EFFECT OF MYOFASCIAL TRIGGER POINT PRESSURE RELEASE ON HEADACHE IN CHRONIC MECHANICAL NECK PAIN. Radwa Fayek Hammam Mansour

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2 EFFECT OF MYOFASCIAL TRIGGER POINT PRESSURE RELEASE ON HEADACHE IN CHRONIC MECHANICAL NECK PAIN By Radwa Fayek Hammam Mansour

3 First of all I would like to kneel thanking to ALLAH that enable me to conduct this work. I would like to thank Prof. Dr. Ragia Mohamed Kamel, Professor of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University for her great support and advice to start and complete this study as the best as I could do. My gratitude appreciation wishes Dr. Amro Saber El Sayed, Lecturer of orthopedic surgery department, faculty of medicine, Menofia University, for his great support.

4 My deepest thanks to Dr. Salah El Din Bassit Ahmed, Lecturer of Physical Therapy Basic Science Department, Faculty of Physical Therapy, Cairo University, for her kind help, valuable advices, constant encouragement to complete this study. I would like to thank My Parents for great support and constant encouragement to complete this study.

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6 Headache is a common experience in adults. Recurring headaches negatively impact family life, social activity, and work capacity. For many people, headache starts as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, the forehead, or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse. A disorder of the upper neck joints or muscles can cause referred pain to the head.

7 Cervicogenic headache (CH) is a secondary headache, which means head pain with a cervical source. It is characterized by unilateral headache with symptoms and signs of neck involvement, for example, pain by movement, external pressure over the upper cervical, and/or sustained awkward head positions.

8 It has been hypothesized that muscle TrPs can play a relevant role in the genesis of headache. A TrP is usually defined as a hyperirritable spot within a taut band of a skeletal muscle that elicits a referred pain upon examination However, data related to TrPs in CH are scarce. Therefore the aim of the present study was to investigate the efficacy of myofasial trigger point release for upper cervical muscles on CH in patients with chronic mechanical neck pain.

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10 Could myofascial trigger point pressure release for active trigger points (ATrPs) in upper cervical muscles reduce pain and improve functional ability in patients with CH?

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12 Conservative therapies are recommended as the first treatment of choice. Few studies have been directed towards evaluating the efficacy of treatment methods for CH. There are other physical therapeutic modalities that can only add to the beneficial short term effects of myofascial trigger point pressure release or exercises. These modalities are such as ultrasonic, acupuncture, and such modalities cause an improvement in the signs and symptoms, and are not treatment for the pathological changes. That is because the short sarcomeres forming the taut bands are not stretched, and the release of the trigger points themselves does not occur, so they have only a temporary effect, without treatment of the pathology itself as do our treatment (myofascial trigger point pressure release).

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14 The purpose of the study was to determine the effect of myofascial trigger point pressure release for upper cervical muscles on pain and functional ability on patients with CH.

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16 Thirty subjects were assigned randomly in two equal groups Study group (A) (15 patients) Control group (B) (15 patients) Myofascial trigger points pressure release Stretching and strengthening exercises for neck muscles Stretching and strengthening exercises for neck muscles

17 Inclusion Criteria: 1. Patients who were included in the study according to the following criteria: Trigger point diagnosis was conducted following the criteria of (Simon et al., 1999): Presence of a palpable taut band in a skeletal muscle. Presence of a hypersensitive spot within the taut band. Reproduction of referred pain elicited by palpation of the sensitive spot. 2. To be eligible, they had to present a diagnosis of CH according to the criteria of (Sjaastad and Fredriksen, 2000): 1.Unilateral pain starting in the neck and radiating to the frontotemporal region. 2.Pain aggravated by neck movement. 3.Joint tenderness in at least one of the joints of the upper cervical spine (C1-C3). 4.Headache frequency of at least 1 per week over a period greater than 3 months. 3. Thirty subjects of both sexes ranged from year were included in the study.

18 Exclusion Criteria: Patients were excluded if they exhibit other primary headaches (ie, migraine, tension-type headache), suffer from bilateral headaches, receive treatment for neck or head pain in the previous year or exhibit any contraindications to manual therapy.

19 Instrumentations: (a) Visual analogue scale. (b) Neck disability index (NDI): (Vernon and Mior, 1991). (c) Smart phone inclinometer was used to measure active cervical range of motion.

20 Assessment procedures: Subjects were assessed before and at the end of study period (4 weeks). Smart phone inclinometer was used to measure active cervical range of motion Cervical flexion

21 Cervical extension

22 Cervical side bending

23 Treatment procedure: Isometric neck extensor exercise

24 Isometric neck flexor exercise

25 Isometric neck side bending muscle exercise

26 Stretching exercise: Unilateral passive stretching for sternocleidomastoid muscle:

27 Passive stretching for the neck extensor muscles:

28 Passive stretching of the neck side-bending muscles:

29 Trigger point pressure release for suboccipitalis trigger point.

30 Trigger point pressure release for upper trapezius muscle

31 Trigger point pressure release for trigger point at the root of the neck

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33 VAS Visual Analogue Scale (VAS) Study group Control group Post treatment median values of VAS of study and control groups.

34 NDI Neck disability index (NDI) Study group Control group Post treatment median values of NDI of study and control groups.

35 Neck flexion ROM (degrees) Neck flexion ROM Study Control Pre Post Pre and post treatment mean values of neck flexion ROM of study and control groups.

36 Neck Extension ROM (degrees) Neck extension ROM Study Control Pre Post Pre and post treatment mean values of neck extension ROM of study and control groups.

37 Neck rightbending ROM (degrees) Neck right bending ROM Study Control Pre Post Pre and post treatment mean values of neck right bending ROM of study and control groups.

38 Neck leftbending ROM (degrees) Neck left bending ROM Study Control Pre Post Pre and post treatment mean values of neck left bending ROM of study and control groups.

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40 Based on the scope and findings of this study, It can be concluded that Myofascial Trigger Point Pressure Release Technique is a safe and effective modality, and resulted in great improvements in pain intensity, and functional ability in patients with cervicogenic headache.

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