cervicogenic headache

[morwenna]

Thanks for your opinion Linbin.

I must add that I do not completely disregard research articles by any means. Obviously they are valuable tools. My point was to say that I put more credence in patients' response to my treatments than research articles.

Quite. "Evidenced-based Practice" relies on various evidence, certainly not on research papers alone, but personal experience and even anecdotal evidence are all grist to the mill.

[jacinta]

hello,

thanks for all the informative posting.
how about a pt with problem mentioned above, who developed chronic fibromylagia over the years. Palaption reveals
- 'lumps' on right C2-C3,
- cord-like right upper trapz from C2 all the way to spine of right scapula.
- occasional numbness, right shd to right arm
generally Cx spine quality of movement is poor.
postural problem: poke-chin.

in 2/12, various sessions of manual therapy, stretching and strengthening ex ( continued as home ex prog) doesnt produce significant improvement.
pt c/o Upp Cx flx(retraction) ex as tough as ' fighting against my own neck'.

kindly share your idea. thanks.

[linbin]

hi
i suggest you to check the segmental mobility of spine seperately,i mean upper ,middle and lower.
try myofascial release-especially suboccipital release
ice and stretch to trapezius
ischaemic compression in trapezius
relaxation exercise
ergonomic advice

[jacinta]

Hi linbin,

thanks for ur reply.

hi
i suggest you to check the segmental mobility of spine seperately,i mean upper ,middle and lower.
try myofascial release-especially suboccipital release
ice and stretch to trapezius
ischaemic compression in trapezius
relaxation exercise
ergonomic advice

well, we tried MFR and heat treatment, instead of ice.
Trapz stretch was done manually (maitland), and as self-strectching at home.
the mention areas do get soften aft treatment, however,
according to pt., effect last < 1/7.
the size and hardness of lump at upp. cx remained unchanged when
pt come back for treatment, twice weekly.

something to clarify,
is ischemic compression the same with acupressure point release?


thanks

[jesspt]

Sorry about my infrequent posts over the last few weeks - I was in a very rural part of South Dakota on vacation and had essentially no internet access.

I was just revisting this thread and and I was re-reading it, I saw a few things I must have missed earlier....the mind isn't what it once was, I'm afraid.

Unfortunately, I do not rely as heavily as you do on research studies, and the explanation is simple. Nothing unfortunate about it. Some therapists are strongly into correlating thier practice with research, others are not. It sounds as though you appraise the literature on occasion, at the very least.
I have learned over the years, in both performing research and studying research articles, that for every research article that proves one thing there are typically at least one other article that disproves the same thing. And before you discredit that statement, I ask you to please do a peer review of all ultrasound research articles.
I have.
You will find that there are more research articles that debunk the effectiveness of ultrasound than there are that support its use. (I have done this in the past and was quite surprised at what I found, it quite literally shook my understanding of PhysioTherapy and turned it upside-down) And despite this PTs all over the world rely heavily on ultrasound as an effective modality, and I believe rightfully so.
I respectfully disagree here. I think the modality has little, if any, clinical utility, and is widely overused by physiotherapists worldwide. The reasearch and my opinion are in absolute agreement on this. I haven't used an ultrasound for patient care in over a year, with no negative change in patient outcomes

In regards to the sacrum contributing to headaches, I simply say how can it not? Once you expand your box and begin to see that a craniosacral model is an appropriate model to explain motility of the nervous system, the explanation is in front of you. Very simply, the direct link between the cranium and the sacrum is the dural tube

My problem with craniosacral therapy is the theory behind its applciation. From what I can tell, the theory makes no sense. The body of research that flies in the face of the components of craniosacral therapy is large, and the body of evidence supporting it is very small.
Now, note that I am [I][I]not saying that craniosacral therapy does not result in some pain relief for some people, but I am saying that this pain relief is almost certainly not as a result of the normalisation of craniosacral rhthym or from mobilizing the cranial sutures. I also am unaware of any reliable assessment technique that would allow a clinician to ascertain which patients might receive benefit from craniosacral therapy - essetially, it's a shot in the dark, and should be used as such. In short, we should be using interventions such as craniosacral therapy (or ultrasound, for that matter) that have a mountain of evidence that show them to be ineffective, as a treatment of last resort. Our first therapeutic actions should be to use treatments that have been shown to have better efficacy in the patient population that we are treating.