Hip Taping Positively Alters Running Kinematics in Asymptomatic Females.

Greater functional knee valgus (FKV) is thought to contribute to a greater risk of sustaining overuse running injuries. The hip is commonly implicated in greater functional knee valgus, but no studies have investigated the effects of hip taping on running kinematics. The present study investigated whether or not hip taping altered hip and knee kinematics compared to sham and no taping in female runners demonstrating excessive functional knee valgus. Lower limb stance-phase kinematics were collected from 23 female runners using three-dimensional motion capture. Participants performed over ground running at 3.5 m/s and 5.0 m/s. Three taping conditions (no tape; sham tape; hip tape) were tested. Statistical inference was performed using Statistical Parametric Mapping Hotelling's paired t-tests, with post-hoc paired t-tests. Hip taping significantly decreased hip adduction and internal rotation angles throughout stance phase by up to 7°, compared to sham and no taping. Hip taping significantly increased knee adduction, internal rotation, flexion, and reduced peak knee flexion angles, compared to no tape. Hip taping reduced excessive hip motion by clinically meaningful magnitudes, and also benefited knee frontal and transverse plane kinematics at the slower running speed. Hip taping may provide an immediate solution in correcting FKV in running.

Multidimensional impact of low-Dye taping on low-load hopping in individuals with and without plantar fasciitis.

OBJECTIVES: Evaluate the acute effect of low-Dye, placebo and no tape on motor behaviour in individuals with plantar fasciitis (PF). DESIGN: Prospective, experimental. SETTING: Motion analysis laboratory. PARTICIPANTS: Ten participants with PF and ten matched controls. MAIN OUTCOME MEASURES: Hopping behaviour (lower-limb stiffness and ankle angle at peak loading) were evaluated during low-load sleigh hopping, during three taping conditions. Stiffness and ankle angle were determined using three-dimensional motion analysis. Pain during submaximal loading was assessed with a numeric pain rating scale. RESULTS: The lower-limb stiffness response to therapeutic taping was modulated by the presence of PF (interaction, F = 4.48, p = 0.018). Matched controls demonstrated a significant increase in stiffness post application of low-Dye taping (p = 0.001), stiffness was unchanged in the PF group. In the PF group, low-Dye taping decreased hopping pain in comparison to placebo (p = 0.037) and no-tape (p = 0.024). There was no difference in ankle angle at peak loading between the groups or across taping conditions. CONCLUSIONS: Low-Dye taping reduces nociceptive inputs more than placebo in the presence of PF pain. Low-Dye tape alters stiffness in the control group but not the PF group. The motor behavioural outputs such as stiffness, during low-load hopping is modulated by both pathology and therapeutic taping.

Lower Limb and Trunk Biomechanics After Fatigue in Competitive Female Irish Dancers.

CONTEXT: Because of the increasing popularity of participation in Irish dance, the incidence of lower limb injuries is high among this competitive population. OBJECTIVE: To investigate the effects of fatigue on the peak lower limb and trunk angles as well as the peak lower limb joint forces and moments of competitive female Irish dancers during the performance of a dance-specific single-limb landing. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Fourteen healthy, female, competitive Irish dancers (age = 19.4 ± 3.7 years, height = 165.3 ± 5.9 cm, mass = 57.9 ± 8.2 kg). INTERVENTION(S): Participants performed an Irish dance-specific leap before and after a dance-specific fatigue protocol. During each landing movement, 3-dimensional lower limb kinematics (250 Hz) and ground reaction forces (1000 Hz) were collected. Paired t tests were performed to determine the differences (P ≤ .05) in lower limb and trunk biomechanics prefatigue and postfatigue. MAIN OUTCOME MEASURE(S): Peak lower limb and trunk angles as well as peak lower limb joint reaction forces and external moments. RESULTS: Compared with the prefatigue trials, dancers landed with reduced ankle plantar flexion (P = .003) and hip external rotation (P = .007) and increased hip-adduction alignment (P = .034) postfatigue. Dancers displayed greater anterior shear (P = .003) and compressive (P = .024) forces at the ankle and greater external knee-flexion moments (P = .024) during the postfatigue compared with the prefatigue landing trials. CONCLUSIONS: When fatigued, dancers displayed a decline in landing performance in terms of aesthetics as well as increased ankle- and knee-joint loading, potentially exposing them to a greater risk of injuries.

The Effect of the Mulligan Knee Taping Technique on Patellofemoral Pain and Lower Limb Biomechanics.

BACKGROUND: Patellofemoral pain (PFP) affects 25% of the general population, occurring 2 times more often in females compared with males. Taping is a valuable component of the management plan for altering lower limb biomechanics and providing pain relief; however, the effects of alternative taping techniques, such as Mulligan knee taping, appear yet to be researched. PURPOSE: To determine whether the Mulligan knee taping technique altered levels of perceived knee pain and lower limb biomechanics during a single-legged squat (SLSq) in adult females with PFP. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 20 female patients with PFP, aged 18 to 35 years, participated in this study. Participants performed 3 to 5 SLSq on their most symptomatic limb during a taped (Mulligan knee taping technique) and nontaped (control) condition. During the eccentric phase of the SLSq, the 3-dimensional kinematics (250 Hz) of the knee and hip and the ground-reaction forces (1000 Hz) and muscle activation patterns (1000 Hz) of the gluteus medius, vastus lateralis, and vastus medialis oblique were measured. Participants' perceived maximum knee pain was also recorded after the completion of each squat. RESULTS: Between-condition differences were found for hip kinematics and gluteus medius activation but not for kinetics or vastus medialis oblique and vastus lateralis muscle activity (timing and activation). Compared with the nontaped condition, the Mulligan knee taping technique significantly (P = .001) reduced perceived pain during the SLSq (mean ± SD: 2.29 ± 1.79 and 1.29 ± 1.28, respectively). In the taped condition compared with the control, the onset timing of the gluteus medius occurred significantly earlier (120.6 ± 113.0 and 156.6 ± 91.6 ms, respectively; P = .023) and peak hip internal rotation was significantly reduced (6.38° ± 7.31° and 8.34° ± 7.92°, respectively; P = .002). CONCLUSION: The Mulligan knee taping technique successfully reduced knee pain in participants with PFP. This is the first study to establish a link between Mulligan knee taping and the reduction of PFP in conjunction with decreased hip internal rotation and earlier activation of gluteus medius. CLINICAL RELEVANCE: The Mulligan knee taping technique may benefit the clinical environment by providing an alternative evidence-based treatment plan for PFP.

Hip adduction and abduction strength profiles in elite, sub-elite and amateur Australian footballers.

OBJECTIVES: It has been reported that obtaining an adduction-to-abduction strength ratio of 90-100%, and an adduction strength equal to that of the uninjured side, are suitable clinical milestones for return to sport following groin injury. Little is known about hip adduction and abduction strength profiles in Australian footballers. This study aimed to compare isometric hip adduction and abduction strength profiles between preferred and non-preferred kicking legs in elite, sub-elite and amateur Australian footballers. DESIGN: Cross sectional study METHODS: 36 elite, 19 sub-elite and 18 amateur Australian footballers, with a mean age of 24, 19 and 23 years respectively, were included. Maximal hip isometric adduction and abduction strength were measured using a hand held dynamometer with external belt fixation. RESULTS: There were no significant differences in isometric hip adduction (p=0.262) or abduction (p=0.934) strength, or the adduction-to-abduction ratio (p=0.163), between preferred and non-preferred kicking legs, regardless of playing level. Elite players had significantly greater isometric hip adduction and abduction strength than both sub-elite (mean difference; adduction=46.01N, p<0.001, abduction=30.79N, p=0.003) and amateur players (mean difference; adduction=78.72N, p<0.001, abduction=59.11N, p<0.001). There was no significant difference in the adduction-to-abduction ratio between the playing levels (p=0.165). CONCLUSIONS: No significant differences were found between preferred and non-preferred kicking legs across the playing levels for isometric hip adduction, abduction or the adduction-to-abduction ratio. This may have implications for developing groin injury prediction and return to sport criteria in Australian footballers.

The effects of vestibular stimulation and fatigue on postural control in classical ballet dancers.

This study aimed to investigate the effects of ballet-specific vestibular stimulation and fatigue on static postural control in ballet dancers and to establish whether these effects differ across varying levels of ballet training. Dancers were divided into three groups: professional, pre-professional, and recreational. Static postural control of 23 dancers was measured on a force platform at baseline and then immediately, 30 seconds, and 60 seconds after vestibular stimulation (pirouettes) and induction of fatigue (repetitive jumps). The professional dancers' balance was unaffected by both the vestibular stimulation and the fatigue task. The pre-professional and recreational dancers' static sway increased following both perturbations. It is concluded that professional dancers are able to compensate for vestibular and fatiguing perturbations due to a higher level of skill-specific motor training.

Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers.

OBJECTIVE: To determine any differences between the prevalence of adolescent idiopathic scoliosis in ballet dancers who are girls compared with age-matched nondancers, and to establish if any relations exist between the presence of scoliosis and generalized joint hypermobility, age of menarche, body mass index (BMI), and the number of hours of dance training per week. DESIGN: Cross-sectional, matched pair study. SETTING: Dance school. PARTICIPANTS: Dancers (n=30) between the ages of 9 and 16 years were recruited from a certified dance school in Western Australia; each dancer provided a consenting age-matched nondancer (n=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements were taken for angle of trunk rotation using a scoliometer (presence of scoliosis) and for height and weight to produce generalized joint hypermobility using Beighton criteria and an age-adjusted BMI, respectively. A subjective questionnaire regarding age of menarche and participation in dance and other sports was completed. RESULTS: Thirty percent of dancers tested positive for scoliosis compared with 3% of nondancers. Odds ratio calculations suggest that dancers were 12.4 times more likely to have scoliosis than nondancers of the same age. There was a higher rate of hypermobility in the dancer group (70%) compared with the nondancers (3%); however, there were no statistically significant relations between scoliosis and hypermobility, age of menarche, BMI, or hours of dance per week. CONCLUSIONS: Adolescent dancers, similar to adult dancers, are at significantly higher risk of developing scoliosis than nondancers of the same age. Vigilant screening and improved education of dance teachers and parents of dance students may be beneficial in earlier detection and, consequently, reducing the risk of requiring surgical intervention.

Effect of ankle taping on angle and force matching and strength of the plantar flexors.

OBJECTIVE: Investigate the effect of ankle taping on plantar-flexion strength, angle matching and force matching. DESIGN: Single group, repeated measures. SETTING: Laboratory of an educational institution. PARTICIPANTS: Twenty uninjured females (22.9 ± 3.6 years). MAIN OUTCOME MEASURES: Tape was applied to the ankle using a conventional hindfoot technique. Angle and force matching, and plantar-flexor strength were assessed using the purpose built dual ankle dynamometer, and measures were taken prior to and following taping. Angle matching was assessed passively and actively at 10, 15 and 20° of plantar-flexion. Participants were required to match the angle of the reference leg with the contralateral leg. Force matching was assessed at 10° of plantar-flexion and participants matched the torque of the reference leg with the contralateral leg. RESULTS: Taping had no effect on absolute errors during active or passive angle matching. Regardless of taping, the ankle angle tested had a significant effect on passive angle matching (p < 0.001); subjects were most accurate at matching a plantar-flexion angle of 20°. Ankle taping had no effect on force matching. Taping significantly improved peak plantar-flexion strength by 20% (p = 0.028). CONCLUSION: Ankle taping has little effect on contralateral force and angle matching, but it can enhance peak plantar-flexion strength.

Comparison of upper arm kinematics during a volleyball spike between players with and without a history of shoulder injury.

Volleyball players are at high risk of overuse shoulder injuries, with spike biomechanics a perceived risk factor. This study compared spike kinematics between elite male volleyball players with and without a history of shoulder injuries. Height, mass, maximum jump height, passive shoulder rotation range of motion (ROM), and active trunk ROM were collected on elite players with (13) and without (11) shoulder injury history and were compared using independent samples t tests (P < .05). The average of spike kinematics at impact and range 0.1 s before and after impact during down-the-line and cross-court spike types were compared using linear mixed models in SPSS (P < .01). No differences were detected between the injured and uninjured groups. Thoracic rotation and shoulder abduction at impact and range of shoulder rotation velocity differed between spike types. The ability to tolerate the differing demands of the spike types could be used as return-to-play criteria for injured athletes.

A pilot study to investigate the short-term effects of specific soft tissue massage on upper cervical movement impairment in patients with cervicogenic headache.

OBJECTIVES: Upper cervical movement impairment and muscle dysfunction have been identified as core components of cervicogenic headache (CGH) pathogenesis. The purpose of this single-group pre-post test pilot study was to investigate the short-term effects of a specific soft tissue massage (SSTM) intervention to the cervical spine on range of upper cervical motion. METHODS: Eight subjects (mean age 28.1 years) with published criteria of CGH (mean history of headache for 7.1 years) were investigated. Range of rotation of the upper cervical spine to the left and right was determined by the flexion-rotation test. Movement was assessed in three phases: pre-intervention, intervention, and post-intervention. The SSTM intervention consisted of an 8-minute soft tissue massage to the cervical muscles bilaterally. RESULTS: Pre-intervention measures of flexion-rotation test range of motion prior to the intervention over two assessment points were consistent. In contrast, a repeated measures analysis of variance revealed a significant improvement in range of rotation to the left and right after the first (P<0.01), second (P<0.01), but not third intervention (P = 0.19), from an average range of 27.5° at baseline to 45.9° at the third treatment session. After the 2-week post-intervention phase, range of motion remained stable without decline, and was considered full range. DISCUSSION: This pilot study provides preliminary evidence of the potential for SSTM to improve, at least in the short-term, upper cervical range of motion in people with CGH.

The relationship between cervicogenic headache and impairment determined by the flexion-rotation test.

OBJECTIVE: This study evaluates the association between probable cervicogenic headache (CGH) and associated headache symptoms and cervical spine impairment identified by the flexion-rotation test (FRT). METHODS: This was an observational study. Ninety-two subjects were evaluated, 72 with probable CGH and 20 who were asymptomatic. Headache symptoms were evaluated by questionnaire. A single blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion (ROM). Fifteen subjects reported headache during testing and were subsequently retested when pain-free. A paired t test was used to determine whether FRT mobility to the most restricted side differed when the subject was experiencing headache. Univariate linear regression analysis and multiple regression analysis were used to examine the relationship between subject and headache characteristics, and range of motion during the FRT. Logistic regression analysis was used to examine relationships between subject and headache characteristics and whether the FRT was positive or negative. RESULTS: Mean ROM was significantly reduced (P < .01) by 6° in the presence of headache, but this did not influence test interpretation. Regression analysis revealed that half the variance in FRT ROM was explained by an index of headache severity or component parts but not by other headache characteristics. CONCLUSIONS: These findings indicate a relationship between cervical movement impairment and the presence and severity of CGH.

Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache.

This study investigated the reliability of manual examination procedures and the frequency that each or multiple segments in the upper cervical spine above the C4 vertebra were the dominant source of pain in subjects with cervicogenic headache (CGH). Eighty subjects were evaluated, 60 with CGH (39 females, mean age 33 years) and arbitrarily a further 20 asymptomatic subjects (13 females, mean age 34 years) included to reduce examiner bias, but subsequently omitted from data analysis. Two experienced physiotherapists examined on the same day each subject with standard manual examination procedures, independently rating each segment in the upper cervical spine above the C4 vertebra for involvement. Examiners were blind to each other's findings and the subject's clinical status. Standard and adjusted Kappa coefficients were calculated for each segment in symptomatic subjects only. Chi-squared analysis for goodness of fit was used to identify the segment that was most frequently determined the predominant symptomatic segment. Manual examination above the C4 vertebra showed good reliability. The C1/2 segment was most commonly symptomatic, with a positive finding at this segment in 63% of cases. The high frequency of C1/2 involvement in CGH highlights the importance of examination and treatment procedures for this motion segment.

Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test.

The aim of this study was to compare the findings of the cervical flexion-rotation test (FRT) between subjects with probable cervicogenic headache (CGH), migraine without aura (Migraine), and multiple headache forms (MHF). An additional aim was to identify the diagnostic accuracy of the FRT in CGH evaluation. Sixty subjects were evaluated: 20 with CGH, 20 with Migraine, and 20 with MHF. Subject and headache symptoms were evaluated by questionnaire. A single-blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. The average range of unilateral rotation to the most restricted side was 25°, 42° and 35° for groups CGH, Migraine and MHF, respectively. The difference between groups was significant (P < 0.001). Range of rotation was significantly reduced in the CGH group when compared to groups Migraine (P < 0.001) and MHF (P = 0.001), with an additional smaller significant difference between groups Migraine and MHF (P = 0.039). A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 85% of the time (P < 0.001), with a positive cut-off value of 30°. Multivariate regression analysis revealed that 44% of the variance in FRT range of motion was explained by the presence of two variables: neck movement or positions provoke headache, and neck symptoms precede headache, but not by other factors associated with migraine. These findings provide further evidence supporting the clinical utility of the FRT in CGH evaluation.

Long-term stability and minimal detectable change of the cervical flexion-rotation test.

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 degrees for right rotation and 7 degrees for left rotation. Examiner interpretation of the FRT was consistent over time, with kappa = 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 degrees is required to be confident that a change has occurred due to an intervention rather than measurement error.

The influence of lower cervical joint pain on range of motion and interpretation of the flexion-rotation test.

OBJECTIVE: The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion-rotation test (FRT). METHODS: A single blind, comparative group design was used to investigate whether lower CFP influences FRT mobility and examiner interpretation. Twenty-four subjects were evaluated, 12 with cervicogenic headache (age 26-63 years) and 12 with lower CFP (age 44-62 years), confirmed by therapeutic cervical facet joint intervention. A single blinded examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. Subjects with lower CFP were evaluated by the FRT prior to therapeutic intervention and were excluded from analysis if they did not gain complete symptomatic relief following the procedure. Only subjects with immediate complete relief were included. RESULTS: The average range of unilateral rotation to the limited side during the FRT was 26 and 37.5° for the cervicogenic headache and lower CFP groups respectively. The difference between groups was significant (P<0.01). Sensitivity and specificity for cervicogenic headache diagnosis was 75 and 92% respectively. A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 90% of the time (P<0.01), with a positive cut-off value of 32°. DISCUSSION: These findings provide further evidence for the clinical utility of the FRT in cervical examination and cervicogenic headache diagnosis.

Throwing velocity and jump height in female water polo players: performance predictors.

Throwing velocity and vertical jumping ability are essential components for shooting and passing in water polo. The purpose of this study was to determine whether there is a relationship between throwing velocity and water jump height in highly skilled female water polo players. Throwing velocity and head height at ball release were measured in twenty-two female players (age 20.41 years (6.16); weight 68.28 kg (8.87)) with two 50 frames per second cameras while shooting at goal. Water jump height was also measured with a modified Yardstick device. Multiple regression analyses showed that peak lower limb power was the most significant predictor of maximal velocity. Power alone accounted for 62% of the variance in maximum velocity (p<0.001). Once power was entered into the model none of the other physical characteristics (lean mass, fat mass, land jump height and anthropometry) made a significant contribution to throwing velocity. After controlling for the effect of power, head height at ball release accounted for an additional significant proportion of the variance in maximal velocity (R(2) change 7%; p=0.049). Lower body power was a significant predictor of higher throwing velocity in highly skilled female water polo players. Players with relatively higher underlying levels of lower limb power who are able to generate greater elevation out of the water are able to throw the ball faster.

The influence of Mulligan ankle taping during balance performance in subjects with unilateral chronic ankle instability.

OBJECTIVE: To determine whether Mulligan ankle tape influenced the performance in subjects with unilateral chronic ankle instability (CAI) during static balance; postural sway recovery patterns after hopping and dynamic tracking balance tasks. DESIGN: A cross-sectional, within-subjects experimental study design between 4 ankle conditions (taped; untaped: injured and uninjured). PARTICIPANTS: 20 volunteer recreational athletes with unilateral CAI were recruited. Means and standard deviations highlighted the athletes' characteristics: age =23+/-1 years; height=173.1+/-2.4 cm; weight=69.3+/-3 kg; Functional Ankle Disability Index (FADI)=93.5+/-5.1% and FADI Sport=84.2+/-9.4%. INTERVENTIONS: Mulligan ankle taping. MAIN OUTCOME MEASUREMENTS: Static balance (10s); postural sway recovery patterns after a 30s functional hop test (immediately, 30 and 60s); dynamic tracking balance tasks (wandering, target overshoot and reaction-time). RESULTS: Between the four conditions, static balance showed no significant differences (p=0.792); significant changes occurred in postural sway over time (p<0.001); no significant changes were reported for the dynamic tracking tasks. Wandering was highly correlated with reaction-time and overshooting (p<0.01). CONCLUSION: Under resting and fatigued conditions, Mulligan ankle taping did not impact on the neuromuscular control during static and dynamic balance in subjects with healthy and unstable ankles.

Functional recovery after anterior cruciate ligament reconstruction: a longitudinal perspective.

OBJECTIVE: To evaluate functional hop performance in subjects with an anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone graft during 12, 18, 26, 39, and 52 weeks. DESIGN: A longitudinal comparative study. SETTING: University research laboratory. PARTICIPANTS: Patients (N=19) were evaluated at 12, 18, 26, 39, and 52 weeks after ACL reconstruction surgery. INTERVENTION: Testing on 5 separate occasions. MAIN OUTCOME MEASURES: The Cincinnati Knee Rating System and analog scales, the 6-meter timed hop, crossover hop, stair hop, and vertical hop, and limb symmetry indices. RESULTS: The uninjured and injured legs and test order were randomized. There was a significant test occasion main effect for both the Cincinnati and analog scores (P=.001). Subjective rating scores improved over the 5 testing occasions. For all 4 hop tests, test occasion and limb main effects were significant (P=.001). Paired t test comparisons at each testing occasion indicated a significant difference between the reconstructed and uninjured limb (P<.05). Furthermore, significant test occasion main effects were noted for limb symmetry indices for the 4 hop tests (P=.001). Using a score of greater than or equal to 85% as a criterion for normative limb symmetry, normative scores were recorded in the 6-m timed hop at the week 18 test occasion, the stair hop and vertical hop at the week 26 test occasion, and the crossover hop at the week 39 test occasion. CONCLUSIONS: These hop tests showed different levels of imposed demands on the knee that could be used to assess functional recovery and readiness to resume sport.

Clinical evaluation of cervicogenic headache: a clinical perspective.

Headache is a common complaint that affects the majority of the population at some point in their lives. The underlying pathological bases for headache symptoms are many, diverse, and often difficult to distinguish. Classification of headache is principally based on the evaluation of headache symptoms as well as clinical testing. Although manual therapy has been advocated to treat a variety of different forms of headache, the current evidence only supports treatment for cervicogenic headache (CGH). This form of headache can be identified from migraine and other headache forms by a comprehensive musculoskeletal examination. Examination and subsequent diagnosis is essential not only to identify patients with headache where manual therapy is appropriate but also to form a basis for selection of the most appropriate treatment for the identified condition. The purpose of this paper is to outline, in clinical terms, the classification of headache, so that the clinician can readily identify those patients with headache suited to manual therapy.