Neck Flexor Research Articles

The Effect of Postural Rehabilitation on Pain, Balance, Mandibular Movement, and Posture in Temporomandibular Disorder Patients: A Comparison Between Posterior Edentulous and Dentate Groups.

Objective: Posterior edentulism reduces occlusal support, thus increasing the risk and symptoms of temporomandibular disorder. No previous study has explored its effect on the treatment of temporomandibular disorders. This study aimed to examine the relationship between neck posture, balance, and posterior edentulism in patients with temporomandibular disorder and compare the effectiveness of physical therapy. Methods: In a quasi-experimental controlled trial, 26 patients with temporomandibular disorder were divided into 13 in the partly edentulous group and 13 in the dentate group. Both groups received manual therapy, postural exercises, deep neck flexor stabilization, and Kinesio tapping for 6 weeks. Each participant completed 12 physiotherapy sessions, administered twice weekly, with a minimum interval of 48 hours between sessions. Outcomes were assessed at baseline and after the 6-week program, including pain, mandibular movement, posture, and balance. Results: The physical therapy program significantly improved all measured outcomes (P < .05). Furthermore, the partially edentulous group showed more remarkable improvement in pain and balance compared to the dentate group (P < .05). Conclusions: Postural exercises effectively alleviate symptoms in patients with temporomandibular disorder, with more significant improvements observed in the partially edentulous group than in the dentate group.

The effect of tongue-to-palate on deep neck flexor activity

Deep neck flexor (DNF) muscles contribute to cervical stability and proprioception. Reduced muscle strength and endurance lead to faulty movement patterns, muscle imbalances, and dysfunction. Potentially, the orofacial muscles contribute to cervical strength by providing stability through muscular connections. This study examined effects of tongue muscle activity on cervical spine muscular stiffness. Twenty-three healthy subjects assumed three supine positions [at rest (AR), chin tuck (CT), and head lift (HL)] with and without tongue-to-palate pressure. The DNF stiffness was measured using shear wave elastography. Without tongue-to-palate, stiffness increased with CT and HL compared to AR (p <0.001) but not between CT and HL (p = 0.22). Tongue-to-palate increased stiffness AR (p <0.001) but not during CT (p = 0.95) or HL (p = 0.67). Stiffness levels between the AR and HL conditions during tongue-to-palate performance did not differ (p = 0.734), but CT stiffness was significantly greater than AR (p = 0.029) with tongue-to-palate. Tongue-to-palate AR increases DNF stiffness to a similar level as HL with or without tongue-to-palate, while CT with or without tongue-to-palate resulted in the highest stiffness levels. Tongue-to-palate pressure AR or with CT performance may be alternatives to HL strengthening in healthy necks. This may be a useful strategy to increase cervical stability during loads on the cervical spine.

The Effects of cervical mobilization and clinical pilates exercises in cervicogenic headache: randomized controlled trial.

To investigate the effects of Cervical Mobilization (CM) and Clinical Pilates Exercises (CPE) in Cervigogenic Headache (CHA). The 37 patients were randomized into the 3 groups. The CM for 1st group, CPE for 2nd group and CM+CPE for 3rd group were applied 3 days/a week for 6 weeks. Pain frequency, pain intensity, number of analgesic, were recorded. The posture was measured by Posture Screen application, the cervical range of motion by the CROM device, deep neck flexor muscle endurance by the pressurized biofeedback device. Evaluations were applied 2 times as pre-post treatment. In within-group comparison a decrease in pain parameters, neck-shoulder postural deviation and an increase DNFE and CROM were observed in all groups (p<0.05). In between-group comparison pain frequency, intensity and number of analgesics were significant changes in the CM and CM+CPE groups according to CPE (respectively p<0,001, p=0,001, p=0,018). Head and shoulder angulation were significant in the CPE and CM+CPE groups according to CM (respectively p=0.009, p=0,011). It was determined that the cervical right lateral flexion range of motion and right rotation were significant changes in the CM and CM+CPE groups according to CPE (respectively p=0,026, p=0,040). DNFE were significantly increased in CM+CPE according to CM and CPE (p=0.001). This study suggests that it would be beneficial to add CM and CPE to the treatment plans of patients with CHA.

Normative Scores and Test-Retest Reliability of Neck Strength, Endurance, and Proprioception Tests in Children and Adolescents

OBJECTIVE: To determine normative scores, test-retest reliability, and minimal detectable change for the neck flexor endurance test (NFET), craniocervical flexion test (CCFT), and joint position error test (JPET) in children. DESIGN: Cross-sectional. METHODS: Two hundred typically developing children (10-15 years) were recruited. Participants were screened for cervical spine instability using the alar and transverse ligament tests prior to administering the NFET, CCFT, and JPET. Testing was performed twice on the same day, 6 hours apart. RESULTS: For the younger age group, average NFET scores were as follows: females = 9.1 seconds, males = 10.1 seconds. Mean CCFT scores decreased with an increase in pressure (22 millimeters of mercury [mmHg]: females = 6.1 seconds [1], males = 6.8 seconds [1]; 30 mmHg: females = 4.07 seconds [1.1], males = 4.1 seconds [0.9]). For the CCFT, reliability reduced as pressure increased. The JPET had moderate reliability (ICC2, k = 0.4-0.63) with the highest error in right rotation (females = 14.1 cm [5], males = 13.4 cm [4.7]). The NFET had excellent reliability (ICC2, k = 0.96 [0.94-0.97], P&lt;.001). CONCLUSION: The normative scores presented serve as a reference standard for future studies and for systematic screening and head and neck injury prevention. JOSPT Open 2024;2(4):348-353. Epub 20 May 2024. doi:10.2519/josptopen.2024.1135

Individuals With Chronic Migraine Present Changes in The Electromyographic Signal Oh The Head and Neck Flexors

Individuals With Chronic Migraine Present Changes in The Electromyographic Signal Oh The Head and Neck Flexors

Between-Session Reliability of Field-Based Assessments of Isometric Neck Strength.

The reliability of the fixed-frame dynamometer for measuring isometric neck strength is established, but with limited field-based applications. This study aimed to establish the inter- and intra-session reliability of the peak force for neck flexors, extensors, and side flexors using the VALD ForceFrame and DynaMo and the force-time characteristics in the quadruped position (ForceFrame). Twenty-seven recreationally active males performed three repetitions of isometric neck flexion, extension, and side flexion over two sessions in random order using the VALD ForceFrame and DynaMo. Both devices demonstrated acceptable reliability, with the Forceframe ICC > 0.8 and CV% < 13.8% and the DynaMo ICC > 0.76 and CV% < 13.8%. No systematic or proportional differences were found using the Passing-Bablock procedure, and Bland-Altman analysis confirmed agreement across measures. Reliability was shown for right-side (ICC > 0.76) and left-side (ICC > 0.79) flexion and flexion (ICC > 0.75) across 50, 100, 150, and 200 ms. Statistical parametric mapping indicated no differences in ForceFrame-generated isometric force-time curves between sessions, though the CV was highest in the force development phase. The findings suggest that both tools can reliably assess neck strength, supporting their use in sports and clinical settings. However, assessment methods are not interchangeable, emphasising the need for standardised neck strength assessment approaches.

Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study

ABSTRACT Aim To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache. Methods In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed. Results Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%. Conclusions Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.

The Effects of Deep Neck Muscle Exercises on Chronic Non-Specific Neck Pain

Introduction: The study aimed to investigate the effects of deep neck flexor (DNF) and deep neck extensor (DNE) muscle exercises on pain, passive range of motion (PROM), craniovertebral angle (CVA), neck flexor endurance (NFE), neck extensor endurance (NEE), and the number of weekly painkiller usage (NWPKU) in chronic non-specific neck pain (CNNP) patients. Materials and Methods: A total of 27 CNNP patients, incuding intervention group (n=15) and control group (n=12), were recruited for this study. Patients in the intervention group participated in 6 weeks of DNF and DNE exercises plus traditional physiotherapy. After 10 sessions (3 weeks), the exercise protocol was followed for 3 weeks of the home-based exercise form. Control group patients received traditional physiotherapy alone. The numeric pain rating scale (NPRS), PROM, CVA, NFE, NEE, and NWPKU were examined and compared between groups, at the baseline and after six weeks. Results: Numeric pain rating scale, PROM, CVA, NFE, NEE, and NWPKU improved significantly in both groups after treatment (P&lt;0.001). The NPRS, passive flexion, passive extension, passive right-side bending, passive left rotation, CVA, NFE, NEE, and NWPKU differences were significant (P&lt;0.05). Conclusion: The study supports the positive effects of combination therapy (DNF and DNE exercises plus traditional physiotherapy) on pain, passive neck range of motion, neck lordosis posture, and neck muscle endurance in CNNP patients.

Effect of hamstring flexibility on cervical range of motion and deep neck flexor endurance in healthy young adults: A study to explore myofascial tensegrity network

IntroductionAccording to the concept of biotensegrity, the whole body consists of fascial lines. The relationship between muscles and fascia is important to ensure full and proper range of motion. This study investigated the effect of hamstring flexibility on cervical range of motion and deep neck flexor muscle endurance. The aim was to explore the relationship between the hamstring muscles and neck region in the myofascial tensegrity network. MethodSixty healthy participants with a median age of 22.0 years (24 male, 36 female) were included. Hamstring flexibility was categorized as “normal (n = 31)” or “limited (n = 29)” according to hip flexion angle (HFA) using the passive straight leg raise (PSLR) test. Active cervical range of motion was measured by the Clinometer smartphone application, and the following movements were recorded: flexion, extension and lateral flexion. The craniocervical flexion test was performed to evaluate deep neck flexor endurance using performance index and highest-pressure score. The Mann-Whitney U test was used for statistical analysis. ResultsNo significant differences in cervical range of motion were observed between the groups (p > 0.05). Participants with limited hamstring flexibility presented lower deep neck flexor muscle endurance scores (performance index and highest-pressure score) than participants with normal hamstring flexibility (p = 0.002, and p = 0.012, respectively). ConclusionThe results suggest that hamstring flexibility can influence deep neck flexor muscle endurance in healthy young adults. This preliminary clinical finding supports the hypothesis of a myofascial network between the hamstring muscles and neck region.

The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial.

Randomised controlled trial with computerised allocation, assessor blinding and intention-to-treat analysis. This study wanted to prove that cervicocranial flexion exercise (CCFE) and superficial neck flexor endurance training combined with common pulmonary rehabilitation is feasible for improving spinal cord injury people's pulmonary function. Taoyuan General Hospital, Ministry of Health and Welfare: Department of Physiotherapy, Taiwan. Thirteen individuals who had sustained spinal cord injury for less than a year were recruited and randomised assigned into two groups. The experimental group was assigned CCFEs and neck flexor endurance training plus normal cardiopulmonary rehabilitation. The control group was assigned general neck stretching exercises plus cardiopulmonary rehabilitation. Lung function parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), inspiratory capacity (IC), dyspnoea, pain, and neck stiffness were recorded once a week as short-term outcome measure. The experimental group showed significant time effects for FVC (pre-therapy: 80.4 ± 21.4, post-therapy: 86.9 ± 16.9, p = 0.021, 95% CI: 0.00-0.26) and PEFR (pre-therapy: 67.0 ± 33.4; post-therapy: 78.4 ± 26.9, p = 0.042, 95% CI: 0.00-0.22) after the therapy course. Furthermore, the experimental group showed significant time effects for BDI (experimental group: 6.3 ± 3.0; control group: 10.8 ± 1.6, p = 0.012, 95% CI: 0.00-0.21). The exercise regime for the experimental group could efficiently increase lung function due to the following three reasons: first, respiratory accessory muscle endurance increases through training. Second, posture becomes less kyphosis resulting increasing lung volume. Third, the ratio between superficial and deep neck flexor is more synchronised. TYGH108045. NCT04500223.

McKenzie neck exercise versus cranio-cervical flexion exercise on strength and endurance of deep neck flexor muscles, pain, disability, and craniovertebral angle in individuals with chronic neck pain: a randomized clinical trial

ABSTRACT Purpose To compare the effectiveness of McKenzie neck exercise and cranio-cervical flexion (CCF) exercise on strength and endurance of deep neck flexor (DNF) muscles, pain, disability, and craniovertebral angle (CVA) in individuals with chronic neck pain. Methods Forty individuals with chronic neck pain were randomly allocated to the McKenzie neck or CCF exercise group. Each group performed exercises at home daily. The strength and endurance of DNF muscles were measured at baseline, immediately after the first exercise session, and each week follow-up for six weeks. Average pain over the past week was measured at baseline and each week follow-up for six weeks. Disability and CVA were measured at baseline and the end of six weeks. Results At six weeks, both groups exhibited significant improvements across all outcome variables (p < 0.001) but there were no differences between groups (p > 0.05). The significant difference from baseline in the strength of DNF muscles was observed as early as the second week of each intervention (p ≤ 0.001). The significant difference from baseline in the endurance of DNF muscles was observed as early as the first week in the CCF exercise group (p < 0.05) and the second week in the McKenzie neck exercise group (p < 0.05). A significant decrease in pain intensity from baseline was observed after the first week in the McKenzie neck exercise group (p < 0.001) while it was after the second week in the CCF exercise group (p < 0.05). Conclusion Both the McKenzie neck exercise and CCF exercise produced similar effects in enhancing the strength and endurance of the DNF muscles, decreasing pain, alleviating neck disability, and improving the CVA.

Evaluation of Subjective Visual Vertical and Cervical Neuromotor Control in Young Nomophobians: A Cross Sectional Study.

Misperceptions of subjective visual vertical are associated with poor balance, increasing the risk of falls and accidents. The aim of the present study was to evaluate the effect of nomophobia on verticality perception using subjective visual vertical (S.V.V.) test and cervical neuromotor control of the deep neck flexors (DNF) in adults aged 18-29 years old. This cross-sectional study employed convenience sampling and was conducted at a tertiary health institute over an eight-month period.After obtaining the written informed consent, 102 participants were asked to fill the Nomophobia Questionnaire (NMP-Q) and based on the responses participants were stratified into mild (n1 = 34), moderate(n2 = 34), and severe(n3 = 34) nomophobian group. Each nomophobian group underwent testing for verticality perception by using the SVV test and cervical neuromotor control. 102 healthy age and gender matched controls were recruited and underwent testing for verticality perception by using the SVV test and cervical neuromotor control. The mean age of the study participants was 22 ± 3.15 years with 35(33.98%) males and 67(65.04%) females. There was a statistically significant difference between the median scores across the three nomophobian groups with S.V.V. (p = 0.005), activation score (p = 0.012), and endurance score (p = 0.000) of the deep neck flexors in the severe nomophobia group. This study demonstrated that SVV and cervical neuromotor control was predominantly affected in the severe nomophobian group.

Isolated Bilateral Triceps Weakness in Myasthenia Gravis

Purpose: Myasthenia gravis (MG) is the most common autoimmune disease that affects the neuromuscular junction and can cause weakness in various muscle groups. The most commonly affected muscles are the eye, facial, and neck flexors. Focal or dominant weakness of the triceps muscle is rare. In this case, we aimed to describe a rare form of MG consisting of selective or dominant triceps muscle weakness. Case report: We present a 45-year-old male patient whose initial complaints were diplopia and ptosis. Acetylcholine receptor antibody was positive. After 10 years of well-being following thymectomy, bilateral triceps weakness was added to his ocular symptoms despite regular medication (pyridostigmine and prednisone). Repetitive nerve stimulation (RNS) showed decremental responses in the right triceps muscles. Conclusion: It is important to recognize this type of myasthenia gravis to facilitate diagnosis and appropriate treatment and to avoid unnecessary investigations and treatments.

Characteristics of head and neck alignment and function of deep cervical flexor muscles in patients with nonspecific neck pain

ObjectivesThe objectives were to compare forward head posture (FHP) in natural and corrected head postures between patients with nonspecific neck pain (NSNP) and controls and to clarify the relationship between natural and corrected head posture angle differences and deep cervical flexor function. This study aimed to provide useful evidence for postural assessment and treatment in patients with NSNP. MethodsIn this cross-sectional study, 19 patients with NSNP reporting a pain score of 3–7 for at least 3 months and 19 participants with no neck pain within the previous 12 months were recruited. To evaluate FHP, the cranial rotation and vertical angles were measured using lateral head and neck photographs. The craniocervical flexion test was used to evaluate deep cervical flexor activation and endurance. We evaluated the head and neck alignment in natural and corrected head postures and the relationship between the degree of change and deep cervical flexor function. ResultsFHP in the natural head posture did not differ between groups. In the corrected head posture, FHP was significantly smaller in the NSNP group than in the control group. In the NSNP group, the cranial rotation and vertical angles were significantly different between the natural and corrected head postures, and the angle difference correlated significantly with deep cervical flexor function. ConclusionsPatients with NSNP show hypercorrection in the corrected head posture, which may be correlated with deep cervical flexor dysfunction. Further investigation into the causal relationship between hypercorrection, deep neck flexor dysfunction, and neck pain is required.

Effect of pain on cranio-cervico-mandibular function and postural stability in people with temporomandibular joint disorders.

Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on craniocervico- mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Jaw and neck pain negatively affected CVA (R2 = 0.130), TMJPS (R2 = 0.286), DNFE (R2 = 0.355), TMJ depressor (R2 = 0.145), cervical flexor (R2 = 0.144), and extensor (R2 = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R2 = 0.116) and extension (R2 = 0.146), as well as total sway degree (R2 = 0.128) and MFIQ (R2 = 0.230). Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.

Effects of exercise combined with cervicothoracic spine self-mobilization on chronic non-specific neck pain

To investigate the short-term effects and differences between exercise alone and exercise combined with self-mobilization training on chronic non-specific neck pain (CNSNP). Thirty subjects who met the criteria were recruited and randomly assigned to the exercise training group, the exercise combined with cervical self-mobilization training group (ECCM), and the exercise combined with cervicothoracic self-mobilization training group (ECCTM). The exercise training group received 6 weeks of deep neck flexor under biofeedback and scapular stability training, and the other two groups received 6 weeks of cervical self-mobilization and cervicothoracic self-mobilization, respectively, in addition to exercise training. Neck pain, cervical range of motion (ROM), neck disability, strength and endurance of deep neck flexor and quality of life were assessed before and after 6 weeks of training. The study results showed that all the three training programs for 6 weeks increased the strength and endurance of deep neck flexor, increased cervical ROM, reduced pain, and improved neck function (P < 0.05). The exercise combined with self-mobilization two groups compared with only the exercise training group had better improvement in ROM of extension, lateral flexion, rotation and quality of life (P < 0.05). Compared with exercise alone and exercise combined with cervical self-mobilization training, the exercise combined with cervicothoracic self-mobilization training was the best in improving ROM of right lateral flexion (exercise training group vs ECCTM: P < 0.01, d = 1.61, ECCM vs ECCTM: P < 0.05, d = 1.14) and pain (exercise training group vs ECCTM: P < 0.05, d = 1.34, ECCM vs ECCTM: P < 0.05, d = 1.23). Deep flexor muscle and shoulder stability training can improve the endurance and strength of the deep flexor muscles of the neck and coordinate the movement patterns of the shoulder and neck. Self-mobilization techniques can promote improvements in cervical lateral flexion and rotation range of motion, alleviate neck disability and further improve quality of life. A combination of exercise and cervicothoracic self-mobilization training appears beneficial for the management of neck pain.

Prevalence of Upper Cross Syndrome in Multipara Women

Background: Upper Cross Syndrome (UCS) is now a commonly emerging syndrome in the presently existent population. In terms of clinical features, it can be defined as a postural disorder resulting from constriction of the pectoral muscles coupled with weakness of the trapezius and deep neck flexors, leading to forward-facing head stance, rounded shoulders, and kyphosis of the thoracic cavity. Comprehensive documentation of the incidence of this syndrome in multiparous communities is lacking in the literature. As a result, a study was carried out to ascertain the prevalence of UCS in multiparous women. Objective: To determine the prevalence of UCS in multiparous women. Methods: This study was approved by the Ethical Committee and the Protocol Committee (protocol no. 629/2022-2023). The subjects of the prospective cohort study were women who are multiparous and reside in Karad, Maharashtra, India. Using cluster sampling, 76 multiparous participants were included. Assessments were conducted for individuals within the age range of 23 to 58 years, evaluating them based on Craniovertebral Angle (CVA), Forward Head Posture (FHP), pectoralis minor tightness, and deep neck flexor strength. Results: This research looked at 76 participants involved in the study out of which 66.7% were prone to upper cross syndrome. Conclusion: The prevalence of UCS was notably high among multiparous women, with poor posture habits identified as a significant risk factor.

The Effect of Exercise-Induced Central Fatigue on Cervical Spine Joint Position Error, Strength, and Endurance.

Fatigue is common in sports, impairing performance and increasing injury risk, yet little is known regarding fatigue and concussion. Impaired neck neuromuscular function may contribute to concussion at baseline, where central fatigue may further impair neck function resulting in increased concussion risk. These effects may be magnified in athletes with a history of concussion. To determine the effect of exercise induced central fatigue on neck joint position error, strength, and endurance in healthy subjects and those with a history of concussion. The investigators hypothesized that EICF would have a negative effect on all variables. Healthy subjects were examined using a single factor, within-subjects repeated measures design. Concussion history subjects were examined using a single-subject design. Nineteen healthy subjects and five subjects with a history of concussion were recruited for the study. Cervical joint position error, muscle strength, and neck flexor endurance were tested before and after exercise induced fatigue. There was a significant increase in constant (p = 0.0027) and absolute joint position error (JPE) (p < 0.001); decrease in neck flexor endurance (p < 0.001); and decrease neck strength into cervical flexion (p = 0.01) in healthy subjects following fatigue. Among concussion history subjects, five demonstrated a significant increase in absolute and constant JPE (p < 0.05); four demonstrated a significant decrease in neck flexor endurance (p < 0.05); one in neck flexion muscle strength (p < 0.05); and three in neck extension and rotation muscle strength (p < 0.05) following fatigue. Cervical neuromuscular function deteriorated following fatigue in healthy subjects. Resulting impairments may affect force alterations in cervical control, potentially increasing concussion risk. Concussion history subjects descriptively demonstrated similar results, however further research should examine formal comparisons involving subjects with and without concussion history. 3b.

Management of Cervicogenic Headache - A Case Study

Purpose: To describe the use of manual therapy and muscle reeducation for an individual with cervicogenic headache. Background: This patient was a 30-year-old woman with complaint of headache. She was functionally limited with posture. She also demonstrated impairments in cervical mobility and muscular performance. Methods and measures: This patient was treated 8 sessions over a 8 week period. Study design: Case study Intervention: Intervention included manual upper cervical spine mobilization techniques, muscle re-education for deep neck flexors muscles and scapular stabilization exercises. Results: Following treatment, the patient demonstrated in an increase in cervical mobility, improved muscular performance, a decrease in headaches, and resolution of functional limitations. Statistical analysis of the data showed significant differences from pre to post intervention from Day 1 to Day 8. There was clinical and statistical significance found in ROM and functional ability. Conclusion: Findings suggest that the mulligans manual therapy with exercises is more effective in reducing headache, improving range of motion of cervical spine and functional ability in patients with Cervicogenic Headache. Keywords: Cervicogenic headache (CGH), mulligans mobilization, snags, manual therapy, sub occipital muscle release.

Effects of dry needling on pain, range of motion and function in patients with upper cross syndrome

Background: In upper cross syndrome, upper trapezius, levator scapulae, sub occipital, sternocleidomastoid, pectoralis major and minor become tight. Whereas, the phasic muscle including lower and middle trapezius, deep neck flexor and serratus anterior muscle weaken. Objectives: To determine the effects of dry needling on pain, range of motion and function in upper cross syndrome. Methods: This randomized clinical trial was conducted at Sheikh Zaid Hospital Rahim yar khan. Ethical approval REC/RCRS/20/1049 was obtained from Riphah International University Lahore. Group A was treated with dry needling along with conventional therapy and group B was treated with conventional therapy and 34 subjects were allocated in both groups. The duration of study was of 2 weeks with 1 session per week. The pre and post intervention scores were taken for Visual analogue scale, Neck disability index and neck range of motion. The data was analyzed using SPSS 25. Results: There was no significant difference (p&lt;0.05) between groups based on demographic data at baseline. The BMI in group A was 24.38(1.14) and in group B 23.19(2.59). The mean difference of VAS in group A was 2.89(1.68) with CI [1.98, 3.76] (p&lt;0.05) and in group B was 2.87(1.03) with CI [2.33,3.42] (p&lt;0.05). The mean difference for NDI in group A was 21.25(10.85) with CI [15.46, 27.03] (p&lt;0.05) and in Group B was 14.68(8.42) with CI [10.20,19.17] (p&lt;0.05). In VAS and NDI between group analysis did not show significant result (p&gt;0.05). Conclusion: Dry needling along with conventional therapy only improves range of motion but in term of pain and functionality, dry needling and conventional therapy are equally effective. Clinical Trial Number: NCT04674904