Übungsprogramm bei HWS-ausgelösten Kopfschmerzen
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http://ebm.bmj.com/content/suppl/2003/08/08/8.4.109.DC1/84109authorreply.pdf
The therapeutic exercise techniques used in the randomised control trial (RCT) for
cervicogenic headache aimed to address the changes in muscle function found to accompany
cervical musculoskeletal disorders. In particular, the aim was to rehabilitate the muscles’
supporting and postural functions. The programme specifically addressed impairments in the
deep neck flexor and extensor muscles and changes in patterns of muscle use that have been
documented in the cervicoscapular muscle system. In the presence of neck pain and
headache, weakness has been identified in the deep neck flexor muscles, and patients show
increased activity in their superficial flexors, presumably as a compensation strategy. 1 2
Atrophy has been shown in the suboccipital extensors,3 and thus the deep muscle sleeve,
important for active support of the cervical segments,4 becomes impaired. Additionally,
increased activity has been shown in muscles such as the upper trapezius in patients with
neck pain during functional tasks,5 6 which may cause unnecessary loading on cervical
structures. Thus, the exercise approach is a motor relearning programme where the emphasis
is on rehabilitating the impaired coordination of the cervical and scapular muscle synergies
and on retraining the endurance capacities of the deep neck flexor and extensor muscles and
shoulder girdle muscles at low levels of load as is required for their function of support and
control of cervical joints and posture.
The prescription of specific exercises is based on the findings of the clinical
examination. This includes the muscle test of craniocervical flexion (CCF) and the clinical
analysis of muscle use in functional tasks such as assuming an upright sitting posture, the
pattern of muscle control during neck extension and flexion, and the pattern of scapular
muscle control with arm function.
