A Specific Exercise Program and Modification of Postural Alignment for Treatment of Cervicogenic Headache: A Case Report

Abstract

Study Design: Case report. Objective: To describe an intervention approach consisting of a specific active-exercise program and modification of postural alignment for an individual with cervicogenic headache. Background: The patient was a 46-year-old male with a 7-year history of cervicogenic headache. He reported constant symptoms with an average intensity of 5/10 on a visual analogue scale where 0 indicated no pain and 10 the worst pain imaginable. Average pain intensity in the week prior to the initial evaluation was 3/10 secondary to trigger point injections. The patient's headache symptoms worsened with activities that involved use of his arms and prolonged sitting. Methods and Measures:The patient was treated 7 times over a 3-month period. Impairments of alignment, muscle function, and movement of the cervical, scapulothoracic, and lumbar regions were identified. Outcome measurements included headache frequency, intensity, and the Neck Disability Index (NDI) questionnaire. Intervention included modification of alignment and movement during active cervical and upper extremity movements. The patient also received functional instructions focused on diminishing the effect of the weight of the upper extremities on the cervical spine. Results: The patient reported a decrease in headache frequency and intensity (1 headache in 3 weeks, intensity 1/10) and a decrease in his NDI score from 31 (severe disability) to 11 (mild disability). The patient also demonstrated improvement in upper cervical joint mobility, cervical range of motion, scapular alignment, and scapulothoracic muscle strength. Conclusion: Interventions that included modification of alignment in the cervical, scapulothoracic, and lumbar region, along with instruction in a specific active-exercise program to address movement impairments in these 3 regions, appeared to have been successful in relieving headaches and improving function in this patient. J Orthop Sports Phys Ther 2005;35:3-15.

Inter-and intra-tester reliability of a battery of cervical movement control dysfunction tests

“…Altered neuromuscular control of neck movement is considered to be an important factor contributing to the recurrent nature of neck pain (O'Leary et al, 2009), as it may impose unwanted stresses on cervical structures (Jull et al, 2008a;Comerford and Mottram, 2012). Consequently, evaluation of cMCD and treatment directed towards its improvement forms an integral part of diagnosis and management of cervical musculoskeletal disorders (McDonnell et al, 2005;Childs et al, 2008;Jull et al, 2008a). cMCD is defined operationally for the clinical setting as the presence of aberrant or uncontrolled movements of the cervical spine which are observed during prescribed active movements of the neck and/or upper limb (Comerford and Mottram, 2012).…”

Effects of 6-Week Self-Scapular Upward Rotation Exercise on Downward Pulling Tension in Subjects With Scapular Downward Rotation Syndrome

“…To solve these problems, the self-SURE program intervention has been suggested to restore optimal muscle length and strength for normal upper extremity function (Ha, 2012;Ludewig and Borstad, 2003;Sahrmann, 2002). Previous studies have investigated a self-questionnaire (pain and disability), ROM, muscle strength, and alignment before and after the therapeutic intervention Ha et al, 2011;Ha, 2012;McDonell et al, 2005). However, no prior studies have examined the effects of program on DPT in subjects with SDRS.…”

“…Stretched scapular upward rotator muscle can not maintain a normal scapular position in subjects with SDR, which can lead to excessive DPT. The DPT due to subject's prolonged SDR position was considered to contribute to the prolonged compressive loading of posterior cervical structures by way of transfer of the weight of the upper extremities to the cervical region through the attachments of the cervicoscapular muscles (levator scapulae and upper trapezius) (McDonell et al, 2005). The 6-week self-SURE program may have induced correction of the anatomic muscle length adaptation and changed the relative muscle flexibility of the shortened scapular downward rotator muscles (levator scapulae, and rhomboid), leading to the decreased DPT.…”

“…Previous studies have suggested that modifying the scapular position is useful to reduce mechanical stress or pain by decreasing muscle's tension, which improve ROM in the neck, neck pain, and proprioception Azevedo et al, 2008;Ha et al, 2011;McDonell et al, 2005). In addition, axio-scapular muscles stiffness through 6-week 한국전문물리치료학회지 2012년 19권 4호 Phys Ther Kor.…”

Limited evidence to support the use of physical therapy for temporomandibular disorder

“…5,6 Recent evidence highlights the role of posture and associated pain referral that can mimic TMD or exist as a co-morbidity: 7,8 reports of this may be found in CSD publications and are included in the physical therapist's curriculum. [9][10][11][12][13] Specialised certification also now exists for this profession in the evaluation and comprehensive management of TMD, OFP and CSD. 14 The graphic is based on the Centre for Evidence-based Medicine levels of Evidence tables www.cebm.net/levels_of_evidence.asp (see Evidence- Ecological studies SR (with homogeneity*) of case-control studies * By homogeneity we mean a systematic review that is free of worrisome variations (heterogeneity) in the directions and degrees of results between individual studies.…”