To evaluate the effectiveness of integrating passive physiological intervertebral movements (PPIVMs) with therapeutic exercises on headache intensity and frequency, neck pain and disability, mental health symptoms, and overall quality of life in patients with cervicogenic headache (CGH).
Participants with CGH were randomized into two groups: the intervention group and control group. Each group underwent eight supervised treatment sessions over four weeks, each lasting 15-20 minutes. The exercise regimen included cervical flexion loading, scapular retraction, passive static self-stretching, and active neck mobility exercises. Participants were encouraged to perform these exercises daily at home. The intervention group also received customized PPIVM therapy targeting the upper cervical joints (C0-3). Assessments were conducted at baseline, post-intervention, and follow-up. Outcome measures included headache intensity measured by numeric pain rating scale (NPRS), headache frequency (number of headaches/weeks), neck pain (NPRS), Neck Disability Index (NDI), Depression Anxiety and Stress Scale (DASS21), and short-form quality of life questionnaire (SF-12). Multivariate ANOVA was used to analyze the difference between intervention and control groups at each assessment point (baseline, four weeks, and three months). Independent t-tests for each variable followed significant multivariate tests. A significance level was set at p 0.05 (one-tailed).
At baseline, there were no significant differences between the intervention and control groups, indicating homogeneity. At four weeks, the intervention group had significantly lower scores in all measures: NPRS-Headache (1.47 vs. 2.55, p.001), headache frequency (1.12 vs. 1.44, p=0.022), NPRS-Neck pain (1.87 vs. 3.32, p.001), Neck Disability Index (3.67 vs. 7.29, p.001), DASS-Stress (2.93 vs. 4.26, p=0.084), DASS-Anxiety (2.33 vs. 3.23, p=0.031), and DASS-Depression (1.03 vs. 2.58, p.001). SF-12 Physical (18.27 vs. 17.00, p=0.002) and Mental (23.87 vs. 21.71, p=0.001) component scores were significantly higher. At three months, the intervention group maintained lower NPRS-Headache scores (1.75 vs. 2.62, p=0.008), headache frequency (0.96 vs. 2.05, p.001), NPRS-Neck pain (1.86 vs. 3.38, p.001), and Neck Disability Index (3.70 vs. 7.20, p.001). DASS-Stress (2.57 vs. 4.79, p=0.006), DASS-Anxiety (1.79 vs. 3.21, p=0.014), and DASS-Depression (0.54 vs. 2.14, p.001) scores were better. SF-12 Physical (18.64 vs. 16.72, p.001) and Mental (23.86 vs. 20.90, p.001) component scores remained significantly higher.
This study provides scientific evidence supporting integrating PPIVMs as a manual therapy technique into therapeutic exercise. It demonstrated significant improvements in physical and mental health outcomes for CGH patients immediately after and after three months of treatment. However, the results were statistically significant but not clinically significant in most measures.
The findings highlight the importance of incorporating exercise and PPIVMs into treatment plans, especially for patients who prefer manual therapy and when therapists possess the necessary skills. The findings highlight the importance of incorporating exercise and PPIVMs into treatment plans, especially for patients who prefer manual therapy and when therapists possess the necessary skills.
Manual Therapy
Treatment
