Measurement of Movements of Upper Cervical Joints in Patients with Cervicogenic Headache after Myofascial Release
Date Issued
2012
Date
2012
Author(s)
Tsai, Shih-Ying
Abstract
Background: Cervicogenic headache is pain referred from musculoskeletal structure of neck, and the preference is 20% in population of patients with chronic headache. Restricted mobility and pain in upper cervical joints is one of the clinical features of cervicogenic headache. However, the results of previous studies those compared the range of motion within upper cervical segments between patients with cervicogenic headache and asymptomatic subjects were controversial, probably due to methodology limitation. Myofascial release techniques for suboccipital region to increase mobility of upper cervical spine are commonly applied on patients with cervicogenic headache, whether this technique could produced immediately quantitatively increase of cervical mobility is unknown.
Purposes: The purposes of this study were 1) to establish the measurements of the range of motions of upper cervical joints by Zebris system, 2) to establish the measurement of the movement of C0-C1 segment in sagittal plane by measuring the distance change between C0 and C1 by ultrasonography 3) to compare the movements of upper cervical region and the mobility of C0-1 segment between population with cervicogenic headache and asymptomatic ones 4) to measure the change of range and mobility of upper cervical spines after myofascial release that applied on this region in subjects with cervicogenic headache and asymptomatic subjects.
Methods: The study used two methods: 1) ultrasound-based motion analysis system to measure movements (including: nodding, chin-up and rotation to right and left) which were generated from upper cervical segments by manual fixation below C2; 2) ultrasonography was used to record the distance change between occiput and the first cervical vertebrae during craniocervical flexion, which presenting the mobility derived from C0 and C1 on sagittal plane. Asymptomatic subjects were tested twice with a 15-min rest between two sessions in the same day and the intraday test-retest reliability was examined. Range of motion of upper cervical region was compared between 15 patients with cervicogenic headache and 15 asymptomatic ones. Furthermore, the effects of myofascial release applied to suboccipital muscles and C0-C1 joint in 10 patients with cervicogenic headache were compared with 10 min-rest in a crossover study over 2 separate days. Intra-class correlation coefficients (ICC3,3) were calculated to examine the inter-session reliability of the measures. Differences between headache and asymptomatic groups were examined by independent sample t-test or Mann-Whitney U test. Data of crossover study were analyzed using ANOVA with repeated measure. The scores of subjective tightness during carniocervical test before and after two interventions were examined by Wilcoxon signed ranks test.
Results: There were high levels of repeatability of within-day measurements (all ICC3,3 range 0.85 to 0.97) for these two methods. The results revealed that significant difference in the distance change between C0 and C1 (p<0.001). However, no difference was noted between these two groups in ROM of upper cervical segments and total cervical spine. The distance change between C0 and C1 significantly increased after myofascial release (p<0.001), with no significant changes after 10 minutes rest. The scores of subjective tightness during carniocervical test had significant reduced after myofoscial release (p=0.008).
Conclusions: Using ultrasonography to measure the distance change between C0 and C1 could detect the restricted upper cervical range of motion in patients with cervicogenic headache and immediate increases of upper cervical range of motion after myofascial release. This study provided a method to evaluate the movement in C0 and C1 segment other than previous method using radiographic images. It is appropriate for differential diagnosis and assessment of treatment outcome. The results also confirmed that myofascial release could have immediate increase of mobility in C0-C1 segment in individuals with restricted upper cervical range of motion and gave us a reference to improve craniocervical movement pattern in patients with cervicogenic headache.
Subjects
Cervical mobility
Ultrasonography
Cervical spine
Cervicogenic headache
Myofascial release
Type
thesis
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