STUDY DESIGN: Reliability of clinical measurements over time. OBJECTIVES: To determine the long-term stability and minimal detectable change (MDC) of the flexion-rotation test (FRT) measurements over days in subjects with cervicogenic headache (CGH). BACKGROUND: The FRT is used by physical therapists to assist in identifying upper cervical movement impairment, as well as to gauge treatment effectiveness. Test-retest reliability for the FRT has been reported, but the stability of range-of-motion measures taken during the FRT over time and the MDC have not been investigated. METHODS: Fifteen subjects with CGH were evaluated on headache-free days using the FRT by a blinded examiner at baseline, 2, 4, and 14 days later. An additional 10 asymptomatic subjects were included for blinding purposes. On each occasion, the examiner measured range of motion and determined whether the FRT was positive or negative. RESULTS: For subjects with CGH, there was no significant change in FRT range of motion over days (P>.05). Intraclass correlation coefficients for intratester reliability were 0.95 (95% CI: 0.90 to 0.98) and 0.97 (95% CI: 0.94 to 0.99) for right and left rotation, respectively. MDC₉₀ was 4.7° for right rotation and 7° for left rotation. Examiner interpretation of the FRT was consistent over time, with κ = 0.92. CONCLUSIONS: This study provides evidence that FRT measurements are stable over time, and the MDC₉₀ indicates that a change in FRT range of motion of at least 7° is required to be confident that a change has occurred due to an intervention rather than measurement error.

J Orthop Sports Phys Ther 2010;40(4):225-229, Epub 12 March 2010. doi:10.2519/jospt.2010.3100

KEY WORDS: cervicogenic headache, neck, psychometrics, ROM, spine

STUDY DESIGN: Randomized, double-blind, placebo controlled trial. OBJECTIVES: To determine the effect of a C1-C2 self-sustained natural apophyseal glide (SNAG) on cervicogenic headache. BACKGROUND: Cervicogenic headache is a common condition causing significant disability. Recent studies have shown a high incidence of C1-C2 dysfunction, evaluated by the flexion-rotation test (FRT), in subjects with cervicogenic headache. To manage this dysfunction, Mulligan has described a C1-C2 self-SNAG, though no studies have investigated the efficacy of this intervention approach. METHODS: A sample of 32 subjects (mean ± SD age, 36 ± 3 years) with cervicogenic headache and FRT limitation were randomized into a C1-C2 self-SNAG or placebo group. After an initial instruction and practice visit in the clinic, interven­tions consisted of exercises applied independently by the subject twice daily at home on a continual basis. FRT range was measured twice, before and immediately after the instruction and practice visit. Headache symptoms were determined by a headache index over time, assessed by question­naire preintervention, at 4 weeks postintervention, and at 12 months postintervention. RESULTS: No differences were found in baseline measures between groups. Immedi­ately after the initial instruction and practice visit performed with the supervision of the therapist, FRT range increased by 15° (SD, 9) for the C1-C2 self-SNAG group (P<.001), which was significantly more than 5° (SD, 5) for the placebo intervention (P<.001). There was also a significant interaction for the variable headache index between group and time (P<.001), indicating that group difference was dependent on time. There was no difference in headache index scores at baseline between groups. Headache index scores were substantially less in the C1-C2 self-SNAG group (mean ± SD points at 4 weeks, 31 ± 9; mean ± SD points at 12 months, 24 ± 9) compared to the placebo group (mean ± SD points at 4 weeks, 51 ± 15; mean ± SD points at 12 months, 44 ± 13) at 4 weeks (P<.001) and 12 months (P<.001), with an overall (±SD) reduction of 54% (±17%) for the individu­als in the C1-C2 self-SNAG group. CONCLUSIONS: These results provide evidence for the efficacy of the C1-C2 self-SNAG technique in the management of individuals with cervicogenic headache.  

J Orthop Sports Phys Ther. 2007;37(3):100-107. doi:10.2519/jospt.2007.2379  

KEY WORDS: atlantoaxial joint, cervical spine, flexion-rotation test, joint mobilization, Mulligan

Two of the authors of this paper are members of the Mulligan Concept Teachers Association. They both provide educational workshops in the Mulligan Concept to postgraduate physiotherapists, for which they receive a teaching fee.

Study Design: Prospective nonrandomized controlled trial.
Objectives: To determine the effect of fibular repositioning tape (FRT) on incidence and severity of ankle injury.
Background: Pain and functional disability is common following ankle sprain and a major problem in sport. A novel method of taping, FRT, which has been described to prevent ankle sprain, requires less tape than traditional methods and is easier to apply. The objective of this study was to determine the effect of FRT on the incidence and severity of ankle injury in basketball.
Methods and Measures: One hundred twenty-five male basketball players were assigned at time of play to either the control (209 exposures) or FRT (224 exposures) condition in a manner of convenience. Control participants had the choice on the use and type of prophylaxis, excluding FRT. FRT participants were taped using the method described by Mulligan. Ankle injury data were collected after each exposure. Injury severity was determined by functional limitation, pain levels, and days to return to play.
Results: Four hundred forty-three measured basketball exposures resulted in 11 ankle injuries. All injuries occurred in subjects with a history of previous ankle sprain. Significantly less ankle injuries were sustained by members of the FRT condition (n = 2), compared to members of the control condition (n = 9) (Fisher exact test, P = .03). The odds ratio of sustaining an ankle injury was 0.20 (P = .04; 95% confidence interval [CI]: 0.04, 0.93) when taped with FRT and the number needed to treat was 22 (95% CI, 12-312).
Conclusions: This study provides preliminary data regarding the prophylactic effects of FRT on ankle injury in male basketball players.

J Orthop Sports Phys Ther. 2006;36(9):661-668. doi:10.2519/jospt.2006.2259

Key Words: ankle sprain, injury prevention, inversion injury, taping