Effects of different methods of physiotherapy in individuals with cervicogenic headaches

Objective. To assess the effects of different physiotherapy methods in individuals with cervicogenic headache. Methods. 20 subjects with cervicogenic headaches have been studied. Subjects were randomized to two groups of 10 subjects. The first group of subjects underwent physiotherapy with post – isometric relaxation, the second group – physiotherapy in combination with vibration. Before and after the interventions, pain intensity, neck disability index, active cervical range of motion and neck muscle strength were evaluated in all subjects. Results. Physiotherapy reduces the intensity of pain (from strong and very strong to moderate intensity), improves neck function (from severe to moderate disability), increases active cervical range of motion by four to six degrees and increases neck muscle strength (p < 0,05). When comparing results between groups, no statistically significant difference in results were observed (p > 0,05). Conclusion: Complex physiotherapy in combination with post – isometric relaxation or vibration helps to improve the function of individual neck, increase active cervical range of motion and strength of muscle strength.

Myofascial Induction Therapy Improves the Sequelae of Medical Treatment in Head and Neck Cancer Survivors: A Single-Blind, Placebo-Controlled, Randomized Cross-Over Study

Head and neck cancer (HNC) is the sixth most common cancer worldwide. Yet, less than 60% of HNC survivors receive adequate therapy for treatment-related sequelae. The objective of this study was to determine the efficacy of myofascial induction therapy (MIT) in improving cervical and shoulder pain and range of motion, maximal mouth opening, and cervical muscle function in HNC survivors. This crossover, blinded, placebo-controlled study involved 22 HNC survivors (average age 56.55 ± 12.71) of which 13 were males (59.1%) who received, in a crossover fashion, both a single 30-min session of MIT in the form of manual unwinding and simulated pulsed shortwave therapy (placebo), with a 4-week washout interval between the two. Cervical and shoulder pain (visual analogue scale) and range of motion (cervical range of motion device and goniometer), maximum mouth opening (digital caliper), and cervical muscle function (deep cervical flexor endurance test) were measured before and after the treatment and placebo sessions. A single session of MIT improved cervical and affected side shoulder pain, cervical range of motion, maximum mouth opening, and cervical muscle function. The associated effect sizes ranged from moderate to large. The present study suggests that MIT, in the form of manual unwinding, improves cervical (−3.91 ± 2.77) and affected-side shoulder (−3.64 ± 3.1) pain, cervical range of motion (flexion: 8.41 ± 8.26 deg; extension: 12.23 ± 6.55; affected-side rotation: 14.27 ± 11.05; unaffected-side rotation: 11.73 ± 8.65; affected-side lateroflexion: 7.95 ± 5.1; unaffected-side lateroflexion: 9.55 ± 6.6), maximum mouth opening (3.36 ± 3.4 mm), and cervical muscle function (8.09 ± 6.96 s) in HNC survivors.

Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder

ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.

Effectiveness of Neural Mobilisation Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report

Objective The objective was to assess the effectiveness of neural mobilisation (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). Methods We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion and mechanosensitivity as the main outcome measures. Results The systematic review included 22 studies (n = 978). More favourable outcomes were observed for NM on pain intensity compared with control interventions (standardised mean differences (SMDs) −0.92; 95% CI − 1.66-−0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI − 0.02-2.15). Regarding neck pain intensity, no significant differences were found in favour of NM compared with OTs (SMD 0.37; 95% CI − 0.35-1.1). However, between-treatment differences were found in favour of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI − 0.06-0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD −0.08; 95% CI − 0.36-−0.20, and SMD −1.44; 95% CI − 2.28-−0.6, respectively). Finally, NM was associated with more favourable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). Conclusions NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Analysis and comparison of pain pressure threshold and active cervical range of motion after superficial and deep dry needling techniques of the upper trapezius muscle

Objectives: To evaluate the changes in pain pressure threshold (PPT) and active cervical range of motion (ACROM) after the application of superficial dry needling (DN) or deep DN in myofascial trigger point (MTrP) 1 of the upper trapezius versus a simulated DN technique in the gastrocnemius muscle (control group). Design: Double-blind, randomized controlled trial with 7-day follow-up. Participants: Asymptomatic volunteers (n = 180; 76 men, 104 women) with a latent MTrP 1 in the upper trapezius were randomly divided into three groups: G1, receiving superficial DN in the upper trapezius; G2, receiving deep DN in the upper trapezius; and G3, control group, receiving simulated DN technique in the gastrocnemius muscle. Main outcome measures: While sitting in a chair, each subject underwent measurements of PPT and ACROM (ipsilateral and contralateral side flexion and rotation, flexion and extension) preintervention, (immediately) postintervention, and at 24 h, 72 h and 7 days. Results: Superficial and deep DN produced an increase in PPT at 7 days with respect to preintervention levels. Furthermore, superficial and deep DN produced a decrease in cervical flexion at 24 h and an increase in ipsilateral rotation until 72 h, increasing to 7 days in the case of deep DN. On the contrary, superficial DN produced an increase in ipsilateral and contralateral side flexion after intervention, unlike deep DN that produced a decrease at 24 h. Furthermore, superficial DN produced an increase in contralateral rotation at 24 h and deep DN decreased extension at 72 h. Conclusion: A single intervention of superficial or deep DN did not produce statistically significant changes in PPT or goniometry measurements. Trial registration number: NCT03719352 ( ClinicalTrials.gov )

Neck Active Movements Assessment in Women with Episodic and Chronic Migraine

We aimed to compare movement parameters and muscle activity during active cervical spine movements between women with episodic or chronic migraine and asymptomatic control. We also assessed the correlations between cervical movement measures with neck-related disability and kinesiophobia. Women with episodic (n = 27; EM) or chronic (n = 27; CM) migraine and headache-free controls (n = 27; CG) performed active cervical movements. Cervical range of motion, angular velocity, and percentage of muscular activation were calculated in a blinded fashion. Compared to CG, the EM and CM groups presented a reduced total range of motion (p < 0.05). Reduced mean angular velocity of cervical movement was also observed in both EM and CM compared to CG (p < 0.05). Total cervical range of motion and mean angular velocity showed weak correlations with disability (r = −0.25 and −0.30, respectively; p < 0.05) and weak-to-moderate correlations with kinesiophobia (r = −0.30 and −0.40, respectively; p < 0.05). No significant correlation was observed between headache features and total cervical range of motion or mean angular velocity (p > 0.05). No differences in the percentage of activation of both flexors and extensors cervical muscles during active neck movements were seen (p > 0.05). In conclusion, episodic and chronic migraines were associated with less mobility and less velocity of neck movements, without differences within muscle activity. Neck disability and kinesiophobia are negative and weakly associated with cervical movement.

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

Introduction The purpose of the present study is to compare the effect of the physiotherapy to onabolulinumtoxin-A, and their combination, in relation to cervical and headache parameters in patients with chronic migraine. Methods This is an observational cohort study conducted by a headache center and a physiotherapy degree course on 30 patients with chronic migraine. The patients were distributed in three groups of treatments for three months: onabolulinumtoxin-A only, physiotherapy only, and onabolulinumtoxin-A plus physiotherapy. The patients were evaluated, before and after each treatment, using the following: the postural assessment software SAPO for the forward head posture; the CROM goniometer for the cervical range of motion; the Migraine Disability Assessment Score for headache parameters. Results After 3 months of each treatment, the scores obtained for the headache-related disability and the frequency of migraine decreased significantly for all groups, but the pain intensity scores changed significantly only in the onabolulinumtoxin-A (p = 0.01) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.007). On the other hand, the forward head posture was reduced significantly in the physiotherapy (p = 0.002) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.003). The cervical range of motion increased significantly in certain directions in the physiotherapy group and in the onabolulinumtoxin-A plus physiotherapy groups. Conclusions The physiotherapy improved the cervical parameters. The onabolulinumtoxin-A decreased pain intensity. As a consequence, it can be said that the combined treatment was more useful than a mono-therapy alone. From our results, it can be concluded that onabolulinumtoxin-A plus physiotherapy could be a good option in the management of chronic migraine.

Effectiveness of Muscle Energy Technique with and without Strain Counter Strain Technique in Individuals with Non-Specific Neck Pain - A Pilot Study from Aurangabad, India

BACKGROUND Evidence till date indicates high incidence of neck pain, and soft tissue techniques [muscle energy technique (MET), strain counter strain (SCS)] have proven to be effective for non-specific neck pain (NSNP). However, their comparative effect is yet to be proven, hence the present study attempted to investigate the comparative effectiveness of MET with SCS techniques in individuals with NSNP. METHODS Total 10 participants diagnosed with NSNP were included in the study. They were allocated into two groups utilizing convenient sampling. Group A received MET with SCS technique and Group B received MET with conventional physiotherapy. The interventions were given for 2 weeks, 3 sessions per week for 45 minutes. The outcome measures used in the study were numeric pain rating scale (NPRS), neck disability index (NDI), range of motion (ROM) which were assessed before the intervention immediately after the first session and at 1st week and end of 2nd week. RESULTS Intragroup comparison found to be significantly reduced in terms of pain and neck disability index and improvement in cervical range of motion (P = < 0.05). However intergroup comparisons showed significant difference in Group A only at the end of 2nd week of intervention (P = < 0.05), but the results were not significant immediately and at the 1st week of intervention (P = > 0.05). CONCLUSIONS The study concluded that MET with SCS technique is more effective in reducing pain, neck disability and improving cervical range of motion. KEY WORDS MET, SCS, NSNP