Spotlight on Electives: Comprehensive Evaluation of Cervicogenic Headaches and Temporomandibular Disorders

“Comprehensive Evaluation of Cervicogenic Headaches and Temporomandibular Disorders: Etiology, Pathophysiology and Comprehensive Management,” developed and taught by Dr. Mannheimer, is a highly specialized course that explores the inter-relationship between the cranium, cervical spine and shoulder girdle with the masticatory and orofacial musculature, teeth/occlusion and temporomandibular joints. Various types of headaches, orofacial, craniomandibular and cervical pain syndromes with or without dysfunction can arise from one or more of the above regions and trigger pain and dysfunction of the cervical and/or temporomandibular complex. Symptoms such as tinnitus, barohypoacusis, tooth-gingival pain, dysphagia, dizziness, nausea, reflux/bloating and visual disturbances are common and can lead to improper diagnosis with treatment that is commonly limited to medication and/or palliative physical therapy modalities.

Dr. Mannheimer has been teaching this course at Columbia since 2005 when it was initially presented in a one-weekend format. It has since expanded to its current 10-day format, due to the increasing amount of new clinical and research data, evaluative methodology, hands-on manual, and therapeutic exercise techniques as well as adjunctive devices, therapeutic modalities, ergonomic modifications and postural corrective garments for home use.

The course consists of lectures followed by hands-on workshop sessions designed to teach the student how to perform a comprehensive evaluation of the cervical and temporomandibular complex. Manual therapeutic techniques include joint mobilization, myofascial release and sub-occipital traction specific to the cranium and temporomandibular complex, sub-occipital spine, cervical and shoulder girdle. Therapeutic exercises for each of the above regions include postural correction, stretching and strengthening paradigms that are enhanced by ergonomic instruction, proper driving-sitting-sleeping positions, garments, and home pain control devices and techniques (2-3).

Upon completion of the course, each student should be able to perform an individualized comprehensive evaluation and initiate treatment paradigms that address the causative and perpetuating factors, decrease pain and restore function as much as possible.

While the physical therapy profession has matured into specialized fields such as pediatrics, geriatrics, orthopedics, sports, women’s health, neurology, Dr. Mannheimer points out that there has been a void within physical therapy in the field that encompasses the inter-relationship of cervical spine disorders (CSD), cervicogenic headaches (CGH), orofacial pain (OFP) and temporomandibular disorders (TMD).

He found that the number of physical therapists with specialized training and advanced education in this composite field represents a small fraction of the American Physical Therapy Association (APTA) membership that parallels that of the dental profession. The majority of dentists, oral surgeons, and physicians of all specialties as well as the public and the insurance industry continue to be unaware that there are physical therapists who specialize in the evaluation and treatment of patients with CSD, CGH, OFP, and TMD. This factor and the need to develop an educational and certification program for physical therapists spawned the creation of the Physical Therapy Board of Craniofacial and Cervical Therapeutics (PTBCCT) in 1999 that Dr. Mannheimer founded with the assistance of the American Academy of Orofacial Pain  (AAOP). (1) The impact that physical therapists who are AAOP members have fostered within the academy has led their current status to be equal to that of dentists.

Ashleigh Donaldson, a former student, commented on her experience with the course. “Dr. Mannheimer is a highly skilled and experienced clinician who puts extensive time and care into the course material. The class allows students to hone their craft and become comfortable with how to conduct treatment sessions from start to finish. Highly recommended for anyone going into outpatient.” 

References

1. Mannheimer JS. 2010. The Physical Therapy Board of Craniofacial and Cervical Therapeutics. Guest Editorial. J of Craniomandibular Practice.

2. Mannheimer, JS. 1994. Prevention and Restoration of abnormal upper quarter posture.  In Gelb H (ed). Postural Considerations in the Diagnosis and Treatment of Cranio-Cervical-Mandibular and Related Chronic Pain Disorders. Mosby-Wolfe.

3. Kietrys DM, Palombaro KM & Mannheimer JS.  2014. Dry Needling for Management of Pain in the Upper Quarter and Craniofacial Region.  Current Pain & Headache Reports.