Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.
American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; PRISMA Health Physical Therapy Specialists, Columbia, SC, USA.
Spine J. 2021 Feb;21(2):284-295. doi: 10.1016/j.spinee.2020.10.008. Epub 2020 Oct 13.
Spinal manipulation, spinal mobilization, and exercise are commonly used in individuals with cervicogenic headache (CH). Dry needling is being increasingly used in the management of CH. However, questions remain about the effectiveness of these therapies and how they compare to each other.
The present study aims to compare the combined effects of spinal manipulation and dry needling with spinal mobilization and exercise on pain and disability in individuals with CH.
STUDY DESIGN/SETTING: Randomized, multicenter, parallel-group trial.
One hundred forty-two patients (n=142) with CH from 13 outpatient clinics in 10 different states were recruited over a 36-month period.
The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale. Secondary outcomes included headache frequency and duration, disability (Neck Disability Index), medication intake, and the Global Rating of Change (GROC). Follow-up assessments were taken at 1 week, 4 weeks, and 3 months.
Patients were randomized to receive upper cervical and upper thoracic spinal manipulation plus electrical dry needling (n=74) or upper cervical and upper thoracic spinal mobilization and exercise (n=68). In addition, the mobilization group also received a program of craniocervical and peri-scapular resistance exercises; whereas, the spinal manipulation group also received up to eight sessions of perineural electrical dry needling. The treatment period for both groups was 4 weeks. The trial was prospectively registered at ClinicalTrials.gov (NCT02373605). Drs Dunning, Butts and Young are faculty within the AAMT Fellowship and teach postgraduate courses in spinal manipulation, spinal mobilization, dry needling, exercise and differential diagnosis. The other authors declare no conflicts of interest. None of the authors received any funding for this study.
The 2 × 4 analysis of covariance revealed that individuals with CH who received thrust spinal manipulation and electrical dry needling experienced significantly greater reductions in headache intensity (F=23.464; p<.001), headache frequency (F=13.407; p<.001), and disability (F=10.702; p<.001) than those who received nonthrust mobilization and exercise at a 3-month follow-up. Individuals in the spinal manipulation and electrical dry needling group also experienced shorter duration of headaches (p<.001) at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X=54.840; p<.001) more patients (n=57, 77%) within the spinal manipulation and electrical dry needling group achieved a successful outcome compared to the mobilization and exercise group (n=10, 15%) at 3-month follow-up. Between-groups effect sizes were large (0.94<standardized mean score difference<1.25) in all outcomes in favor of the spinal manipulation and electrical dry needling group at 3 months. In addition, significantly (X=29.889; p<.001) more patients in the spinal manipulation and electrical dry needling group (n=49, 66%) completely stopped taking medication for their pain compared to the spinal mobilization and exercise group (n=14, 21%) at 3 months.
Upper cervical and upper thoracic high-velocity low-amplitude thrust spinal manipulation and electrical dry needling were shown to be more effective than nonthrust mobilization and exercise in patients with CH, and the effects were maintained at 3 months.
脊柱推拿、脊柱松动术和运动常用于颈源性头痛（CH）患者。干针疗法在 CH 的治疗中应用越来越多。然而，这些治疗方法的有效性及其相互比较仍存在疑问。
本研究旨在比较脊柱推拿和干针联合与脊柱松动术和运动对 CH 患者疼痛和残疾的综合影响。
研究设计/地点：随机、多中心、平行组试验。
13 个门诊诊所的 10 个不同州招募了 142 名 CH 患者（n=142），历时 36 个月。
疼痛强度用数字疼痛评分量表测量。次要结局包括头痛频率和持续时间、残疾（颈椎残疾指数）、药物摄入和全球变化评级（GROC）。在 1 周、4 周和 3 个月进行随访评估。
患者随机分为接受上颈椎和上胸椎脊柱推拿加电干针（n=74）或上颈椎和上胸椎脊柱松动术加运动（n=68）。此外，松动组还接受颅颈和肩胛周围阻力运动；而脊柱推拿组还接受多达 8 次周围神经电干针。两组的治疗期均为 4 周。该试验在 ClinicalTrials.gov（NCT02373605）前瞻性注册。Dunning、Butts 和 Young 博士是 AAMT 奖学金的教师，教授脊柱推拿、脊柱松动术、干针、运动和鉴别诊断的研究生课程。其他作者均无利益冲突。本研究的作者均未获得任何资金支持。
2×4 协方差分析显示，接受推力脊柱推拿和电干针治疗的 CH 患者头痛强度（F=23.464；p<.001）、头痛频率（F=13.407；p<.001）和残疾（F=10.702；p<.001）的改善明显大于接受非推力松动术和运动的患者，随访 3 个月时。在 3 个月时，脊柱推拿和电干针组的头痛持续时间也明显缩短（p<.001）。根据 GROC 的≥+5 截分值，在 3 个月的随访中，脊柱推拿和电干针组中（n=57，77%）有显著（X=54.840；p<.001）更多的患者（n=57，77%）达到成功结局，而松动术和运动组（n=10，15%）（n=10，15%）。在所有结局中，脊柱推拿和电干针组的组间效应大小均较大（0.94<标准化平均评分差异<1.25），3 个月时对脊柱推拿和电干针组有利。此外，脊柱推拿和电干针组（n=49，66%）有显著（X=29.889；p<.001）更多的患者（n=49，66%）完全停止服用药物治疗疼痛，而松动术和运动组（n=14，21%）（n=14，21%）在 3 个月时。
上颈椎和上胸椎高速度低幅度推力脊柱推拿和电干针治疗 CH 患者比非推力松动术和运动更有效，且疗效可维持 3 个月。
