Volume 7, Issue 1 (Spring 2017)                   PTJ 2017, 7(1): 19-28 | Back to browse issues page

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1- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2- PhD Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Abstract:   (390 Views)

Purpose: To determine whether Myofascial Release (MFR) technique in upper cervical region is more effective than using conventional exercises to improve cervical muscle strength in patients with cervicogenic headache. Design: Randomized Controlled Trial. Setting: An outpatient physical therapy clinic, University of social welfare and rehabilitation science, Iran.
Methods: We conducted a prospective, randomized controlled, and single blinded trial on 34 patients with cervicogenic headache, aged 15-75 years, which assigned randomly to exercise group (n=17, mean(SD) age=38(11.31) years) and suboccipital myofascial release group (n=17, mean(SD) age=38.88(9.38) years). Ten treatment sessions, 6 times a week for each group were applied. Outcome measures were isometric cervical muscle strength (flexors, extensors, right and left rotators and lateral flexors) measured by force gauge.
Results: Statistical analysis (paired t test) revealed a significant improvement in cervical muscle strength after treatment in the MFR and exercise groups compared with before treatment (P<0.05). Based on ANCOVA results, pretest scores as controlling factor, no significant difference was found between two groups after 10 treatment sessions with regard to all variables (P>0.05) except cervical flexors strength (P=0.021) and cervical left rotators strength (P=0.031).
Conclusion: Pain and myofascial stiffness can be an impediment for full muscle interference in contraction and application of suboccipital MFR and common exercises can be effective techniques in restoring cervical muscle strength, especially in cervical rotatory movements.

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Type of Study: Research | Subject: Special
Received: 2016/09/26 | Accepted: 2017/01/4 | Published: 2017/04/1

1. Bogduk N, Govind J. Cervicogenic headache: An assessment of the evidence on clinical diagnosis, invasive tests, and treatment. The Lancet Neurology. 2009; 8(10):959–68. doi: 10.1016/s1474-4422(09)70209-1 [DOI:10.1016/S1474-4422(09)70209-1]
2. Rubio Ochoa J, Benítez Martínez J, Lluch E, Santacruz-Zaragozá S, Gómez Contreras P, Cook CE. Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review. Manual Therapy. 2016; 21:35–40. doi: 10.1016/j.math.2015.09.008 [DOI:10.1016/j.math.2015.09.008]
3. Becker WJ. Cervicogenic headache: Evidence that the neck is a pain generator. Headache: The Journal of Head and Face Pain. 2010; 50(4):699–705. doi: 10.1111/j.1526-4610.2010.01648.x [DOI:10.1111/j.1526-4610.2010.01648.x]
4. Racicki S, Gerwin S, DiClaudio S, Reinmann S, Donaldson M. Conservative physical therapy management for the treatment of cervicogenic headache: A systematic review. Journal of Manual & Manipulative Therapy. 2013; 21(2):113–24. doi: 10.1179/2042618612y.0000000025 [DOI:10.1179/2042618612Y.0000000025]
5. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. Headache: The Journal of Head and Face Pain. 1998; 38(6):442–5. doi: 10.1046/j.1526-4610.1998.3806442.x [DOI:10.1046/j.1526-4610.1998.3806442.x]
6. Biondi DM. Cervicogenic headache: A review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association. 2005; 105(4):16S-22S. PMID: 15928349 [PMID]
7. Suijlekom HA van, Lamé I, Stomp-van den Berg SGM, Kessels AGH, Weber WEJ. Quality of life of patients with cervicogenic headache: A comparison with control subjects and patients with migraine or tension type headache. Headache: The Journal of Head and Face Pain. 2003; 43(10):1034–41. doi: 10.1046/j.1526-4610.2003.03204.x [DOI:10.1046/j.1526-4610.2003.03204.x]
8. Narouze S. Occipital neuralgia diagnosis and treatment: The role of ultrasound. Headache: The Journal of Head and Face Pain. 2016; 56(4):801–7. doi: 10.1111/head.12790 [DOI:10.1111/head.12790]
9. Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. Effect of neck exercises on cervicogenic headache: A randomized controlled trial. Journal of Rehabilitation Medicine. Acta Dermato Venereologica; 2010; 42(4):344–9. doi: 10.2340/16501977-0527 [DOI:10.2340/16501977-0527]
10. Jull G, Amiri M, Bullock Saxton J, Darnell R, Lander C. Cervical musculoskeletal impairment in frequent intermittent headache; Part 1: Subjects with single headaches. Cephalalgia. 2007; 27(7):793–802. doi: 10.1111/j.1468-2982.2007.01345.x [DOI:10.1111/j.1468-2982.2007.01345.x]
11. Fernández-de-las-Pe-as C. Myofascial head pain. Current Pain and Headache Reports. 2015; 19(7):1-7. doi: 10.1007/s11916-015-0503-2 [DOI:10.1007/s11916-015-0503-2]
12. Bravo Petersen SM, Vardaxis VG. The flexion rotation test performed actively and passively: A comparison of Range of Motion in patients with cervicogenic headache. Journal of Manual & Manipulative Therapy. 2014; 23(2):61–7. doi: 10.1179/2042618614y.0000000085 [DOI:10.1179/2042618614Y.0000000085]
13. Amiri M, Jull G, Bullock Saxton J. Measuring range of active cervical rotation in a position of full head flexion using the 3D Fastrak measurement system: An intra tester reliability study. Manual Therapy. 2003; 8(3):176–9. doi: 10.1016/s1356-689x(03)00009-2 [DOI:10.1016/S1356-689X(03)00009-2]
14. Schleip R, Jäger H, Klingler W. What is "fascia"? A review of different nomenclatures. Journal of Bodywork and Movement Therapies. 2012; 16(4):496–502. doi: 10.1016/j.jbmt.2012.08.001 [DOI:10.1016/j.jbmt.2012.08.001]
15. Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Manual Therapy. 2006; 11(2):118–29. doi: 10.1016/j.math.2005.04.007 [DOI:10.1016/j.math.2005.04.007]
16. Ajimsha MS, Al Mudahka NR, Al Madzhar JA. Effectiveness of myofascial release: Systematic review of randomized controlled trials. Journal of Bodywork and Movement Therapies. 2015; 19(1):102–12. doi: 10.1016/j.jbmt.2014.06.001 [DOI:10.1016/j.jbmt.2014.06.001]
17. Huijing, PhD PA, Langevin, MD HM. Communicating about fascia: History, pitfalls, and recommendations. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. 2009; 2(4):3-8. doi: 10.3822/ijtmb.v2i4.63 [DOI:10.3822/ijtmb.v2i4.63]
18. Schleip R, Findley TW, Chaitow L, Huijing PA. Fascia: The tensional network of the human body: The science and clinical applications in manual and movement therapy. London: Churchill Livingstone; 2012.
19. Barnes JF. Myofascial release: The search for excellence: A comprehensive evaluatory and treatment approach. Baltimore: Rehabilitation Services, Inc; 1990.
20. Greenman PE. Principles of manual medicine. Philadelphia: Lippincott Williams & Wilkins; 2003. [PMCID]
21. Schleip R. Fascial plasticity: A new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies. 2003; 7(1):11–9. doi: 10.1016/s1360-8592(02)00067-0 [DOI:10.1016/S1360-8592(02)00067-0]
22. Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with non specific cervical or lumbar pain. Journal of Bodywork and Movement Therapies. 2011; 15(4):405–16. doi: 10.1016/j.jbmt.2010.11.003 [DOI:10.1016/j.jbmt.2010.11.003]
23. Ajimsha MS. Effectiveness of direct vs indirect technique myofascial release in the management of tension type headache. Journal of Bodywork and Movement Therapies. 2011; 15(4):431–5. doi: 10.1016/j.jbmt.2011.01.021 [DOI:10.1016/j.jbmt.2011.01.021]
24. Watson DH, Trott PH. Cervical headache: An investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia. 1993; 13(4):272–84. doi: 10.1046/j.1468-2982.1993.1304272.x [DOI:10.1046/j.1468-2982.1993.1304272.x]
25. Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004; 29(19):2108–14. doi: 10.1097/01.brs.0000141170.89317.0e [DOI:10.1097/01.brs.0000141170.89317.0e]
26. Pöllmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: A critical review. Cephalalgia. 1997; 17(8):801–16. doi: 10.1046/j.1468-2982.1997.1708801.x [DOI:10.1046/j.1468-2982.1997.1708801.x]
27. Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, et al. Evidence based guidelines for the chiropractic treatment of adults with headache. Journal of Manipulative and Physiological Therapeutics. 2011; 34(5):274–89. doi: 10.1016/j.jmpt.2011.04.008 [DOI:10.1016/j.jmpt.2011.04.008]
28. Jull G, Stanton W. Predictors of responsiveness to physiotherapy management of cervicogenic headache. Cephalalgia. 2005; 25(2):101–8. doi: 10.1111/j.1468-2982.2004.00811.x [DOI:10.1111/j.1468-2982.2004.00811.x]
29. Martelletti P, van Suijlekom H. Cervicogenic headache. CNS Drugs. 2004; 18(12):793–805. doi: 10.2165/00023210-200418120-00004 [DOI:10.2165/00023210-200418120-00004]
30. Yi X, Cook AJ, Hamill Ruth RJ, Rowlingson JC. Cervicogenic headache in patients with presumed migraine: Missed diagnosis or misdiagnosis. Journal of Pain. 2005; 6(10):700–3. doi: 10.1016/j.jpain.2005.04.005 [DOI:10.1016/j.jpain.2005.04.005]
31. Hsieh YL, Kao MJ, Kuan TS, Chen SM, Chen JT, Hong CZ. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. American Journal of Physical Medicine & Rehabilitation. 2007; 86(5):397–403. doi: 10.1097/phm.0b013e31804a554d [DOI:10.1097/PHM.0b013e31804a554d]
32. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002; 27(17):1835–43. doi: 10.1097/00007632-200209010-00004 [DOI:10.1097/00007632-200209010-00004]
33. Jull G, Barrett C, Magee R, Ho P. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia. 1999; 19(3):179–85. doi: 10.1046/j.1468-2982.1999.1903179.x [DOI:10.1046/j.1468-2982.1999.1903179.x]
34. Simons DG. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies. 2002; 6(2):81–8. doi: 10.1054/jbmt.2002.0271 [DOI:10.1054/jbmt.2002.0271]
35. Barnes MF. The basic science of myofascial release: Morphologic change in connective tissue. Journal of Bodywork and Movement Therapies. 1997; 1(4):231–8. doi: 10.1016/s1360-8592(97)80051-4 [DOI:10.1016/S1360-8592(97)80051-4]
36. Levoska S, Keinänen Kiukanniemi S, Hämäläinen O, Jäms T, Vanharanta H. Reliability of a simple method of measuring isometric neck muscle force. Clinical Biomechanics. 1992; 7(1):33–7. doi: 10.1016/0268-0033(92)90005-o [DOI:10.1016/0268-0033(92)90005-O]
37. Ylinen J, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, et al. Active neck muscle training in the treatment of chronic neck pain in women. JAMA. 2003; 289(19):2509. doi: 10.1001/jama.289.19.2509 [DOI:10.1001/jama.289.19.2509]
38. Jordan A, Bendix T, Nielsen H, Hansen FR, Høst D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. Spine. 1998; 23(3):311–8. doi: 10.1097/00007632-199802010-00005 [DOI:10.1097/00007632-199802010-00005]
39. Häkkinen A, Salo P, Tarvainen U, Wirén K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. Journal of Rehabilitation Medicine, Acta Dermato Venereologica; 2007; 39(7):575–9. doi: 10.2340/16501977-0094 [DOI:10.2340/16501977-0094]
40. Bodes Pardo G, Pecos Martín D, Gallego Izquierdo T, Salom Moreno J, Fernández de las Pe-as C, Ortega Santiago R. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. Journal of Manipulative and Physiological Therapeutics. 2013; 36(7):403–11. doi: 10.1016/j.jmpt.2013.05.022 [DOI:10.1016/j.jmpt.2013.05.022]