Conservative Management of Occipital Neuralgia Supported by Physical Therapy: A Review of Available Research and Mechanistic Rationale to Guide Treatment.

PURPOSE OF REVIEW: Conservative management is consistently recommended as a first line intervention for occipital neuralgia (ON); however, there is limited clinical research regarding conservative intervention for ON. This lack of research may lead to underutilization or unwarranted variability in conservative treatment. This article provides mechanism-based guidance for conservative management of ON as a component of a multimodal treatment approach, and discusses the role of the physical therapist in the care team. It also highlights opportunities for further research to refine conservative management of this condition. RECENT FINDINGS: Published research on conservative interventions specific to ON is limited to very low-quality evidence for the use of TENS. The contemporary shift toward precision pain management emphasizing treatment based on a patient's constellation of clinical features-a phenotype-rather than solely a diagnosis provides more personalized and specifically targeted pain treatment. This paradigm can guide treatment in cases where diagnosis-specific research is lacking and can be used to inform conservative treatment in this case. Various conservative interventions have demonstrated efficacy in treating many of the symptoms and accepted etiologies of ON. Conservative interventions provided by a physical therapist including exercise, manual therapy, posture and biomechanical training, TENS, patient education, and desensitization have mechanistic justification to treat symptoms and causes of ON. Physical therapists have adequate time and skill to provide such progressive and iterative interventions and should be included in a multimodal treatment plan for ON. Further research is required to determine appropriate dosing, sequencing, and progression of conservative treatments.

The Interplay of Diversity, Equity, and Inclusion in Addressing Health Inequities.

PURPOSE: The terms diversity, equity, and inclusion have become part of a national conversation as we come to grips with longstanding societal negligence. But what do these terms mean with respect to health care, and are we manifesting them in our medical practices? METHODS: Using the Centers for Disease Control and Prevention's Social Vulnerability Index and Google, we mapped the locations of physical therapy and primary care clinics within the 4 most diverse Wisconsin counties-Milwaukee, Racine, Kenosha, and Dane-which also had high Social Vulnerability Indexes, to assess health equity in these communities. RESULTS: Most physical therapy practices are located outside of vulnerable communities. While primary care is much more proficient at having a presence in these neighborhoods, there are still absences in some areas. CONCLUSIONS: Our analysis suggests that physical therapy services in Wisconsin are often inaccessible to members of vulnerable communities: a matter of equity. Efforts to improve equity via patient access must entail interventions that address the other components of diversity, equity, and inclusion. We recommend that other health care professionals conduct similar analyses in order to determine whether we, as a health care community, are positioning ourselves to best service our patients.