• After the 8 week mark, manual therapy treatment was discontinued. However, patients were instructed to perform self-management exercises.
• At the 26 week evaluation, 125 patients demonstrated an increase in isometric strength of the neck flexor muscles and a decrease in PPS.
The authors confirmed that an increase in strength of the neck flexor muscles significantly correlated with a decrease in PPS in the upper trapezius and suboccitpal muscles. The authors, therefore, concluded that a decrease in PPS correlates with a decrease in frequency and duration of chronic tension-type headache.
The Role of Physical Therapy For certain types of headache, physical therapy is often part of a comprehensive treatment plan. Specific to tension-type headache, physical therapy has been shown to decrease headache frequency, decrease headache intensity, decrease headache duration, and decrease use of medications. This improvement results in an increased ability to function and increased quality of life.
The physical therapist will perform a comprehensive musculoskeletal exam including: assessment of postural abnormalities; assessment of soft tissue such as myofascial trigger points in the head and neck muscles; assessment of joint mobility; and, assessment of strength of the neck flexor muscles.
The physical therapist will use the exam findings to formulate an individualized treatment plan and determine the frequency and duration of visits. The patient will receive education on the exam findings, the individualized treatment plan, and additional items specific to the patient that will allow for optimal care. Physical therapy interventions may include postural correction, manual therapy, neck and thoracic mobilizations, and isometric strengthening of neck flexor muscles.
Postural correction is of importance to decrease stress on the head and neck. The patient is instructed on how to achieve an upright neutral spine position( Figure 2). In this position, the most prominent part of the back of the head should be in line with the most prominent part of the thoracic spine.
Posture. The patient is instructed to sit in an upright position, with the shoulders gently down and back, the chin is gently retracted, and the eyes remain level.
Manual therapy interventions, such as joint mobilization techniques and soft tissue techniques, have been demonstrated to benefit individuals with CTTH. For example, the physical therapist may elect to use a transverse stretch to address trigger points in the upper trapezius muscle( Figure 3). The goals of this technique are to increase blood flow, decrease muscle tension, and decrease pain.
Transverse stretch of the upper trapezius muscle. The patient lies on the treatment table. The physical therapist locates trigger points in the upper trapezius muscle, stabilizes the shoulder, and applies a stretch to the muscle by pulling it towards the patient’ s head. This can be performed until relief is produced and the muscle relaxes.
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