The CO-C3 Segmental Dysfunction Role in Primary Headache
Tutor: Dean Watson – MAppSc (Research – Manipulative Therapy), MMPAA, MAPA
Consultant Headache and Migraine Physiotherapist
COURSE ITINERARY - DATES - LOCATIONS - CONTACTS
COURSE PAYMENT - ENROLMENT
1. Introduction and Philosophy of the Course:
This course challenges traditionally held beliefs.
There are over 300 different types of headache described in the literature — are there 300 different causes of headache? No. There is not a year that goes by when another headache type is recognised including 'ponytail headache' and 'chewing gum headache'! Headache diagnosis is one of the longest lists of differential diagnosis in medicine.
This is a highly practical course based on current research and Dean's unparalleled clinical experience (see profile) in the assessment (identification of) and management of relevant cervicogenic dysfunction in benign recurring headache.
The subjective examination of headache is arguably more important than in any other musculoskeletal condition for three reasons:
- In other musculoskeletal conditions there are reproducible objective signs which can be reassessed but this is not the case in headache — there is an increased reliance on the subjective features;
- Recognition of the 'Red Flags' — intracranial pathology; tumours (particularly in children) or a low volume slow leaking aneurysm which are misdiagnosed significantly — up to 60 per cent;
- Potential Instability — it has been argued that at best, it is presumptive of us, and at worst dangerous, for us as physiotherapists to be assessing the craniovertebral ligamentous structures; the ability to recognise instability before you lay your hands on is crucial.
Research has demonstrated that cervicogenic dysfunction exists in different headache forms but is it relevant? Dean has developed innovative examination techniques, which not only ascertain if cervicogenic dysfunction is relevant to headache or migraine but can also determine which of the spinal segments or combination thereof is responsible. This diagnostic accuracy underpins successful management.
Reproduction and lessening of headache (as the technique is sustained) is crucial otherwise a false impression may be gained. Reproduction with subsequent lessening of symptoms implies that the dysfunction is relevant and, combined with knowledge of the relevant biomechanics and recognition of clinical patterns, it is possible to determine at a segmental level the source of the headache during a headache free period.
Are you not confident using high velocity thrust techniques in the upper cervical spine? The treatment of relevant movement abnormalities does not involve high velocity thrust techniques. This course will demonstrate assessment and treatment on participants with headache and Dean also examines two unseen patients.
The course also reviews the standard examination techniques of craniovertebral stability (and the subjective features suggestive of potential instability). Arguably some of the tests are gross, potentially missing some of the minor instabilities we are presented with and at worst dangerous as they are stressing already vulnerable structures; alternative testing which lessens the impact on possibly already damaged structures will be demonstrated and practised.
- To improve your ability to recognise "Red flags" and potential instability;
- To improve your ability to identify relevant segmental (CO-C3) dysfunction;
- To improve your ability to localise which segmental level (or combination thereof) is the source of headache;
- To lessen the impact of your manual examination (and treatment) on potential craniovertebral instability;
- To provide an effective alternative (to HVTTs) for the management of upper cervical hypomobility;
- To add another dimension to your treatment of headache
3. Learning Outcomes of the Course:
On completion of the course you will be able to:
- Conduct a sensitive (to 'Red Flags' and potential instability) and effective subjective examination;
- Perform a responsible and sensitive assessment of the craniovertebral ligamentous status;
- Determine the relevancy of segmental (CO-C3) hypomobility to the headache mechanism;
- Determine which segment or segments are the source of headache;
- Treat hypomobility of the upper cervical segments without the use of HVTTs
4. Structure of the Course (see also Course Program):
- The Medical Model of Headache. (Interactive Lecture) A review of the traditional medical model of headache and the diagnostic criteria of the 3 primary headache groups — and also how orthodox medicine views cervicogenic headache.
- Cervicogenic Dysfunction and Benign Recurring Headache. (Interactive Lecture) What’s in a diagnosis? Diagnosis is after all based on a set of signs and symptoms, which do not give any indication as to the underlying pathophysiology. This section comprises an extensive review of the literature which supports Dean’s clinical experience i.e. cervicogenic dysfunction has the potential to be involved in and is significantly underestimated in benign recurring headache. The current research into the primary headache types is presented which indicates that intracranial blood vessels and muscle tension are not the key players in migraine and tension-type headache respectively. Participants will be introduced to 'SNAM' — the sensitive new age migraine.
- The Subjective Examination. (Interactive Lecture) There is an increased reliance of the subjective features of headache for signs of improvement. The participants will be guided through a detailed subjective examination, highlighting the features of 'Red Flags' and potential instability along with those features, which are likely to be the key indicators of progress. This lecture will also involve reviewing the features of the standard headache x-ray views.
- The Anatomy and Biomechanics of the CO-C3 Complex. (Lecture; each participant will be provided with a life-sized articulated model of the upper cervical spine) The relevant (to stability assessment and examination and treatment techniques) anatomy and biomechanics will be presented as it is described in the 'ideal world' ... but we do not live in an ideal world. The issues of the considerable asymmetry, which exists in the CO-C3 complex, will be discussed.
- The Objective Examination. (Demonstration / Practical; each participant will be provided with a life-sized articulated model of the upper cervical spine; participants work in groups of 3 to promote discussion / comparison of palpation findings) Participants will be guided through the Objective Examination including:
- New and non aggressive assessment procedures for the craniovertebral ligamentous structures based on biomechanical principles
- New positioning (involving retraction) procedures of the neck during headache which can determine which segment(s) are involved
- New passive accessory and physiological vertebral examination techniques which not only confirm the relevancy of dysfunction (by reproduction and lessening of headache symptoms) to the headache mechanism but also enables isolation of the dysfunction to a specific segment/s
- Examination of 2 Patients. (Interactive / Demonstration) Dean will examine two unseen patients, demonstrating the Subjective and Objective examinations and the use of the examination techniques in treatment.
- Treatment. (Interactive Lecture / Demonstration) This section involves discussion of the examination techniques as treatment techniques; the progression of techniques; frequency of sessions and home strategies / exercises. Reproduction of familiar symptoms, which lessen as the technique is sustained, are paramount.
- Introducing ENDUROFLEX™ (Interactive Lecture / Demonstration) Subsequent to his Masters research Dean has developed Enduroflex™, which is a novel, convenient and functional way of assessing the deep neck flexors. Assessment can now be done in sitting or standing with precise feedback.
5. Teaching and Learning Strategies:
- Interactive Lectures / Group discussion
- Practical sessions with ongoing feedback from fellow participants and coaching from Dean
- Use of a life-sized articulated model of the upper cervical spine
- Extensive 100 page manual
The course is programmed such that the lectures / interactive lectures and demonstrations prepare the participant for the practical component. Participants work in groups of 3 ensuring feedback from an 'observer', with the articulated model and the 'patient'.
6. Course Numbers:
7. Formative Assessment:
- receive feedback from fellow participants
- complete an Evaluation Questionnaire
- also complete a multiple-choice/self assessment examination.
8. Learning Resources for Participants:
A comprehensive course manual (approx 100 pages) will be issued. Participants will also have the use of a life-sized fully articulated model of the upper cervical spine.
9. Location of the Course:
Various. Please see: COURSE ITINERARY - DATES - LOCATIONS - CONTACTS
COURSE PAYMENT - ENROLMENT
10. Planned Dates for Delivery of the Course:
Variable. Please see: COURSE ITINERARY - DATES - LOCATIONS - CONTACTS
COURSE PAYMENT - ENROLMENT
11. Planned Lecturers:
MAppSc (Research), MMPAA, MAPA
Consultant Headache and Migraine Physiotherapist
PhD Candidate, Murdoch University, Western Australia
Dean graduated as a physiotherapist from the South Australian Institute of Technology (SAIT) in 1976. Dean completed a Graduate Diploma in Advanced Manipulative Therapy in 1983 (SAIT) and a Master of Applied Science by Research at the University of South Australia in 1991. Dean is currently a PhD Candidate at Murdoch University, Western Australia, where he is investigating the role of cervicogenic dysfunction in migraine and other forms of headache.
The findings of his Master’s program in which natural head posture and upper cervical flexor muscle performance was investigated in cervicogenic headache sufferers were published in Cephalalgia and have influenced the management of cervicogenic headache sufferers.
Dean was invited to join the Cervicogenic Headache International Research Group and is also member of the International Headache Society, the Australian Physiotherapy Association and Musculoskeletal Physiotherapy Association of Australia.
Dean is the Director of The Headache Clinic and the Watson Headache Institute and has been treating headache exclusively since 1991. In this time he has consulted over 5000 headache patients and completed in excess of 13000 treatments.
Dean has taught and presented conference papers in Australia and internationally in New Zealand, The Netherlands, Belgium, Germany, Switzerland, Hong Kong, Singapore and the United Kingdom and is an invited lecturer on the Masters Musculoskeletal program at the University of South Australia.
Please note: Audio or electronic recording in any form during the course is prohibited.
Copyright © 2002 – 2007 and beyond: The Watson Headache Institute