Mechanical Diagnosis and Therapy vs Traditional Physical Therapy in the Treatment of Mechanical Headaches
Condition: Headaches, Tension
MeSH terms: Tension-Type Headache; Headache
Study type: Interventional

Summary: 
      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.

      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 tension-type
      headaches (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.
    

Detailed description: 
      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.
    

Intervention name(s): Traditional Physical Therapy; MDT based physical therapy
Intervention type(s): Other; Other
Intervention description(s): Physical therapy-based interventions; MDT based physical therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two randomized groups. One receiving traditional physical therapy treatments for patients with mechanical headaches. The other will receive an MDT- based approach.
Masking: Single (Participant)
Primary purpose: Treatment