing they can do. So let's dive into Some clinical takeaways and how you can apply this to your practice. Well, spinal adjustments work and they work fast. Number one, if your patient is appropriate, there's no red flags or anything like that. Cervical and thoracic adjustments can offer massively rapid pain relief and functional gains. Now, really important when we talk about rapid pain relief, we don't want to dive into what I'll call the chiropractic aspirin. I think we can do much better than that. So we all know pain is the last thing to come and the first thing to go. Most of your patients probably find pain relief in a visit, two visits, three visits. But that doesn't mean they're better. If they have tissue, let's say they're having tendon ligament issues. The remodeling of that tissue takes weeks and months. So are you actually guiding the exercise along that process? Let's say they do have cervicogenic headaches and a significant portion of that, maybe it's postural related, for example. Well, are you checking, going through movement assessments? And have you seen outcomes, not just pain relief? You give an adjustment, the person's probably gonna feel better. But have you actually, have they done, should I say, the hard work to make the lifestyle changes so that it doesn't just come right back? And that is where I look towards maintenance care, wellness care, however you want to define that. And I find that there's a lot of chiropractors that just stop care too soon. The patient feels better. They're like, oh, I know I'm going to get a good review. I don't, I don't want to treat people too long. I hear you. But find a middle ground. Because if you believe what you're doing, you have to take that all the way. And when I say take that all the way, you have to understand that habits don't change in days, they take weeks or months. That tissue remodeling takes weeks and months. That understanding, educating everything that you've come to understand takes time to be able to have a patient begin to understand it. They don't need to be you, they don't need to be a chiropractor. But what they do need is to get the outcome they desire. And often the outcome they desire isn't just that they feel better tomorrow, is that they feel better next week and next month. So being super direct, being super clear and highlighting, tying directly the care that you deliver, how that impacts and affects what's going on with them, and then making those steps, you might not be Adjust. Maybe you are, but you might not be adjusting every single visit. That's okay. Are you doing your movement assessments? Are you ensuring that they are continuing to reduce the likelihood for the issue to come back? Because if you are, it's one of the best things you can quote, unquote, sell. And too many of us, I'm going to say, are underselling it or we're not describing it well enough. And when I say selling, you use that word on purpose. I'm not afraid of that word whatsoever and I hope you aren't either. Because anytime we're communicating and have an exchange of value with somebody, that's a buying and selling proposition. There's nothing nefarious about that. And that's a conversation for a different day. But make sure that you are being clear, make sure you're being direct, and make sure you are delivering the care at the level necessary to get the desired outcome. So takeaway number two was mobilizations are powerful as well. So patients that might not tolerate a high velocity adjustment. Mobilizations can be really great. They're long lasting, they're low risk, they're great for people post surgery, post trauma, that are hypermobile or super anxious. You get in there with immobilization. It's not as impactful as an adjustment, but it does a really good job and it's a great start. Additionally, massage is best as an adjunct. So using for tissue reducing muscle tension. It's not the primary driver of outcomes for reduction in cervicogenic headache, but it can be a nice addition if it's something that you have that's offered in your practice and then matching your technique to your patient, as always. So your skill matters big time. This paper just continues to emphasize that outcomes patients get are tied closely to your the provider experience and expertise, your ability to assess and apply the right techniques, the the right treatment, the right care in the right place, the right duration matters so much. Now here's the great news. If you're listening to this, chances are you're already on the right path. If you're a chiropractor who uses your hands to help people heal, to help people feel better, tell people function better, then this research hopefully reinforces the value of what you do. As you're listening. It's not just about making them feel better. It's about applying techniques that outperform the alternatives, especially pharmacologic interventions without any of those side effects. Often patients are actually making that decision day in and day out. Do I take an Aleve? Do I take an nsaid do I go to see a chiropractor? And quite frankly many are choosing the first two. I mentioned about 85% of people out there, about 15% see a chiropractor. Right. So that's a lot of opportunity for you to get out there and tell this story, to utilize everything we discussed today and highlight in your reels, in your blogs. As you've heard me say time and time again, there's a new research study that just came out highlighting how what we do here with chiropractic adjustments is actually the best thing you can do if you're struggling with cervicogenic headaches. Here's what a cervicogenic headache is. Here's how we typically take care of it. Here's the results some of our patients are receiving that is massively powerful content that helps you raise above the noise, speak specifically to the individuals you're trying to attract and, and make it easy for them to pick up the phone or hit you up on the computer and schedule that visit. What you are doing is safe, what you are doing is effective and what you are doing is backed by super high level research and evidence. So whether that patient comes in and you are adjusting them, mobilizing them, you know, incorporating other techniques and massage, the research says keep up the great work. What you are doing in the hands on care manual therapy you're delivering is not only a good option, again it is the best option. So for those people, which are tens of millions, if not hundreds of millions, probably around the world suffering with cervical genic headaches, they're super common, it is treatable. And today's research, the study from today again, drop it down in the show notes, shows that targeted manual therapy, spinal adjustments, when done correctly can dramatically improve the quality of life for the those individuals. So I'm gonna drop a link down to this in the show notes. You can be sure to check it out before we wrap up. Speaking of cervical spine, if you want the best cervical spine assessment tool on the market, bar none, head over to neckcare.com if you tell them that I connected you over there, they're gonna hook you up with a first month free. It is the best assessment tool for neuromuscular control, proprioception, range of motion, sensory motor integration, bar none, easy slam dunk. Head over as a listener here, they're going to hook you up. Be sure to tell them about the evidence based chiropractor because they will give you your first month for free. What's better than that? And finally turncloud minimalist design without being sparse. Turncloud ehr. You can learn more and connect with their team over@TurnCloud.com or I will drop a link in the show. Notes if you have not left a rating or review for this podcast, I would love it if you would take a moment and do so. It helps more and more docs find out about this podcast. Thank you so much for tuning in. Thank you for being a chiropractor. Have a fantastic week in practice and I will talk to you soon.

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