• 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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