The Upper Cervical Spine in Headaches, Dizziness & Pain:
A Neuro-Orthopedic Perspective 2013
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Course Dates
- March 9-10th, ProMedica Total Rehab at Bay Park Hospital 2751 Bay Park Drive Suite 150 (Entrance #1) Oregon, Ohio 43616 contact Frank Gargano
Outline:
This lab based course will bridge the gap between neurological theory and the clinical application of manual therapy based protocols. The current literature on cervicogenic headaches and the Dr. Gargano's dissertation research on cervicogenic dizziness will be presented. Hands on treatment protocols are presented in a logical treatment progression. In depth discussions on the various conditions that influence treatment outcomes such as Migraine, and Orthostatic Dysautonomia will be presented. The production of pain, referred pain and dizziness from the Craniomandibular and Sinuses will be addressed anatomically as well as neurologically. The signs and symptoms of Cervical Dystonia will be discussed as it relates to treatment failure and how to handle these patients. Discussion and treatment thoughts on Somatically Modulated Tinnitus will be presented. Evaluation and treatment of the vestibular system as it relates to the upper cervical spine is discussed to provide the orthopedic clinician with a basic comfort level with this patient population. Common vestibular dysfunctions such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular hypofunction and loss of visual stabilization are identified and treatment strategies are discussed. Clinicians' primarily practicing vestibular rehabilitation will develop the manual therapy skills necessary to evaluate and treat cervical causes of dizziness. Trouble shooting patients that do not respond to treatment and possible reasons/solutions for this will be discussed. A reintegration exercise protocol will be presented and practiced with immediate clinical application.
Objectives:
- Understand the relationship between the vestibular, visual, and somatosensory (upper cervical spine) systems as they relate to rehabilitation.
- Understanding of the relevant anatomy, neurology and biomechanics of the craniocervical and thoracic spine.
- Understand the myofascial involvement and referral patterns of the upper quarter. Understand the various headaches types and how they relate to orthopedic management.
- Discuss Orthostatic Intolerance and how it relates to persistent symptoms.
- Be able to identify and treat symptoms consistent with a peripheral vestibular disorder.
- Be able to perform various joint and soft tissue mobilization techniques to the craniocervical and thoracic spine.
- Develop a comprehensive reintegration exercise progression that will address the complaints of headaches, cervical pain and dizziness.
Course Outline:
Day 1. Saturday, 8 am - 5 pm
- 8:00 - 8:15 Introduction
- 8:15 - 9:00 Neurophysiology (lecture)
• Subjective Evaluation Concepts - 9:00 - 9:15 Break
- 9:15 - 10:45 Objective Evaluation of the Upper Cervical Spine (lab)
• Craniocervical Motion Testing (lab) - 10:45 - 12 Myofascial Examination and Treatment (lab)
• Cervical (lab) - 12:00 - 1:00 Lunch
- 1:00 - 2:30 Myofacial Examination and Treatment continued (lab)
• Craniomandibular (lab)
• Sinus - 2:30 - 2:45 Break
- 2:45 - 4:45 Vestibular Anatomy and Clinical Screening (lecture/lab)
• Central and Peripheral Screening (lab)
• Benign Paroxysmal Positional Vertigo (BPPV/VNG)
• Particle Repositioning Therapy (PRT)
• Postural control assessment (lecture)
• Functional outcome tools (lecture) - 4:45 - 5:00 Questions & Case Study
Day 2. Sunday, 8 am - 4:30 pm
- 8:00 - 9:30 Migraines and Orthostatic Intolerance (POTS) (lecture)
- 9:30 - 9:45 Break
- 9:45 - 12:00 Manual and Neuromuscular Treatment of the Craniocervical Region (lab)
- 12:00 - 1:00 Lunch
- 1:00 - 2:00 Manual and Neuromuscular Treatment of the Craniocervical Region Continued (lab)
- 2:00 - 3:00 Manual and Neuromuscular Treatment of the Thoracic Spine (lab)
- 3:00 - 3:15 Break
- 3:15 - 3:45 Craniocervical Reintegration Exercise Progression (lab)
• Cervical and vestibular reintegration
• Central reintegration - 3:45 - 4:15 Somatic Tinnitus and Cervical Dystonia (lecture)
- 4:15 - 5:00 Review of pre-test, conclusions and questions
Course Format:
This 2 day course will be presented in a PowerPoint format with active audience participation through case studies and considerable hands on lab time. Workbook of lecture, articles written by instructor and exercise sheets will be provided for future reference.
Course Instructors:
- Frank Gargano PT, DPT, OCS, MCTA, CWT
