Neck/shoulder function in tension-type headache patients and the effect of strength training

Abstract

IntroductionMuscle pain has been associated with reduced maximal muscle strength, and reduced rate of force development (RFD). Strength training (ST) has shown an effect in not only normalizing muscle function but also reducing neck muscle pain.AimThe aims of this study were to compare muscle function in terms of strength, force steadiness in neck flexion, as well as extension, and rate of RFD of the shoulder in tension-type headache (TTH) patients and healthy controls and to examine the correlation to tenderness. Furthermore, the aim of the study was to examine the effect of ST on neck and shoulder functions in TTH patients.Participants and methodsIn all, 60 TTH patients and 30 sex- and age-matched healthy controls were included for a case–control comparison. The 60 patients with TTH were randomized into an ST and an ergonomic and posture correction (EP) control group. The ST group trained for 10 weeks with elastic bands.ResultsTTH patients had a lower extension force steadiness with a significant 15% higher coefficient of variation (CoV) compared to healthy controls (p=0.047). A significantly lower RFD (25%) was noted in the TTH group than in the healthy controls (p=0.031). A significant (p<0.01) and moderate correlation to muscle tenderness was found. In the intervention, 23 patients completed ST and 21 patients completed EP. No significant between-group effect was observed, but at 22 weeks follow-up, both groups had a significant within-group effect of improved extension force steadiness (ST: p=0.011 and EP: p<0.01).ConclusionTTH patients showed a deteriorated muscle function, indicated by a lower force steadiness and RFD, compared to the healthy controls. The effect of ST was not larger than EP as both groups of TTH patients showed some improvement in neck and shoulder functions during the 10 weeks intervention and at follow-up. Future interventions are needed to elucidate if normalization of muscle function can lead to a reduction in headache.

Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review

“…This assumption is based on the presence of motor output changes of the cervical musculature, e.g., reduced neck muscle strength [62], an increased co-activation of the superficial cervical muscles [63], in patients with TTH. In fact, the application of strengthening exercises, ergonomic/posture correction programs and motor control exercise programs have demonstrated to be effective in TTH [64][65][66]. Interestingly, Castien et al found that neck flexor musculature endurance partially mediates the potential effects of manual therapy interventions in TTH [67].…”

Comparing neck extensor muscle function in asymptomatic Canadian adults and adults with tension-type headache: a cross-sectional study

“…As such, Madsen et al reported a 12% decrease in neck extension/flexion strength ratio in the TTH population36 and a 26% difference in extension strength between TTH and healthy subjects 21. In addition, patients with TTH have been found to have significantly lower neck extension force steadiness compared with healthy controls 35. Even though in our study those with severe headache-related disability showed a significantly reduced force production, the TTH group as a whole did not show a significant difference in neck extensor force compared with the control group.…”

“…However, Madsen et al reported that concomitance of neck tenderness in patients with TTH has a negative influence on force production which could be explained by a modulation of muscle activity aimed at avoiding painful experiences characterised by an increased activity in antagonist muscles and a decreased activity in agonist muscles 35. An imbalance in force production between the neck flexor and extensor muscles has also been considered a potential contributing factor of CTTH development.…”

Does pain influence force steadiness? A protocol for a systematic review

“… 30 Finally, others showed that force steadiness deficits in people with neck, shoulder pain or knee osteoarthritis were apparent only during specific movements and/or during the exertion of high forces. 13 31 32 …”