Effects of manual therapy on craniofacial pain in patients with chronic rhinosinusitis: a case series

J Manipulative Physiol Ther. 2012 Jan;35(1):64-72. doi: 10.1016/j.jmpt.2011.09.012. Epub 2011 Oct 27.


Objective: Chronic rhinosinusitis (CRS) is thought to develop through an inadequate drainage of nasal and sinus secretions and perpetuated by local mechanical and autonomic nervous system factors. Manual therapy may have an effect on these factors providing symptomatic relief of CRS symptoms. The purpose of this prospective case series was to report the results of manual therapy on a set of patients with craniofacial pain and a diagnosis of CRS.

Methods: Fourteen consecutive patients presenting with a primary report of craniofacial pain and a diagnosis CRS completed self-report questionnaires including the Sinonasal Assessment Questionnaire, Rhinosinusitis Task Force, visual analog scale for craniofacial pain, and pressure pain threshold over 4 sinus points on the face. Patients were seen once a week for 7 consecutive weeks and completed all outcome measures at baseline and subsequent weekly sessions. They received manual therapy interventions only on the second, third, and fifth weekly sessions.

Results: No significant changes in outcome measures were observed from baseline to 1 week, where no intervention was applied. Significant improvements were observed on all outcome measures (Ps ≤ .015) for pre- and post-first treatment session, as well as from baseline to 7 weeks (Ps < .001). All patients exhibited a significant decrease in craniofacial pain and increased pressure pain thresholds and reported less severity of their symptoms.

Conclusion: Patients with craniofacial pain and CRS who were treated with manual therapy demonstrated improvements in all outcome measures only after each treatment session. Our results suggest that manual therapy treatment could be considered as an appropriate alternative treatment of CRS.

MeSH terms

  • Adult
  • Chronic Disease
  • Facial Pain / etiology*
  • Facial Pain / physiopathology
  • Facial Pain / therapy*
  • Female
  • Humans
  • Male
  • Manipulation, Chiropractic / methods*
  • Musculoskeletal Manipulations / methods
  • Pain Measurement
  • Patient Satisfaction
  • Rhinitis / complications*
  • Rhinitis / diagnosis
  • Sampling Studies
  • Severity of Illness Index
  • Sinusitis / complications*
  • Sinusitis / diagnosis
  • Treatment Outcome
  • Young Adult