in isometric strength of the neck flexor muscles would result in a decrease in pressure pain( indicating a decrease in sensitization). This study utilized data from 145 patients, between the ages of 18 and 65, meeting the criteria for CTTH. Patients were excluded if they presented with a coexisting diagnosis of: rheumatoid arthritis; malignancy or brain tumor; pregnancy; inability to read or write Dutch( the study site was in the Netherlands); or, having undergone manual therapy treatment within 2 months prior to the study.
During the study, the patients received manual therapy treatment for 8 weeks, with a maximum of nine 30-minute sessions. The sessions consisted of a combination of mobilization of the cervical spine( neck) and the thoracic( the upper part of the trunk between the neck and the abdomen) spine; postural correction; and, isometric strengthening of the neck flexor muscles. Patients were given a booklet on self-management exercises with instructions to perform the exercises during the 8-week period of treatment and to continue beyond the treatment period.
Measurements were taken at the start of treatment, 8 weeks post-treatment, and 26 weeks post-treatment. Measurements included: isometric strength of the neck flexor muscles, pressure pain, and Headache Impact Test. The Headache Impact Test was only completed at the initial( baseline) visit. First, isometric strength of the deep neck flexor muscles was tested( Figure 1). This test assesses the integrity of the muscle group that maintains stability of the neck. It is a timed test in which the patient is instructed to lift his / her head from the table while lying in the supine( face upward) position.
Neck flexor muscle endurance test: The patient is instructed to lie on the treatment table with his / her knees bent. The patient is instructed to perform a chin retraction – lift the head up about 1 inch and maintain this position. The physical therapist times this test. The test ends when the patient can no longer hold his / her head up, or the patient is unable to maintain the correct position.
The second test assessed pressure pain scores( PPS) of the upper trapezius and suboccipital muscles. A pressure algometer( measures pain) was used with 3.0kg / cm pressure at 4 different points; 2 points on the upper trapezius muscle and 2 points on the suboccipital muscles. Patients were instructed to rate their pain on a scale of 0 to 10, whereby 0 equals no pain and 10 equals the most severe pain.
Lastly, the Headache Impact Test( HIT-6) was administered at baseline only. This 6-item questionnaire quantifies an individual’ s degree of pain intensity, and measures the negative effect headache has on social functioning, role functioning, vitality, cognitive functioning and psychosocial distress. The results of this study are as follows:
• At the 8 week visit, 142 of 145 patients demonstrated a significant increase in isometric strength of the neck flexor muscles and a significant decrease in PPS which is the degree of peripheral and central sensitization.
28 HeadWise ® | Volume 6, Issue 1 • 2016