Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache

Manual Therapy
Toby Hall, Kathy Briffa, Diana Hopper, Kim Robinson
Received 3 December 2009; received in revised form 26 April 2010; accepted 8 June 2010.
published online 07 July 2010.

Abstract

This study investigated the reliability of manual examination procedures and the frequency that each or multiple segments in the upper cervical spine above the C4 vertebra were the dominant source of pain in subjects with cervicogenic headache (CGH). Eighty subjects were evaluated, 60 with CGH (39 females, mean age 33 years) and arbitrarily a further 20 asymptomatic subjects (13 females, mean age 34 years) included to reduce examiner bias, but subsequently omitted from data analysis. Two experienced physiotherapists examined on the same day each subject with standard manual examination procedures, independently rating each segment in the upper cervical spine above the C4 vertebra for involvement. Examiners were blind to each other’s findings and the subject’s clinical status. Standard and adjusted Kappa coefficients were calculated for each segment in symptomatic subjects only. Chi-squared analysis for goodness of fit was used to identify the segment that was most frequently determined the predominant symptomatic segment. Manual examination above the C4 vertebra showed good reliability. The C1/2 segment was most commonly symptomatic, with a positive finding at this segment in 63% of cases. The high frequency of C1/2 involvement in CGH highlights the importance of examination and treatment procedures for this motion segment.

School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology, Hayman Road, Bentley, Perth, Western Australia

Deep Cervical Muscle Dysfunction and Head/Neck/Face Pain

Practical Pain Management. Vol.9, No.1 Jan/Feb 2009
by Leonard B. Goldstein, DDS, PhD and Howard W. Makofsky, PT, DHSc, OCS

Nearly fifty percent (50%) of the population is affected by cervical spine pain and/or headaches during their lives.1 Headache is not only one of the most common human ailments,2 but also accounts for the expenditures of billions of health care dollars annually and is a leading cause of lost time from work.3

Cervical dysfunction may be seen in up to seventy percent (70%) of the population suffering from any type of headache.4 This suggests that the cervical spine may be either a causative or contributing factor in the pathogenesis of many headaches.5

The pilot study by Placzek, Pagett, et al. demonstrated and supported the theory that headache may be influenced by cervical muscle strength, and that weakness of the cervical spine musculature may lead to abnormal stress on the upper cervical facets which are related to head and neck pain. It is further speculated that stability, and thus normal function and biomechanics, is dependent on a balance of anterior and posterior cervical muscle balance. Despite advances, the pathogenesis of tension-type headache is not clearly understood. However, cervical musculoskeletal abnormalities have been linked to multiple headache types.6-8

In the study published by Fernandez-De-Las-Penas, Perez-De-Heredia, Molero-Sanchez, and Miangolarra-Page,9 the authors presented results similar to those previously reported:

impairment in deep neck flexor muscles in individuals with cervicogenic headaches, and
deficits in the performance of the cranio-cervical flexion test (ie., reduced endurance or holding capacity of the deep neck flexor muscles).
Please refer to the Jan/Feb 2009 issue for the complete text.