Clinical Reasoning for Manual Therapy in Headaches: An Evidence-Based Approach

6th & 7th August 2016 at Fox Point, WI
Freedom Physical Therapy Services is honored to host César Fernández-de-las-Peñas PT, DO, MSc, PhD who will be teaching a course at our Fox Point location. This hands-on 2-day course will provide an evidence based approach to the evaluation and treatment of headache patients. Freedom is committed to providing comprehensive and leading edge therapy, based on the latest evidence and techniques. Dr. Fernández-de-las-Peñas is highly regarded internationally for his research and publications on treatment recommendations for headache and chronic pain patients. This course will allow us to provide better care for our patients who suffer from temporomandibluar disorders, headaches, chronic pain and related conditions.

Course Description

This hands-on 2-day (16 hr) course will provide participants with an evidence based approach to the evaluation and treatment of headache patients, particularly tension type and cervicogenic. It will include a comprehensive presentation on the most recent findings by leading researchers including Gwen Jull from the University of Queensland, Australia and César Fernández-de-las-Peñas. Topics will include the efficacy of manual therapy, sensory and motor control impairments, neurophysiological changes in the nociceptive system and descending inhibitory systems, as well as recent evidence showing the presence of cortical changes in the brainstem of patients with headaches. Findings will be summarized to demonstrate the effectiveness of a new multisystem approach to the evaluation, treatment and management of patients with headaches. Areas of focus will include muscular trigger points, neural mechano-sensitivity, cervical and thoracic spine dysfunctions, and pain inhibition with repercussion on the “pain neuromatrix” of the brainstem.

This course will bring anatomical, biomechanical, neurophysiological headache treatment elements together in a clinically relevant way. It is appropriate for providers of all types who work with headache patients.

Course Objectives

  • Critically evaluate evidence for the clinical treatment of tension type, cervicogenic, and migraine headaches
  • Learn clear and concise subjective evaluation skills for headache patients
  • Learn how to generate a working hypothesis based on structures involved, the presentation and the behavior of the pain, and the functional repercussion on patient lifestyle
  • Plan and conduct objective examination of areas implicated by the working hypothesis
  • Plan optimal courses of treatment using orthopedic manual therapy, with special emphasis on neurophysiological aspects
  • Demonstrate clinical application of muscle, joint and neural approaches with emphasis on adaptations in the “pain neuromatrix” of the brainstem

About the Instructor

César Fernández-de-las-Peñas
Dr. Fernández-de-las-Peñas received his Degree in Physical Therapy from Universidad Rey Juan Carlos, Spain in 2000. He received a Post-Graduate Diploma in Spinal Manipulative Therapy (6 years) and Osteopathy (DO) from the Scientific European Osteopathic Society in 2005-06. He also received a Post-Graduate Diploma in Myofascial Pain Syndrome from the Universidad Castilla-La-Mancha in 2003. He reached his first PhD degree in Biomedical Sciences in 2007 at the Sensory-Motor Interaction Centre (SMI) in Aalborg University (Denmark) under the supervision of Prof. Lars Arendt-Nielsen. He also finished a second PhD degree in 2008 at the Universidad Rey Juan Carlos. Dr. Fernández-de-las-Peñas currently works as clinical researcher and teacher at the Universidad Rey Juan Carlos since 2001 and he is the Head Division of the Pain Laboratory and the Department of Physical Therapy of the same University. He also works in private practice in Madrid where he specializes in treating chronic pain.

Dr. Fernández-de-las-Peñas has published around 300 publications and he is the first author of approximately 150 of them. The most relevant topics of his research focus on chronic pain including neck pain, headaches, lateral epicondylalgia, carpal tunnel syndrome, fibromyalgia syndrome and neuro-physiological effects of manual therapy. His clinical research is mainly concentrated on biomedical sciences within neuroscience. He has participated in 60 conferences with related published proceedings and has given several lectures at national and international meetings/workshops /seminars.

Course Layout

Day 1 
08:30 – 08:35Welcome & Intro
08:35 – 09:05The problem of headache: The pain neuromatrix
09:05 – 09:30Clinical presentation of tension type, cervicogenic headache and migraine
09:30 – 10:30Sensitization mechanisms in headaches and chronic pain
10:30 – 10:45Break
10:45 – 11.30Cervical and thoracic spine and head pain: An Evidence-Based Approach
11:30 – 13:00Lab: Manual exploration of cervical spine dysfunction
13:00 – 13:30Lunch
13:30 – 14:00Manual therapy for cervical-thoracic spine: Evidence-Based Approach
14:00 – 16:00Lab: Joint mobilization/manipulation of the cervical and thoracic spine
16:00 – 17:00Lab: Motor control impairments and exercise for headaches
Day 2 
08:30 – 08:40Review and Q
08:40 – 09:30Myofascial pain and referred pain to the head: Research in headache
09:30 – 10:30Clinical and neurophysiological presentation of trigger points: Evidence-Based Approach
10:30 – 11:00Management of trigger points for headache: Evidence-Based Approach
11:00 – 11:15Break
11:15 – 12:00Lab: Clinical examinations of muscle trigger points of the head and neck
12:00 – 13:30Lab: Manual therapies for muscle trigger points, including exercises
13:30 – 14:00Lunch
14:00 – 16:30Lab: Dry needling for head and neck muscle trigger points
 Summary and Questions