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Phys Ther Korea 2017; 24(2): 37-47

Published online May 1, 2017

https://doi.org/10.12674/ptk.2017.24.2.037

© Korean Research Society of Physical Therapy

뒤통수밑근 이완기법과 병행된 고주파 심부투열이 만성 긴장성 두통 환자들의 압통과 목 가동성 및 기능장애에 미치는 영향

이형렬1, 심재훈2, 오덕원3

1새하늘정형외과의원 물리치료실,,
2백석대학교 보건학부 물리치료학과,,
3청주대학교 보건의료대학 물리치료학과

Effects of High-frequency Diathermy Integrated into Suboccipital Release on Tenderness and Neck Mobility and Disability in People with Chronic Tension-type Headache

Hyoung-ryeol Lee1, Jae-hun Shim2, and Duck-won Oh3

1Dept. of Physical Therapy, Saehaneul Orthopedic Surgery Clinic,
2Dept. of Physical Therapy, Division of Health Science Baekseok University,
3Dept. of Physical Therapy, College of Health Science, Cheongju University

Correspondence to: Corresponding author: Jae-hun Shim clinicalpt@bu.ac.kr

Received: January 18, 2017; Revised: January 18, 2017; Accepted: February 25, 2017

Abstract

Background:

Active trigger points (TrPs) of the suboccipital muscles greatly contribute to the occurrence of chronic tension-type headache, with increased sensitivity of TrPs and facilitated referred pain.

Objects:

This study aimed to investigate whether the integration of high-frequency diathermy into suboccipital release is more beneficial than the use of suboccipital release alone.

Methods:

Thirty subjects were assigned to either experimental group-1 (EG-1) to undergo suboccipital release combined with high-frequency diathermy (frequency: 0.3 MHz, and electrode type: resistive electronic transfer), or EG-2 to undergo suboccipital release alone, or the control group (CG) with no intervention, with 10 subjects in each group. The assessment tools included the headache impact test 6 (HIT-6), perceived level of tenderness, neck disability index, and neck mobility. Intervention was performed for 10 minutes, twice per week, for 4 weeks, and measurements were performed before and after the interventions.

Results:

The between-group comparison of the post-test values and changes between pretest and post-test showed significant differences for all parameters at p<.05, except for the left-to-right lateral bending range. In the post hoc test, EG-1 showed significant differences for the parameters in comparison with the CG, while no significant differences in the perceived tenderness level, on both temporal regions, were found between EG-2 and CG. Furthermore, the HIT-6 score and perceived tenderness level, in the right temporal region, showed significant differences between EG-1 and EG-2. In the within-group comparison, EG-1 and EG-2 appeared to be significantly different between pretest and post-test (p<.05), except for the perceived tenderness level in the right temporal region, with significance for the EG-1 group only (p<.05).

Conclusion:

These findings suggest that the suboccipital release technique may be advantageous to improve headache, tenderness, and neck function and mobility, with more favorable effects with the incorporation of high-frequency diathermy.

Keywords: High-frequency diathermy, Neck function, Suboccipital release, Tension-type headache.

Article

ARTICLE

Phys Ther Korea 2017; 24(2): 37-47

Published online May 1, 2017 https://doi.org/10.12674/ptk.2017.24.2.037

Copyright © Korean Research Society of Physical Therapy.

뒤통수밑근 이완기법과 병행된 고주파 심부투열이 만성 긴장성 두통 환자들의 압통과 목 가동성 및 기능장애에 미치는 영향

이형렬1, 심재훈2, 오덕원3

1새하늘정형외과의원 물리치료실,,
2백석대학교 보건학부 물리치료학과,,
3청주대학교 보건의료대학 물리치료학과

Received: January 18, 2017; Revised: January 18, 2017; Accepted: February 25, 2017

Effects of High-frequency Diathermy Integrated into Suboccipital Release on Tenderness and Neck Mobility and Disability in People with Chronic Tension-type Headache

Hyoung-ryeol Lee1, Jae-hun Shim2, and Duck-won Oh3

1Dept. of Physical Therapy, Saehaneul Orthopedic Surgery Clinic,
2Dept. of Physical Therapy, Division of Health Science Baekseok University,
3Dept. of Physical Therapy, College of Health Science, Cheongju University

Correspondence to:Corresponding author: Jae-hun Shim clinicalpt@bu.ac.kr

Received: January 18, 2017; Revised: January 18, 2017; Accepted: February 25, 2017

Abstract

Background:

Active trigger points (TrPs) of the suboccipital muscles greatly contribute to the occurrence of chronic tension-type headache, with increased sensitivity of TrPs and facilitated referred pain.

Objects:

This study aimed to investigate whether the integration of high-frequency diathermy into suboccipital release is more beneficial than the use of suboccipital release alone.

Methods:

Thirty subjects were assigned to either experimental group-1 (EG-1) to undergo suboccipital release combined with high-frequency diathermy (frequency: 0.3 MHz, and electrode type: resistive electronic transfer), or EG-2 to undergo suboccipital release alone, or the control group (CG) with no intervention, with 10 subjects in each group. The assessment tools included the headache impact test 6 (HIT-6), perceived level of tenderness, neck disability index, and neck mobility. Intervention was performed for 10 minutes, twice per week, for 4 weeks, and measurements were performed before and after the interventions.

Results:

The between-group comparison of the post-test values and changes between pretest and post-test showed significant differences for all parameters at p<.05, except for the left-to-right lateral bending range. In the post hoc test, EG-1 showed significant differences for the parameters in comparison with the CG, while no significant differences in the perceived tenderness level, on both temporal regions, were found between EG-2 and CG. Furthermore, the HIT-6 score and perceived tenderness level, in the right temporal region, showed significant differences between EG-1 and EG-2. In the within-group comparison, EG-1 and EG-2 appeared to be significantly different between pretest and post-test (p<.05), except for the perceived tenderness level in the right temporal region, with significance for the EG-1 group only (p<.05).

Conclusion:

These findings suggest that the suboccipital release technique may be advantageous to improve headache, tenderness, and neck function and mobility, with more favorable effects with the incorporation of high-frequency diathermy.

Keywords: High-frequency diathermy, Neck function, Suboccipital release, Tension-type headache.

Fig 1.

Figure 1.

Use of suboccipital release technique. (A) palpation of subocciptal region and application of sustained pressure, and (B) distaction of subocciptal region.

Physical Therapy Korea 2017; 24: 37-47https://doi.org/10.12674/ptk.2017.24.2.037

Fig 2.

Figure 2.

Equipment of high-frequency diathermy (radio frequence therapeutique).

Physical Therapy Korea 2017; 24: 37-47https://doi.org/10.12674/ptk.2017.24.2.037

Fig 3.

Figure 3.

Application of high- frequency diathermy during suboccipital release. Physical therapist weared the strap-typed electrode in the middle of forearm (circle) and return-pad plate was positioned under patients’ upper back (square in dot line).

Physical Therapy Korea 2017; 24: 37-47https://doi.org/10.12674/ptk.2017.24.2.037

Fig 4.

Figure 4.

Diagram of the study (EG-1: integration of high-frequency diathermy into suboccipital release technique, EG-2: suboccipital release technique alone, CG: control group, HIT-6: Head impact Test-6, NDI: Neck Disability Index).

Physical Therapy Korea 2017; 24: 37-47https://doi.org/10.12674/ptk.2017.24.2.037

Table 1 .. General characteristics of subjects (N=30).

EG-1a (n1=10)EG-2b (n2=10)CGc (n3=10)F(p)

Gender (male/female)3/72/81/9.5(.5)
Age (year)34.7±7.8d32.20±6.128.80±2.92.4(.1)
Height (cm2)165.7±5.2164.6±8.0167.50±6.2.5(.6)
Weight (kg)64.6±9.165.6±13.860.0±9.1.7(.5)
HIT-6e (scores)63.9±4.362.3±5.962.0±2.0.5(.6)

aexperimental group-1: integration of high-frequency heat therapy into suboccipital release

bexperimental group-2: suboccipital release alone

ccontrol group

dmean±standard deviation

ehead impact test-6.


Table 2 .. Comparison of the outcome of tenderness in pre and post-test among three groups (Unit: lb/cm2).

EG-1a (n1=10)EG-2b (n2=10)CGc (n3=10)F(p)

HIT-6ePre-test63.90±4.30d62.30±5.9462.00±2.00.54(.58)
Post-test46.30±7.4551.00±6.8160.80±2.4415.20(<.001)
Difff17.60±7.1011.30±5.101.20±3.0423.93(<.001)
t(p)7.83(<.001)7.00(<.001)1.24(.25)

Left temporal regionPre-test4.85±1.485.02±1.475.70±1.98.74(.48)
Post-test7.05±2.015.95±1.755.40±1.802.04(.15)
Diff-2.20±2.12-.94±.92.30±.689.72(<.001)
t(p)-3.71(.01)-3.23(.01)1.40(.20)

Right temporal regionPre-test5.30±.935.35±2.095.85±2.51.24(.80)
Post-test7.45±1.675.88±1.705.38±1.823.91(.03)
Diff-2.15±1.30-.53±1.26.47±1.1811.26(<.001)
t(p)-5.23(<.001)-1.32(.22)1.26(.24)

Left suboccipital regionPre-test5.40±2.105.55±2.726.96±2.001.40(.26)
Post-test9.65±2.029.40±2.936.80±2.28.31(.02)
Diff-2.25±1.49-1.84±0.73.16±1.2611.38(<.001)
t(p)-4.75(<.001)-7.93(<.001).40(.70)

Right suboccipital regionPre-test5.91±1.915.44±2.566.78±2.28.90(.41)
Post-test9.72±2.089.25±3.056.84±2.37.30(.03)
Diff-1.81±1.54-1.81±1.02-.06±1.625.04(.01)
t(p)-3.71(<.001)-5.57(<.001)-.11(.91)

aexperimental group-1: integration of high-frequency heat therapy into suboccipital release

bexperimental group-2: suboccipital release alone

ccontrol group

dmean±standard deviation

ehead impact test-6

fdifference between pre- and post-test

significant difference in a comparison with the control group (p<.05)

significant difference in a comparison with the EG-2 group (p<.05).


Table 3 .. Comparison of the outcome of NDI (neck disability index) and neck mobility in pre and post-test among three groups (Unit: degree).

EG-1a (n1=10)EG-2b (n2=10)CGc (n3=10)F(p)

NDIePre-test16.70±3.59d17.60±5.9214.60±4.321.06(.35)
Post-test8.50±4.0811.20±4.1513.70±4.004.05(.02)
Difff8.20±4.346.40±2.83.90±1.9614.10(<.001)
t(p)5.97(<.001)7.13(<.001)1.44(.25)

Flexion-extension rangePre-test91.55±12.4794.7±9.8495.2±7.52.38(.68)
Post-test112.35±10.08112.8±9.0896.1±10.968.90(<.001)
Diff-20.80±8.44-18.1±6.08-.90±4.627.00(<.001)
t(p)-7.79(<.001)-9.41(<.001)-.61(.55)

Left-right rotation rangePre-test112.90±15.36112.00±18.57116.2±13.48.19(.82)
Post-test128.20±10.67128.10±9.36115.3±11.175.05(.01)
Diff-15.30±9.85-16.10±14.73.90±6.647.70(<.001)
t(p)-4.90(<.001)-3.45(.01).42(.68)

Left-right lateral bending rangePre-test77.10±11.2584.5±4.9782.9±5.192.54(.09)
Post-test83.40±7.5787.7±5.2984.2±7.591.09(.34)
Diff-6.30±7.08-3.2±4.39-1.30±7.11.59(.22)
t(p)-2.81(.02)-2.30(.05)-.57(.58)

aexperimental group-1: integration of high-frequency heat therapy into suboccipital release

bexperimental group-2: suboccipital release alone

ccontrol group

dmean±standard deviation

eneck disability index

fdifference between pre- and post-test

significant difference in a comparison with the control group (p<.05)