Pain Descriptors Used by Headache Patients Presenting for Physiotherapy

Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review

BACKGROUND

Tension-type headache (TTH) is a disease with a great incidence on quality of life and with a significant socioeconomic impact.

OBJECTIVES

The aim of this review is to determine the effectiveness of physical therapy by using manual therapy (MT) for the relief of TTH.

DATA SOURCES

A review was done identifying randomized controlled trials through searches in MEDLINE, PEDro, Cochrane and CINAHL (January 2002 - April 2012).

STUDY SELECTION

English-language studies, with adult patients and number of subjects not under 11, diagnosed with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) were included.

DATA EXTRACTION

Initial search was undertaken with the words Effectiveness, Tension-type headache, and Manual therapy (39 studies). In addition, a search which included terms related to treatments such as physiotherapy, physical therapy, spinal manipulation was performed (25 studies).

RESULTS

From the two searches 9 studies met the inclusion criteria and were analysed finding statistically significant results: 1) myofascial release, cervical traction, neck muscles trigger points in cervical thoracic muscles and stretching; 2) Superficial heat and massage, connective tissue manipulation and vertebral Cyriax mobilization; 3) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction; 4) massage, progressive relaxation and gentle stretching, program of active exercises of shoulder, neck and pericranial muscles; 5) massage, passive rhythmic mobilization techniques, cervical, thoracic and lumbopelvic postural correction and cranio-cervical exercises; 6) progressive muscular relaxation combined with joint mobilization, functional, muscle energy, and strain/counterstrain techniques, and cranial osteopathic treatment; 7) massage focused on relieving myofascial trigger point activity; 8) pressure release and muscle energy in suboccipital muscles; 9) combination of mobilizations of the cervical and thoracic spine, exercises and postural correction. All studies used a combination of different techniques and none analyzed treatments separately, also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain.

CONCLUSIONS

The findings from these studies showed evidence that physiotherapy with articulatory MT, combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH. No evidence was found of the effectiveness of the techniques applied separately.

Shoulder pain following tetraplegia: a follow-up study 2–4 years after injury

OBJECTIVES

To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life.

DESIGN

Longitudinal study.

SETTING

Spinal Injuries Unit, Australia.

METHODS

Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair User's Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life.

RESULTS

Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6-T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants.

CONCLUSION

Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.