• Eur J Phys Rehabil Med · Oct 2016

    Randomized Controlled Trial Comparative Study

    The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial.

    • Gemma V Espí-López, Rosario Zurriaga-Llorens, Lucas Monzani, and Deborah Falla.
    • Department of Physiotherapy, University of Valencia, Valencia, Spain - deborah.falla@bccn.uni-goettingen.de.
    • Eur J Phys Rehabil Med. 2016 Oct 1; 52 (5): 606-617.

    BackgroundManipulative techniques have shown promising results for relief of tension-type headache (TTH), however prior studies either lacked a control group, or suffered from poor methodological quality. The aim of this study was to compare the effect of spinal manipulation combined with massage versus massage alone on range of motion of the cervical spine, headache frequency, intensity and disability in patients with TTH.DesignRandomized, single-blinded, controlled clinical trial.SettingUniversity clinic.PopulationWe enrolled 105 subjects with TTH.MethodsParticipants were divided into two groups: 1) manipulation and massage; 2) massage only (control). Four treatment sessions were applied over four weeks. The Headache Disability Inventory (HDI) and range of upper cervical and cervical motion were evaluated at baseline, immediately after the intervention and at a follow-up, 8 weeks after completing the intervention.ResultsBoth groups demonstrated a large (ƒ=1.22) improvement on their HDI scores. Those that received manipulation reported a medium-sized reduction (ƒ=0.33) in headache frequency across all data points (P<0.05) compared to the control group. Both groups showed a large within-subject effect for upper cervical extension (ƒ=0.62), a medium-sized effect for cervical extension (ƒ=0.39), and large effects for upper cervical (ƒ=1.00) and cervical (ƒ=0.27) flexion. The addition of manipulation resulted in larger gains of upper cervical flexion range of motion, and this difference remained stable at the follow-up.ConclusionsThese findings support the benefit of treating TTH with either massage or massage combined with a manipulative technique. However, the addition of manipulative technique was more effective for increasing range of motion of the upper cervical spine and for reducing the impact of headache.Clinical Rehabilitation ImpactAlthough massage provided relief of headache in TTH sufferers, when combined with cervical manipulation, there was a stronger effect on range of upper cervical spine motion.

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