This case report describes the diagnosis and management of a 43-year-old female patient who had sustained an injury to her neck in a motor-vehicle accident two years earlier. The major symptoms described by the patient included headache and neck pain, but history and examination also revealed signs and symptoms potentially indicative of cervical artery compromise. Physical therapy management initially consisted of soft tissue and non-thrust joint manipulation of the lower cervical and thoracic spine, specific exercise prescription, and superficial heat. Cervical vascular compromise was re-evaluated by way of the sustained extension-rotation test. When at the fifth visit this test no longer produced symptoms potentially indicative of vascular compromise, upper cervical diagnosis and management consisting of soft tissue and non-thrust joint manipulation was added. A positive outcome was achieved both at the impairment level and with regard to limitations in activities, the latter including increased performance at work, a return to previous reading activities, improved length and quality of sleep, and greater comfort while driving. At discharge, the patient reported only occasional pain and mild limitations in activities. This report describes the positive outcomes in a patient with chronic whiplash syndrome; however, its main emphasis lies in the discussion and critical evaluation of clinical reasoning in the presence of diagnostic uncertainty with regard to cervical artery compromise.

It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to signifi cant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural defi cits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.Key Words: Cervicogenic Headache, Manipulation, Thrust, Exercise, Physical Therapy Orthopaedic Manual Physical Therapy Including Thrust Manipulation and Exercise in the Management of a Patient withCervicogenic Headache: A Case Report C ervicogenic headaches are commonly encountered in physical therapy (PT) practice. Cervicogenic headache is a headache type validated recently by the International Headache Society (IHS) that is hypothesized to originate due to nociception in the cervical area. In a Scandinavian population study, its prevalence was established at approximately 16%1 . Table 1 outlines the diagnostic criteria for cervical headaches as described by the IHS 2 . Horn and Smith 3 reviewed the literature on approaches to management of cervicogenic headache using orthopedic manual physical therapy (OMPT) principles. They recommended careful examination to identify all impairments, to provide a differential diagnosis, and to plan appropriate intervention. Recommended interventions included joint mobilization, soft tissue mobilization, retraining of specifi c postural muscle groups, and patient education. The authors recommended that emphasis should be placed on home and self-management skills and on increasing patient understanding of the predisposing factors with regard to cervicogenic headache. Jull 4 also described the importance of an accurate differential diagnosis ascertaining the cervical musculoskeletal origin of the headache to assure success with management of a cervical headache patient. She described the history and symptomatic features of cervical headach...

Successful program completion in an online education context is a combination of learner attributes, the university’s focus on meeting the needs of the students, and providing a quality educational product. This article focuses on the needs of the online student and how a program can provide the educational services that promote student retention. By recognizing distance education student needs and putting strategies into place to best meet those needs, programs can have a high course and program completion rate to meet accreditation standards and provide financial stability for the institution.

Successful program completion in an online education context is a combination of learner attributes, the university’s focus on meeting the needs of the students, and providing a quality educational product. This article focuses on the needs of the online student and how a program can provide the educational services that promote student retention. By recognizing distance education student needs and putting strategies into place to best meet those needs, programs can have a high course and program completion rate to meet accreditation standards and provide financial stability for the institution.

The patient's right ilial anterior rotation hypermobility was directly related to the mechanics of her tennis stroke. Her outcomes suggest that rehabilitation should focus on the entire abdomino-sacro-pelvic-hip complex, addressing articular, neural, and muscular inhibitions and deficiencies.