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

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.