When Headache Starts in the Neck: Gwen Jull & Zhiqi Liang on Migraine, Cervicogenic Headache, and Clinical Reasoning

When Headache Starts in the Neck: Gwen Jull & Zhiqi Liang on Migraine, Cervicogenic Headache, and Clinical Reasoning

Neck pain and headache often travel together. But as Gwen Jull and Zhiqi Liang explain in this episode, that does not automatically mean the cervical spine is driving the headache. In this AAOMPT and IFOMPT collaborative episode, hosts Amy McDevitt and Michael Boney explore the evolving science around cervicogenic headache, migraine-associated neck pain, sensitization, and clinical examination. Gwen Jull discusses the development and validation of physical criteria for cervicogenic headache, emphasizing the need for a cluster of comparable musculoskeletal signs involving joint, movement, and muscle impairments. Zhiqi Liang expands the conversation into migraine, reminding clinicians that neck pain can be part of a migraine presentation rather than proof of a cervical source. She challenges clinicians to rethink the meaning of symptom reproduction during upper cervical examination and to consider sensitivity, irritability, and migraine cycles when examining and treating these patients. Together, the guests make a compelling case for more careful clinical reasoning: listen to the patient’s story, examine without over-provoking symptoms, look for comparable signs, and match treatment to the impairments that are actually present. Big takeaway: The neck may matter — but clinicians need to prove it through the whole clinical picture. Timestamped Chapters 00:00 — Welcome to Hands On, Hands Off 00:31 — Introducing the AAOMPT and IFOMPT collaboration 01:19 — Meet Gwen Jull and Zhiqi Liang 03:19 — Why headache and neck pain matter to manual physical therapists 03:40 — Major shifts in clinical thinking around cervicogenic headache 04:09 — Validated physical criteria for cervicogenic headache 05:37 — Joint, movement, and muscle signs 07:33 — The physiotherapist’s role in differential diagnosis 08:02 — How headache can refer pain into the neck 08:51 — Are cervicogenic headache and migraine distinct or a spectrum? 09:26 — Migraine as a primary neurological condition 11:33 — Sorting out mixed headache presentations 12:05 — Patient history clues: migraine vs cervicogenic headache 13:27 — Comparable signs and why intensity matters 14:51 — How much does pain location matter? 16:20 — Why no single feature is enough 17:17 — Neck pain in migraine may not be a neck problem 17:53 — Rethinking symptom reproduction during examination 19:22 — How to decide whether the neck is a driver 20:01 — Avoiding confirmation bias 21:27 — Why non-provocative examination matters 23:08 — Scapular dysfunction and other regional contributors 24:37 — Broadening beyond the diagnostic cluster 26:05 — Sensory-motor control, dizziness, and balance 28:41 — Local cervical findings and global systems 29:31 — Listening for migraine evolution over time 30:46 — Central sensitization and comparable physical findings 31:28 — PIVM vs PAVM assessment considerations 32:08 — Avoiding symptom provocation in migraine 33:04 — Migraine cycles and changing sensitivity 34:36 — Trial treatment and rigorous re-evaluation 35:41 — Individualized care beyond guidelines 36:19 — Who may benefit from a cervical-focused approach? 37:07 — Education, exercise, sleep, stress, and lifestyle strategies 39:02 — Let the physical exam guide treatment 39:46 — PTs as rehabilitation experts, not just pain reducers 41:38 — One assumption clinicians should rethink tomorrow 42:12 — Don’t forget the jaw 42:27 — Neck pain may reflect sensitivity, not source 43:16 — Final reflections and closing

Life After Fellowship: Giving Back to the Profession

Today we’re joined by Liam Globensky, Center Manager at Brooks Rehabilitation and a newly graduated fellow from the Brooks Institute of Higher Learning. Liam’s passion is clear: fellowship is not the finish line—it’s the launch pad for teaching, mentoring, advocating, and elevating the profession. In this episode, Liam discusses: * Why post-professional opportunities matter more than ever * How early-career fellows can “raise the tide” for PT practice * The importance of giving back through mentorship, leadership, and service * His joint presentation with his wife on orthopedic screening of pelvic floor dysfunction * Practical ways clinicians can integrate pelvic floor awareness into orthopedic exams * How new clinicians can shape the future of the profession Key Takeaways: * Fellowship is a platform for service, not a credential to sit on * Growth continues through advocacy, mentorship, and interdisciplinary collaboration * Orthopedic clinicians play an important role in screening pelvic floor dysfunction * The profession rises when clinicians invest in the next generation * Early-career PTs can be leaders today—not just “someday”

Why Kyle Feldman Never “Works a Day”

In this episode, we sit down with Kyle Feldman, National Director of Physical Therapy for ReEnvision PT and owner of WE ARE Physiotherapy. Kyle shares how clinical reasoning, therapeutic alliance, and intentional growth have shaped his work as a clinician, educator, and leader. We discuss: * Why clinical reasoning is often misunderstood * How strong therapeutic alliance amplifies patient outcomes * Safety, intent, and application of spinal manipulation in elderly patients * Using fellowship training to step into leadership or ownership * Kyle’s career path and the mindset that keeps him energized This is a must-listen episode for clinicians looking to level up their reasoning, build meaningful patient relationships, and explore new opportunities in the profession. Key Takeaways: * Clinical reasoning is more than pattern recognition — it’s dynamic decision-making. * Therapeutic alliance isn’t “being nice”; it’s a critical clinical skill. * Older adults are often under-treated due to clinician fear, not evidence. * Fellowships can be springboards for business ownership and leadership innovation. * Growth in PT requires curiosity, reflection, and courage. Guest Info: ???? Kyle Feldman – kylefeldmandpt@gmail.com ???? ReEnvision PT ???? WE ARE Physiotherapy

How to Teach Clinical Reasoning in OMPT

What happens when you mix decades of movement science, deep mentorship, and a passion for solving complex MSK problems? You get Lee Marinko — one of the most beloved educators and mentors in OMPT. Lee has been teaching in the Boston University DPT program for more than 20 years, serves as Chair of the AAOMPT Program Director SIG, and launched the BU OMPT Fellowship in 2014 with one goal: “We can do better than that.” In this conversation, Lee shares her philosophy on mentorship, the joy of Ah ha moments, how to keep clinical problem-solving fun, and what young professionals really need from their teachers and clinical leaders. In this episode, we explore: ???? Why movement science is the foundation for great OMPT ???? Lee’s favorite teaching moments — and what they reveal ???? How to guide learners through complex cases ???? Mentorship tips for faculty, fellows, and CI’s ???? The origin story of the BU Fellowship ???? Why curiosity beats certainty in clinical reasoning ???? The mindset that makes clinicians grow faster ???? How to “do better” for people with MSK pain If you teach, mentor, or simply want to think better as a clinician — do not miss this one.

Why Hip Dysplasia Goes Undiagnosed for 7 Years

Why do patients with hip dysplasia go years without a diagnosis? In this episode, physical therapist and researcher Dr. Libby Bergman [https://performancesciencerehab.com/about/libby-bergman/] explains why hip dysplasia in young adults is frequently overlooked—and what clinicians can do to catch it earlier. Her [https://performancesciencerehab.com/] research explores whether simple clinical tests physical therapists already use—range of motion, strength testing, and hypermobility measures—might help identify hidden hip instability. The findings could help clinicians recognize hip dysplasia sooner and potentially prevent years of unexplained pain and delayed treatment. In this conversation we discuss: • Why hip dysplasia is commonly missed • Early clinical signs physical therapists should watch for • Why athletes like dancers and swimmers may be at higher risk • New research linking range of motion and adductor strength to dysplasia • Why patients often wait 5–7 years for the correct diagnosis