Affiliation:
1. Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical, Amsterdam, Netherlands
Abstract
Background: In patients with chronic tension-type headache (CTTH) changes in pressure pain in
the cervical region are associated with peripheral or central sensitization. It is hypothesized that an
increase of isometric strength of neck flexors would lead to a decrease of pressure pain in CTTH,
as an expression of reduced peripheral or central sensitization
Objective: In this study we aimed to analyze the correlation between change in isometric strength
of the neck flexors and change in pressure pain scores (PPS) in patients with CTTH.
Study Design: Comparative analysis of data from previous study.
Setting: Primary healthcare center.
Methods: Data from 145 patients with CTTH who underwent a manual therapy program
including isometric strength training of the neck flexors were analyzed at 8 and 26 weeks posttreatment. PPS were measured as a total of pain scores on a numeric rating scale (score 0 to 10)
on application of a pressure stimulus of 3kg/cm at 8 cervical- and suboccipital muscles. Isometric
strength of the neck flexors was measured in seconds. Correlations were computed between
changes in PPS and isometric neck flexor strength.
Results: Isometric strength of neck flexors scored significantly different compared to baseline
measurement (mean 30.0 seconds, sd:25.2), and increased with a mean difference of 17.33
seconds (95%CI: 20.61 to 14.05) at 8 weeks and 19.18 seconds (95%CI: 23.48 to 14.87) at 26
weeks. Similarly, compared to PPS baseline measurement (31.6 points, sd:18.6), mean difference
in PPS was significantly decreased at 8 and 26 weeks: -11.3 points (95%CI: -8.77 to -13.83) and
-11.15 points (95%CI: -8.31 to -13.99). There is a negative correlation between changes in PPS
and changes in isometric strength of neck flexors which is weak at 8 weeks (r = -0.243, P = 0.004)
and moderate at 26 weeks (r = -0.318, P < 0.000).
Limitations: Correlational analysis.
Conclusion: Decrease in PPS correlates with increases in isometric strength of neck flexors in
patients with CTTH in short- and long-term
Key words: Chronic tension-type headache, pressure pain, neck flexors, manual therapy,
sensitization, isometric strength, cervical spine
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
10 articles.
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