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