Mechanical Diagnosis and Therapy vs Traditional Physical Therapy in the Treatment of Mechanical Headaches

Headaches affect an estimated 46% of adults worldwide, and the pain can have a detrimental
effect on an individual's livelihood. In a two-week time period, 12.7% of the US workforce
was unable to productively work due to pain, with headache pain as the most common complaint.
For those with headache pain, this resulted in 3.5 +/- 0.1 hours of productivity lost in a
week. Quality of life, financial situation, employment, and social involvement are negatively
impacted by headache pain. Coworkers and family may have to handle work or personal
responsibilities that those with headaches are unable to fulfill.

In addition to manual therapy, mobilizations, manipulations, and exercise, the McKenzie
method of Mechanical Diagnosis and Therapy (MDT) is currently being used to treat headaches.
However, there is little supportive evidence about the efficacy of this type of treatment.
The MDT method focuses on actively involving the patient in education and self-management of
pain. The focus is to have the patient learn about his/her condition and how to manage the
symptoms independently when possible.

A study in Poland compared MDT interventions to a control group that received therapeutic
exercise, massage, and ultra-red radiation for patients with cervical derangement. Although
not targeted at patients with a primary complaint of headache, the percentage of patients in
the MDT group experiencing headache decreased from 80% to 3.33% whereas the percentage of
patients in the control group experiencing headaches decreased from 83.87% to 51.61%. This
indicates that MDT may be an effective treatment for headaches with a mechanical component.

With regards to research that has been conducted on the use of MDT with headaches, one study
compared mechanical traction, rhythmic impulse, and MDT exercises in relieving TTH.
Mechanical cervical traction was found to be more effective at reducing headaches in both
infrequent episodic and frequent episodic TTH. While MDT was used in this study, a general
treatment was prescribed to each patient in that group without consideration to directional
preference. This treatment had the patients perform the same exercises in the same
progression, including four extension exercises, one flexion exercise, two lateral flexion
exercise, and one rotation exercise. In addition, they performed the exercises for the same
length of time for the same number of repetitions. The study was unclear about whether the
exercises were administered by physical therapists or whether the practitioners were MDT
credentialed.

One case study described the treatment of a cervicogenic headache using the MDT retraction
progression along with therapeutic exercises that included deep neck flexor and extensor
strengthening and stretching of neck musculature as indicated . The patient reported that
performing retractions at home provided him relief from his headaches for progressively
longer periods of time as his treatment progressed. By the end of the treatment, the patient
no longer experienced headaches. The results from this article support the proposition that
headaches which present with mechanical origins can be successfully treated with the MDT
approach.

Inclusion Criteria:

1. 18-65 years old: documentation ie: driver's license

2. Decrease in active cervical range of motion, compared to normal values established by
Magee [8]: Measured by Mary Free Bed physical therapists using the Cervical Range of
Motion inclinometer (i.e., the CROM).

3. Headache symptoms change based on manual pressure to cervical spine, posture, or neck
movement: Tested by Mary Free Bed physical therapist during evaluation

4. Cognition adequate for understanding (alert and oriented x3): Tested by Mary Free Bed
physical therapists

5. English-speaking, or able to understand English well enough to follow directions:
Determined at initial evaluation. Translators will not be available during the study
due to lack of funding and availability.

Exclusion Criteria:

1. Cervical spine fusion less than 6 months: Medical documentation and history portion of
initial evaluation. Medical documentation to be reviewed will only be viewed by the
physical therapist and will only include information that is typically available to
physical therapists in standard practice.

2. Trauma to neck or head within the past 3 months: Medical documentation and history
portion of initial evaluation

3. Concussion currently undergoing treatment: Medical documentation and history portion
of initial evaluation

4. Signs and symptoms of vertebral artery insufficiency: history portion of initial
evaluation and potentially the vertebral artery test performed by the Mary Free Bed
physical therapists

5. Diagnosis of Rheumatoid Arthritis or Down Syndrome: Medical documentation and history
portion of initial evaluation

6. Constitutional signs or symptoms: nausea, vomiting, profuse sweating, dizziness, etc
related to systemic illness: history portion of initial evaluation

7. Signs and symptoms of poor upper cervical spine ligament integrity: Identified through
specific manual upper cervical ligament tests performed by the Mary Free Bed physical
therapists

8. Connective tissue disorders: Ehlers-Danlos: Medical documentation and history portion
of initial evaluation

9. Chiari malformation: Medical documentation and history portion of initial evaluation

10. Signs and symptoms or evidence of myelopathy: Medical documentation and history
portion of initial evaluation

11. Diagnosis of dissociative personality disorder: Medical documentation and history
portion of initial evaluation

12. Pregnant: Medical documentation and history portion of initial evaluation

13. Neuropsychology issues such as inability to follow multistep directions and short term
memory loss: Medical documentation and history portion of initial evaluation