Giovanni Parravicini, Matteo Ghiringhelli | Year 2021

Osteopathic Cranial Manipulation for a Patient With Whiplash-Associated Disorder: A Case Report

Pathology:

Whiplash

Type of study:

Case Report

Date of publication of the study’:

2021/Sep/01

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Purpose of the study

  • Objective: to show the possible immediate effects of cranial OMT to reduce pain on cervical mobility in whiplash-associated disorders
  • Measured outcomes: Pain intensity by Numeric Pain Scale (NPS) and active range of motion (ROM) of the neck area by accelerometer and gyroscope

Participants

  • Number: 1
  • Description: a 79-year-old man, a retired firefighter, turned up at the clinic 3 months after a car accident with a lateral and posterior impact. Ten days after the whiplash injury, he underwent rehabilitation – every two weeks for the first month and then every week for the second month – consisting of cervical physiotherapy, transcutaneous electrical nerve stimulation, and ultrasounds. Despite the benefits obtained, the following month he arrived at the osteopathic clinic with a complaint of persistent headache with a pain intensity of 6 out of 10, according to the Numeric Pain Scale (NPS).

The headaches were described as daily, disabling, unilateral, emerging from the cervical and occipital area and then extending to the frontal, temporal, and periorbital levels. The X-Rays showed no bone fractures, while the MRI revealed cervical osteoarthritis (although typical of the man’s age) and a protruded disc at the level of C5. During the medical history, no past medical conditions or head trauma were revealed. According to the TART approach, the osteopathic evaluation aimed to detect any somatic dysfunction in the cervical area and skull. Indeed, tissue restrictions were found in the occipital area, particularly at the level of the atlanto-occipital junction. Since the analysis of the active ROM of the cervical area showed alterations in the flexion and extension test, a diagnosis of somatic dysfunction of head and cervical region was issued.

Consequently, in the face of the previous rehabilitation treatments and of the osteopathic evaluation, it was decided to apply OMT only to the cranial region, particularly the occipital area.

Interventions and evaluations

  • Assessment before and after treatment of pain intensity through NPS and of active ROM of the cervical area through accelerometer and gyroscope.
  • 1 session of OMT
  • OMT:
    • treatment of the cranial area by using two techniques: bilateral fascial release of the mastoid process at the level of the occipital bone; compression and release of the left frontal bone prominence.

Results

Pain intensity decreased from 6 out of 10 to 1 out of 10 after treatment. Similarly, head rotation and tilt improved after cranial manipulation.

Discussion

Cranial OMT produced immediate improvements. Probably, the effect was due to stimulation of fascial mechanoreceptors, an event that changed the tone of the treated tissues and inhibited potentially active nociceptive activity at the cervical and trigeminal levels.

It is possible that the cervicogenic headache (pain decreased when sustained pressure was applied to the high cervical area) remained despite the previous rehabilitation because the occiput-C1 junction was not adequately treated. In fact, the cranium is often not considered in cervicogenic headache. In contrast, cranial osteopathy focuses specifically on this area.

Unfortunately, the literature does not report highquality studies on the efficacy of osteopathy in the cranial setting, just as there is a lack of rigorous randomized controlled trials on the consequences related to whiplash. Similarly, further studies on the mechanisms underlying osteopathic manipulations are essential so that their efficacy, safety, and usefulness can be better understood.

The lack of follow-up is a limitation of the study, as well as the lack of a control, since the symptoms could have disappeared spontaneously.

The review of Osteopedia

By Marco Chiera

Strengths: good description of osteopathic evaluation; good description of techniques used, including photos; use of pictures and graphs to show ROM results; interesting the report of immediate results; one of the few studies on osteopathy and whiplash.

Limits: like all case reports, it is difficult to generalize it; absence of follow-up.

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