Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH), however there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text. Ultimately, ten studies met the inclusion criteria: 1) randomized controlled trial (RCT) or open randomized controlled trial; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison, 2) subjects must have had a diagnosis of CEH; 3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control; and 4) the study included headache pain and frequency as outcome measurements. Seven of the ten studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from CEH, although heterogeneity of the studies makes it difficult to generalize the findings

Cushioning Effect of Conventional Padded Helmets on Interaction between Cerebrospinal Fluid and Brain after a Low-Speed Head Impact

Results of a recent experimental study challenge the widely-held belief that modern combat helmets are more effective at protecting soldiers against concussions. The research shows that helmets used during First World War without inner paddings may have an advantage in protecting soldiers’ brains from concussions when relying solely on cerebrospinal fluid. The present study explains this counterintuitive finding by revealing that while cerebrospinal fluid can prevent direct brain-to-skull contact during a single event, its protective capabilities diminish with each subsequent event occurring in quick succession—something conventional padded helmets appear to aggravate. The cerebrospinal fluid requires a certain amount of time to reset after an acceleration/deceleration event, which allows it to effectively provide cushioning for any subsequent events and protect against potential brain damage. However, an immediate occurrence of a subsequent event, when the fluid has no time to settle down, may significantly diminish the effectiveness of the fluid’s ability to provide adequate cushioning, thereby putting individuals at risk of serious injury. This new information may have implications for helmet design in the future and calls into question current assumptions regarding the best way to protect soldiers and athletes from concussions