Sports Rehabilitation | Neck Pain & Headaches

Tuesday 1st June 2021

Hours: 4 (Observational)

Patient presentations:

Reflection Focus

Reflection Model

Experience

Long-standing patient of the physio. She experiences neck pain and headaches which are treated via STM. The patient’s problem is work-related and despite her DSE set-up being improved the issue persisted.

Reflection

I was surprised that there was little in the way patient education during the session; however, as this is a long-standing patient I imagine that discussions have been had previously. Equally, STM is not indicated as a form of management for headaches (NICE, 2012). However, the patient was reporting symptoms consistent with a cervicogenic headache and there is evidence that physical therapy, such as manipulations and mobilisations can help with the management of this condition (Rani et al., 2021).

Action

I knew that some headaches could be MSK related; however, I had never heard of the term cervicogenic headache. Therefore, I am going to explore the topic further – focusing on its presentation and how to manage the condition through physical therapy, exercise, and patient education.

Revisiting Reflection

NHS, Berkshire have a patient information leaflet for cerviogenic headaches which highlights common symptoms, red flags (VBI) and conservative management strategies. This may be a useful signpost to help individuals manage their symptoms at home.
A delphi study on cervicogenic headaches (CeH) iterated that manual therapy, lifestyle advice and work-related ergonomic training are useful treatment strategies for patients presenting with CeH (Pauw, et al., 2021). Interestingly exercise didn’t achieve consensus; however, it is something still to be considered when dealing with CeH.
Manual therapy and exercise was found to be effective in the treatment for headaches as opposed to either in isolation (Hidalgo, et al., 2017); therefore, techniques such as MET’s, TrP therapy, and mobilisations may all serve a purpose alongside exercises that target general ROM, deep neck flexors and the scapular muscles for CeH.

References

Rani, M., Kulandaivelan, S., Bansal, A., & Pawalia, A. (2019). Physical therapy intervention for cervicogenic headache: an overview of systematic reviews. European Journal of Physiotherapy, 21(4), 217-223. https://doi.org/10.1080/21679169.2018.1523460
National Institute for Health and Care Excellence. (2012, September 19). Headaches in over 12s: diagnosis and management. https://www.nice.org.uk/guidance/cg150
Berkshire Healthcare. (2017, November). Cervicogenic headaches Information and advice. NHS Foundation Trust. https://www.berkshirehealthcare.nhs.uk/media/168324/cervicogenic_headaches_leaflet.pdf
Hidalgo, Benjamin et al. ‘The Efficacy of Manual Therapy and Exercise for Treating Non-specific Neck Pain: A Systematic Review’. 1 Jan. 2017 : 1149 – 1169.
De Pauw, R., Dewitte, V., de Hertogh, W., Cnockaert, E., Chys, M., & Cagnie, B. (2021). Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskeletal science & practice, 52, 102325. https://doi.org/10.1016/j.msksp.2021.102325