International Journal of Physiotherapy and Research

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Type of Article : Case Report

Year: 2015 | Volume 3 | Issue 3 | Page No. 1032-1036

Date of Publication: 11-06-2015

DOI: 10.16965/ijpr.2015.129


Jeyanthi. S *1, Narkeesh Arumugam 2.  

*1 Assistant Professor, Amar Jyoti Institute of Physiotherapy, University of Delhi / Ph D Research Scholar, Punjabi University, Patiala, Punjab, India.
2 Professor, Punjabi University, Patiala, India.

Corresponding author: Dr. Jeyanthi. S (PT)., No.133 First floor, Ram Vihar, Karkardooma, Delhi -110092, India.


Background and Purpose: Myofascial pain syndrome (MPS) is a syndrome presenting with acute or chronic regional pain originating from trigger points (TPs) localized in the muscles or the fascia. TPs are local points showing high irritability, sensitivity to finger pressure and causing characteristic referred pain. The aim of this case study is to assess the effectiveness of cranio-cervical training on neck disability, endurance of deep cervical muscles and pressure pain threshold in a patient with cervical myofascial pain syndrome.
Case description: A 36 year old female who was diagnosed with myofascial pain syndrome. She received cranio cervical training, a low load endurance exercises in order to train and/or to regain muscle control of the cervicoscapular and craniocervical regions. The patient received the treatment program for 10 to 15 minutes. The frequency of treatment is five days in a week for a period of 3 weeks.
Outcome: The outcome measures were neck disability index, pressure pain threshold and deep cervical endurance test, which were measured prior to treatment and at the end of third week.
Conclusion: The craniocervical training programme for a patient with myofascial pain syndrome found to be effective in reducing neck disability, improving the pressure pain threshold and deep cervical flexor muscle endurance.
KEY WORDS: Myofascial Pain Syndrome, Cranio Cervical Training, Neck disability Index, Pressure Pain threshold, Deep Cervical Endurance Test.


  1. Skootsky, S.A., Jaegerb, B., Oye, R.K. 1989. Pevalence of myofascial pain General internal Medicine practice. West. J. Med. 1989; 151:157-60.
  2. Simons, D.G., Travell, J.G., Simons, L.S. 1999. Myofascial pain and dysfunction: The Trigger point manual, upper half of the body. 2nd edition Vol. 1. Baltimore,Williams and Wilkins.
  3. Shah, J.P., Danoff, J.V., Desai, M.J., Parik, S., Nakamura, L.Y., Philips, T.M., Gerber, L.H. Biochemicals associated with pain and inflammation is elevated in sites near to and remote from active myofascial trigger points. Arch. Phys. Med. Rehab. 2008;89:16-23.
  4. Escobar PL, Ballesteros J. Myofascial pain syndrome. Orthop Rev. 1987;16:708-713.
  5. Fishbain DA, Goldberg M, Steele R, Rosomoff H. DSM-III Diagnoses of patients with myofascial pain syndrome (fibrositis). Arch Phys Med Rehabil . 1989;70:433-438.
  6. Auleciems LM. Myofascial pain syndrome: a multidisciplinary approach. Nurse-Pract. 1995;20:18-28.
  7. Meyer HP. Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. Curr Pain Headache Rep. 2002;6:274-283.
  8. Lang AM. A preliminary comparison of the efficacy and tolerability of botulinum toxin serotypes A and B in the treatment of myofascial pain syndrome: a retrospective, open-label chart review. Clin Ther. 2003;25:2268-2278.
  9. Travell J, Simons DG. 1999. Myofascial pain and dysfunction. The trigger point manual. The lower extremities. 1st ed. Vol. II. Baltimore, MD: Lippincott Williams & Wilkins.
  10. Mense S, Simons DG, Russell IJ. 2000. Muscle pain: understanding its nature, diagnosis and treatment. Philadelphia, PA: Lippincott Williams & Wilkins.
  11. Darryl D Curl. 1994. Classification of headache: A new look. “Chiropractic approach to head pain” (Chap. 9) Williams and Wilkins.182-189.
  12. Sauer Sharon and Mary Biancalana.2010. Trigger point therapy for low back pain. 1 st edition. Canada. New Harbinger Publications, page 19.
  13. Chaitow, L., Judith, W.D. 2001. Clinical application of neuromuscular technique. Vol-1, The Upper Body. Churchill Livingstone
  14. Farina, S., Casarotto, M., Benelle, M., Tinazzi, M., Fiaschi, A., Goldoni, M., Smania, N. A randomized controlled study on the effect of two different treatments (FREMS AND TENS) in myofascial pain syndrome. Eura. Medicophys., 2004;40:293-301.
  15. Lluch E, Arguisuelas MD, Coloma PS, Palma F, Rey A, Falla D. Effects of deep cervical flexor training on pressure pain thresholds over myofascial trigger points in patients with chronic neck pain. J Manipulative Physiol Ther. 2013;36(9):604-11.
  16. Hislop Helen and Montgomery Jacqueline, 2007. Daniels and Worthingham Muscle Testing.8th edition.Saunders.
  17. Vermon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14:409-415.
  18. Grimmer K. Measuring the endurance capacity of the cervical short flexor muscle group. Aust J Physiother. 1994;40:251-254.
  19. Kevin D Harris, Darren M Heer, Tanja C Roy, Diane M Santos, Julie M Whitman, Robert S Wainner. Reliability of a measurement of neck flexor muscle endurance. Phys Ther. 2005;85:1349-1355.
  20. Chantal HP de Koning, Sylvia P van den Heuvel, J Bart Staal, Bouwien CM Smits-Engelsman and Erik JM Hendirks. Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review, BMC Musculoskeletal disorders. 2008;9-142.
  21. Takala EP. Pressure pain threshold on upper trapezius and levator scapulae muscles. Repeatability and relation to subjective symptoms in a working population. Scand J Rehabil Med. 1990;22(2):63-8.
  22. Levoska S. Manual palpation and pain threshold in female office employees with and without neck-shoulder symptoms. Clin J Pain. 1993;9:236-41.
  23. Falla D, Rainoldi A, Merletti R, Jull G. Myoelectric manifestations of sternocleidomastoid and anterior scalene muscle fatigue in chronic neck pain patients. Clin Neurophysiol. 2003;114:488–95.
  24. Watson DH, Trott PH. An investigation of natural head posture and upper cervical flexor muscle performance.Cephalalgia. 1993;13:272–84.
  25. Bendtsen L. Central and peripheral sensitization in tension-type headache. Curr Pain Headache Rep. 2003;7:460–5.
  26. Mayoux Benhamou MA, Revel M, Vallee C, Roudier R, Barbet JP, Bargy F. Longus colli has a postural function on cervical curvature. Surg Radiol Anat. 1994;16:367–71.
  27. Olesen J. Clinical and pathophysiological observations in migraine and tension-type headache explaned by integration of vascular, supraspinal and myofascial inputs. Pain. 1991;46:125–32.
  28. Jull G, Barrett C, Magee R, Ho P.  Further characterization of muscle dysfunction in cervical headache. Cephalalgia. 1999;19:179–85.
  29. Bendtsen L. Sensitization: its role in primary headache. Curr Opin Investig Drugs. 2002;3:449–53 (Review).
  30. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D. A randomized controlled trial of excercise and manipulative therapy for cervicogenic headache. Spine. 2002;27:1835–43.
  31. Jensen R. Peripheral and central mechanisms in tension type headache: an update. Cephalalgia. 2003;23 (Suppl.1):49–52 (Review).
  32. Makowska A, Panfil C, Ellrich J. Long-term potentiation of orofacial sensorimotor processing by noxious input from the semispinal neck muscle in mice. Cephalalgia. 2005;25:109–16.
  33. Ettekoven VH & Lucas C. Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. Cephalalgia. 2006;26:983–991.


Jeyanthi. S, Narkeesh Arumugam. EFFECTIVENESS OF CRANIO-CERVICAL TRAINING OVER MYOFACIAL PAIN SYNDROME: A CASE STUDY. Int J Physiother Res 2015;3(3):1032-1036. DOI: 10.16965/ijpr.2015.129




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