Cervicogenic headaches

Previously, Dr. Ylinen published landmark studies showing Thera-Band cervical exercises “relieve or even completely eliminate pain and restore function in patients with chronic neck pain.” His most recent study investigated the same program in patients with neck pain and headaches. In the blinded, randomized controlled trial, 180 female office workers with head and neck pain were assigned to a strengthening group, endurance training, or control group.

Training methods. Both training groups started with 2 weeks of clinical rehabilitation and a home exercise program, 5 days per week. The endurance group exercised by lifting their head up from supine for 3 sets of 20, while the strengthening group used a dynamic isometric Thera-Band exercise in a sitting position for 1 set of 15 in 4 directions.

Both training groups also performed dumbbell exercises including the shrug, press, curl, bent over row, fly, and pull over.  The endurance group performed these exercises for 3 sets of 20 using a 2 kg dumbbell, while the strength group performed these exercises for 1 set of 15 at a 15RM resistance using dumbbells. Both groups also performed squat, sit-up, and back extension resistance exercises, as well as stretches for the upper back, shoulder, and neck. The control group performed aerobic exercise 3 times per week for 30 minutes, and received written information on stretches to be performed at home for 20 minutes.

Results. At a 12 month follow-up, the strengthening group utilizing Thera-Band resistance decreased their pain levels by 58-69%. The table below summarizes the percent decrease in headache pain, upper extremity pain, and neck pain in each group compared to their baseline measurement.

The authors noted that patients with the most severe headaches had the most improvement in their neck pain after strength training including Thera-Band resistance. Their findings were similar to Jull and colleagues who found manipulative therapy combined with neck exercise was effective at reducing headaches.

In conclusion,  Dr. Ylinen and his colleagues stated that stretching alone is not effective. They suggested that strength or endurance exercise combined with stretching exercise is effective at reducing headache and arm pain associated with neck pain. In addition, patients should continue exercising for at least a year, which may prevent recurrence of pain up to 3 years.

Ylinen et al. 2010. Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med. 42:344-49.

Visit the Thera-Band Academy Neck Pain Resource Center here

Related Research Articles:

Ylinen J. et al. 2003. Active neck muscle training in the treatment of chronic neck pain in women. A randomized controlled trial. JAMA. 289(19):2509-2516.

Ylinen JJ et al. 2006. Effects of twelve-month strength training subsequent to twelve-month stretching exercise in treatment of chronic neck pain. J Strength Cond Res. 20(2):304-8.

Researchers in Norway wanted to compare 2 types of exercise programs on patients with whiplash. 25 patients were randomly assigned to a strength and endurance group or a “motor control” exercise group during 6 weeks of physical therapy. The motor control group performed 10 repetitions of deep neck flexor activation against an inflatable blood pressure cuff. The strengthening group used elastic bands to strengthen their neck muscles and dumbbells to strengthen the upper body. Each exercise was performed for 1 set of 15 to 20 repetitions; each session included a 5 minute warm-up and cool down period.

Both groups significantly improved their disability levels approximately 60%; there was no significant difference between the groups. About half of the patients in each group obtained clinically important improvements at 6 weeks and 1 year after the exercise program. Some subjects did not maintain improvements at 1 year, suggesting exercises must be continued.

Whlie the findings are encouraging, the study was limited by a lack of control group and small sample size. Thera-Band elastic resistance can be used to improve pain and disability in chronic neck pain patients.

Reference: Ask T et al. 2009. The effect of two exercise regimes; motor control versus endurance/strength training for patients with whiplash-associated disorders: a randomized controlled pilot study. Clin Rehabil: 23(9):812-23.

Visit the Thera-Band Academy Neck/Whiplash resource center here

An interdisciplinary group of researchers and clinicians reviewed 11 systematic research reviews to develop a ‘toolkit’ for clinicians to apply the best evidence for treating neck pain. The “Cervical Overview Group” created a clinical practice guideline that includes a therapeutic home exercise program for neck pain. The full article was published in the Journal of Orthopedic and Sports Physical Therapy in May, 2009.  The 3-phase “Evidence-based Home Neck Care Program” includes the use of elastic tubing as an integral part of the home program.

Visit the Thera-Band Academy Neck/Cervical Spine resource center to find more articles and exercises for neck pain.