Manual Therapy 25 (2016) e5ee32
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Manual Therapy
journal homepage: www.elsevier.com/math
Abstracts from IFOMPT 2016 conference, 4-8 July 2016, Glasgow, UK
Focused Symposia Abstracts
FOCSYM-171
EVIDENCE-BASED CLINICALLY-INFORMED MANUAL THERAPY CLINICAL
REASONING FOR HEADACHE MANAGEMENT
C. Ferna
ndez de las Pen ~ as 1, *, J. Cleland 2, C. Courtney 3, T. Hall 4,
L. Puentedura 5. 1 Physical Therapy, Occupational Therapy, Rehabilitation
and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain;
2
Physical Therapy Program, Franklin Pierce University, Manchester, United
States; 3 Department of Physical Therapy, University of Illinois at Chicago,
Chicago, United States; 4 School of Physiotherapy & Exercise Science, Curtin
University, Perth, Australia; 5 Department of Physical Therapy, University of
Nevada Las Vegas, Las Vegas, United States
* Corresponding author.
Relevance to IFOMPT and expected audience: Headache is a prevalent,
disabling condition with heterogenous pathogenesis. Although historically
manual therapists treat headache, manual therapy is an under utilized
approach, even though evidence indicates this could help. In addition,
current manual therapy management of headache remains inconsistent
and not always appropriate. This is despite improved knowledge of
headache pathogenesis and clinical reasoning. This presentation is rele-
vant to all manual therapists and will provide evidence-based, clinically
informed clinical reasoning for management of headache.
Summary of session format: The session will be broken into 6 parts:
1. Introduction to headache covering the physical therapist's role in
headache treatment.
2. Effectiveness of manual therapies for tension-type headache.
3. Effectiveness of manual therapies for cervicogenic headache.
4. Identification of cervical musculoskeletal impairments and clinical tests
found to be useful in clinical examination of patients with cervicogenic
headache.
5. Clinical reasoning for management of headache with manual therapy
covering the clinical rational for tension-type and cervicogenic headaches,
and will include demonstration of manual interventions and exercise for
the management of these headaches.
6. Open discussion for question and answer session.
Information concerning any presentations or publications: The pre-
senters have been involved in manual therapy practice, undergraduate and
postgraduate clinical education, and research on the topic of headache for
up to 35 years. Collectively the authors have more than 600 publications in
peer-reviewed journals. In addition they have published many book
chapters and text-books on the topic.
Description: In recent years, there has been an increasing knowledge of
the pathogenesis and clinical reasoning of different headaches. This un-
derstanding has improved current management of these chronic condi-
tions. Scientific evidence supports the role of manual therapies in the
management of tension type and cervicogenic headaches; but the results
are conflicting. In fact, inconsistent results can be related to the fact that
maybe not all manual therapies are appropriate for all types of headaches;
or maybe not all patients with headache will benefit from manual therapy.
A recent meta-analysis supports the role of manual therapies targeted to
soft tissues for the management of tension type headache, but better
understanding of pain mechanisms is clearly required. There is pre-
liminary data suggesting that patients with a lower degree of sensitization
will benefit to a greater extent from manual therapies; although more
studies are needed. In fact, there is evidence demonstrating the presence
of peripheral and central sensitization mechanisms in tension type and
cervicogenic headaches. Clinical management of patients with headaches
needs to extend beyond local tissue-based pathology, to incorporate
strategies directed at normalizing central nervous system sensitivity. This
presentation will outline some examples of manual therapies for tension
type and cervicogenic headache, based on a nociceptive pain rationale, for
modulating central nervous system hypersensitivity.
Introduction to tension-type and cervicogenic headaches:
This section will highlight the physical therapist's role in headache treat-
ment. Clinical reasoning on differential diagnosis (e.g. primary versus
secondary headache), possible underlying pain mechanisms, contributing
factors, and prognosis will be discussed.
Effectiveness of manual therapies for tension-type headache:
This section will discuss the effectiveness of manual therapy strategies for
managing a patient with tension-type headache.
Effectiveness of manual therapies for cervicogenic headache:
This section will discuss effectiveness of manual therapy strategies for
managing a patient with cervicogenic headache.
Musculoskeletal dysfunction of the neck in cervicogenic headache:
This section will discuss relevant musculoskeletal impairments found to be
useful in clinical examination of patients with cervicogenic headache.
Clinical reasoning for management of headache with manual therapy:
This section will discuss the clinical rational for manual therapy in-
terventions for tension-type and cervicogenic headaches, and will include
demonstration of manual interventions and exercise for the management
of these headaches.
Learning objectives: 1. Appreciate the different clinical presentation of
various headache types and correlate clinical headache presentation with
potential pain mechanisms.
2. Understand the effectiveness of physiotherapy in the management of
tension type headache and cervicogenic headache
3. Observe and critically discuss selected manual therapy interventions for
the management of tension-type and cervicogenic headaches
Implication/Conclusions: This presentation will inform manual therapists
of current evidence-based and clinically informed classification of head-
ache and the identification of headache forms suitable for manual therapy.
Appropriate manual therapy management will be described for two
common headache disorder's cervicogenic headache and tension-type
headache based on a nociceptive pain rationale, for modulating central
nervous system hypersensitivity. The implications of this approach are that
manual therapists will be able to appreciate the different clinical presen-
tation of various headache types and correlate clinical headache presen-
tation with potential pain mechanisms. In addition they will better
understand the effectiveness of physiotherapy in the management of
tension type headache and cervicogenic headache. Finally, they will be
able to observe and critically discuss selected manual therapy in-
terventions for the management of tension-type and cervicogenic head-
aches. This will lead to improved outcomes in headache management.
Biography: Carol Courtney PT, PhD, ATC, FAAOMPT is Clinical Associate
Professor at the University of Illinois at Chicago. She received a Bachelor of
Science in Physical Therapy from Washington University in St Louis, Master
e6 Abstracts / Manual Therapy 25 (2016) e5ee32
of Applied Science in Manipulative Physiotherapy from the University of
South Australia, and PhD from the University of Miami. At UIC, she serves
as the director of the post-professional Fellowship in Orthopedic Manual
Physical Therapy. Her research investigates the effects of joint injury and
osteoarthritis on pain processing and joint function, as well as modulation
of pain mechanism through manual therapy intervention. Dr Courtney
serves as co-chair of the Standards Committee of AAOMPT and is a deputy
editor of the Journal of Manual and Manipulative Therapy.
Joshua Cleland PT, PhD is presently a Professor in the Doctor of Physical
Therapy Program at Franklin Pierce University. He practices clinically in
outpatient orthopaedics at Rehabilitation Services of Concord Hospital,
Concord, NH. He is actively involved in numerous clinical research studies
investigating the effectiveness of manual physical therapy and exercise in
the management of spine and extremities disorders. He has published over
170 manuscripts in peer-reviewed journals including Spine, Physical
Therapy, the Journal of Orthopaedic and Sports Physical Therapy and Manual
Therapy. He is an Editorial Review Board Member for the Journal of Or-
thopaedic and Sports Physical Therapy. He is currently an author/editor on 4
text books. Dr Cleland is a well know speaker at both the national and
international level. He is the recipient of the 2013, 2014 and 2015 Rose
Excellence in Research Award and the 2009 Eugene Michels New Inves-
tigator Award. He also received the 2008 Jack Walker Award from the
American Physical Therapy Association.
Ce
sar Ferna

ndez-de-las-Pen ~ as PT, MSc, PhD is presently Head Division and
Clinical Researcher at the Department of Physical Therapy, Occupational
Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos
(URJC), Madrid, Spain. He earned his first PhD in Biomedical Sciences in
Aalborg, Denmark. He practices clinically in outpatient clinic at the Reha-
bilitation Services of URJC. He is actively involved in numerous clinical
research studies investigating the effectiveness of manual physical therapy
and exercise in the management of several chronic pain conditions. He has
published more around 250 publications in peer-reviewed journals
including Spine, Journal of Orthopaedic and Sports Physical Therapy, Manual
Therapy, Clinical Journal of Pain, Brain, Cephalalgia, Headache. Most papers
concentrate on clinical human pain research, drug screening and interaction
between motor control and chronic pain. He has published around 50 clinical
papers on headaches. He is currently an author/editor on 10 text books. He is
the recipient of the 2013 and 2015 Rose Excellence in Research Award.
Toby Hall PT, MSc, PhD is a Specialist Musculoskeletal Physiotherapist (as
awarded by the Australian College of physiotherapists in 2007), graduating
in the UK in 1985, followed by an MSc in 1996 and PhD in 2010. He holds
the position of Adjunct Associate Professor at Curtin University. Toby has
presented at many conferences, published many book chapters and pub-
lished more than 75 peer-reviewed articles relating to cervicogenic
headache, neural tissue disorders and other topics. He has co-authored 2
books “Mobilization with Movement, The Art and the Science” & The
Mulligan Concept of Manual Therapy: Textbook of Techniques”. He regu-
larly reviews for many journals, is on the international advisory panel of
Manual Therapy, and is an Associate Editor for the Journal of Manual and
Manipulative Therapy. Toby is a director of Manual Concepts, for which he
teaches a range of manual therapy courses around the world.
Louie Puentedura PT, DPT, PhD, OCS, FAAOMPT is an Associate Professor at
the University of Nevada Las Vegas. He received his physical therapy de-
gree and completed a Graduate Diploma in Manipulative Therapy from La
Trobe University in Melbourne, Australia in the early 1980s. He completed
a post-professional DPT at Northern Arizona University, and Ph.D. in
Physical Therapy from Nova Southeastern University in Fort Lauderdale,
Florida. He has been involved in orthopedic manual therapy for over 35
years and has lectured and presented seminars on the various approaches
to manipulative therapy. He is a board certified specialist in orthopedic
physical therapy, a Fellow of the American Academy of Orthopedic Manual
Physical Therapists and is an ISPI Certified Spinal Manual Therapist. Louie
has published extensively regarding research on spinal manipulation as
well as research on pain neuroscience education, and was the recipient of
the 2013 Rose Excellence in Research Award as well as the 2012 John
Medeiros Distinguished Author Award.
Funding acknowledgements: Nothing to declare.
Disclosure of interest: None declared.
Keywords: Headache, Manual Therapy, Musculoskeletal Pain
FOCSYM-173
PHYSICAL ACTIVITY AND CHRONIC MUSCULOSKELETAL PAIN: “NO
PAIN, NO GAIN?”
M. Meeus 1, 2, *, R. Smeets 3,4, D. Cook 5, 6, D. Beckwee 7. 1 Department of
Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent,
Belgium; 2 Department of Rehabilitation Sciences and Physiotherapy,
University of Antwerp, Antwerp, Belgium; 3 Rehabilitation Medicine,
Maastricht University, Maastricht, Netherlands; 4 Adelante Centre of
Expertise in Rehabilitation, Maastricht, Netherlands; 5 Department of
Kinesiology, University of Wisconsin Madison, Madison, United States;
6
William S. Middleton Memorial Veterans Hospital, Madison, United States;
7
Department of Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
* Corresponding author.
Relevance to IFOMPT and expected audience: Physical activity is
frequently utilized as a central component in the treatment of patients
with chronic musculoskeletal pain, given the clinical benefits. But, there
are often huge barriers when patients attempt to become more physically
active, eg. pain exacerbations, bad recovery etc. We will address the
challenges encountered when attempting to increase physical activity
levels of select chronic pain populations, by providing insight in mecha-
nisms and modalities for applying physical activity for chronic musculo-
skeletal pain.
Summary of session format: Exercise and chronic pain: Friend or foe?
Benefits and adverse effects of both acute and long term exercise for pa-
tients with chronic musculoskeletal pain are discussed.
Prepared for some action?
Why and what do we need to assess before subjecting a patient to an
activity program, with special emphasis on psychological readiness and
current fitness.
Mens sana in corpore sano?
Unravelling the psychobiology of pain and exercise as it relates to chronic
pain.
How to exercise?
As the response to exercise varies between different pain conditions,
applying personalized health care to exercise therapy, based on of phe-
notyping patients, seems required.
Information concerning any presentations or publications: All authors
published and disseminated widely on the topic of physical activity and
pain, and will bring an innovative comprehensive story to translate their
expertise to clinical practice.
Description: The Exercise and Pain Paradox
Exercise is a common therapeutic modality recommended in the man-
agement of individuals with chronic pain conditions and often used in
manual therapy practice. However, just as not all pain conditions are the
same, neither are individual responses to exercise.
For example, individuals with chronic pain may or may not have facilitated
central mechanisms which is just one, of many, potential factors that in-
fluence pain and responses to exercise.
Although in healthy people an acute bout of exercise normally induces
hypoalgesia or analgesia, we often see the opposite in chronic musculo-
skeletal pain patients as exercise can lead to exacerbation of pain and other
symptoms. This is especially the case in those with facilitated central
mechanisms. Indeed the response to exercise varies between different
conditions and is dependent on the type of exercise.
On the other hand it is known that, in the longer term, training programs
are nevertheless beneficial and that exercise could then even be adopted as
a tool for activating endogenous pain inhibition. For example, structured
exercise is a safe and efficacious treatment for a multitude of chronic pain
conditions e leading to improvements in physical function, greater well-
being and reduced pain symptoms. Chronic muscle pain patients with
higher physical activity levels show brain and behavioral responses
indicative of effective pain modulation while those with higher sedentary
behaviors show an impaired ability to regulate pain. This suggests that
maintaining even minimal levels of physical activity can help preserve the
ability to regulate pain for chronic muscle pain patients. But how to pre-
scribe the exercise, depends on the phenotyping of the patient. To date, the
majority of exercise interventional studies have emphasized effects at the
level of a group rather than taking into account the individual differences.