🦀 PT Crab Issue 104 - Headaches are a headache. Here are some interventions.

This week, we’re intervening on headaches. Next week, we’ll talk pediatrics, then we’re going down the rotator cuff path. I searched my archives and found that I’d only published two summaries about rotator cuffs. Weird, right? But that’s not today’s topic. Today, it’s headaches. Which I have right now. Apparently 46% of the world has a headache at any given time, which is insane.

Y’all are getting one systematic review on headaches, but King Crab supporters got two! One about what you’re about to see and another on how dry needling helps headaches (at it apparently does). And they also dove deep on SNAGs.

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Anyway, let’s dive in!

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Manip and Mobe for Tension Headaches, But You Don’t Have to For Cervicogenic

The Gist - This systematic review and meta analysis from the aptly named,Physical Therapy Reviews journal dug into hundreds of studies and came up with 9 that compared manipulation or mobilization to conservative treatment for cervicogenic and tension-type headaches, and broke down their data. There are some great stats, some huge forest plots, and more inside, but the results are actually quite summarizable. There were 793 subjects in the systematic review and 563 in the meta-analysis, so it’s a pretty robust dataset, which is great for actually getting something useful! Yay for useful!

From all their digging, they found that manipulation and mobilization were better than conservative treatment for pain from tension-type headaches in the short term, but conservative care catches up long-term. Specifically, their assessment of 386 subjects form four studies showed a small preference for manual therapy reducing pain from and disability due to headaches in weeks 1-4 and no difference at months 1-3. Manual didn’t reduced frequency of headaches over any time period.

For cervicogenic, they found that manual “did not provide significant improve- ments compared to conservative care.” That’s for disability, pain, and headache frequency.

Tell Me More - Now for some definitions. The researchers defined conservative treatment as aerobic exercise, stretching, education, muscle specific exercise, and manual therapy (excepting mobilization and manipulation). Manipulation was defined as high velocity, low amplitude movement at or beyond end range, while mobilization was repetitive, rhythmic passive oscillatory movement. The researchers avoided studies that combined these treatments (like in regular PT) due to confounding.

The studies they grabbed were cross-disciplinary, from PT to chiropractic to everything in between. This means that different types of manips and mobes may have been logged and categorized together, making it less powerful. Individual studies did find evidence that mobes and manips were better and the paper does detail those, but on average things sort out as a wash. Even though conservative therapy “won” this battle, it didn’t win by much and the authors end by arguing for an eclectic therapeutic approach rather than any in isolation. Which is probably how you do it anyway, but now you can know that either on its own ain’t bad either.

Show me those Forest Plots. You got it.

And that’s our week! As always, please invite friends and fans to join you as a reader and consider becoming a supporter to avoid ads, triple your content, and support the mission to share and promote EBP. Thanks and bye!