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The Association of Manual Muscle Tests and Treatment Outcomes With Headache and Cranial Dysfunctions: A Retrospective Case Series Report

Charles Blum, DC, CSCP; Scott Cuthbert, DC; Anthony Rosner, PhD, LLD (Hon), LLC

Background • This study examine whether there is an interrelationship between cranio-sacral dysfunctions and the muscle inhibitions found in the muscles attaching to the skull in patients with headaches. Primary Study Objective • To present a retrospective case series report assessing the prevalence of positive manual muscle tests (MMTs) in the assessment and management of adults with headache and cervico-cranial dysfunctions and to present patient outcomes pre- and posttreatment. Methods/Design • Fifty-two patient files with headache (HA) (48 females, 4 males) were retrospectively examined. These patients had either primary (tension-type, migraine, or cervicogenic) or secondary HAs (that result from other medical conditions), according to the International Classification of Headache Disorders. A standardized MMT assessment of the major cervical muscles attaching to the skull was performed on every patient pre- and posttreatment, and a pre- and posttreatment numeric pain scale of neck and associated head pain was recorded. Setting • The setting was an in-office clinical chiropractic trial. Primary Outcome Measures • MMT and numeric pain scale of neck and associated head pain evaluation pre- and posttreatment. Results • Muscle dysfunctions (inhibition) were found to be associated with HA in these patients as follows: sternocleidomastoid, 42 patients; deep neck flexors, 33 patients; anterior scalenes, 24 patients; and upper trapezius, 24 patients. Three patients with HA had no muscle inhibition. Cranial and upper cervical articular dysfunctions were found in 49 and 52 patients, respectively. In this group of 52 patients with HA, 49 patients had cranial dysfunctions that when treated with applied kinesiology improved all or a portion of the muscle inhibitions, whereas the initial numeric pain scale of neck and associated head pain simultaneously fell from an average of 6.75 to an average of 0.49. Odds ratios were calculated to be >1, meaning there was a positive correlation between positive MMT of these muscles (as well as upper cervical and cranial dysfunctions) and HAs in this cohort. Conclusion • A symptomatic group of patients with HA and cranial dysfunctions demonstrated MMT findings in the form of muscle inhibition. Cranial treatments to improve muscle strength were found to correlate with improvements in HA for these patients. This evidence may suggest that the MMT is a potentially useful test for evaluating pericranial muscular impairments in patients with cranial dysfunctions and HA.

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