People who chronically suffer from cervical headaches or cervicalgia haveatrophy of the deepmuscles of the neck.

Magnetic resonance imaging studies have shown that atrophy selectively affects the deeper ^musculature1. It is common for these patients to present overload of the superficial musculature and therefore, there is an important imbalance.

The deep musculature of the neck is responsible for providing stability and support to the entire craniocervical system. In addition, it plays a fundamental role in the proprioceptive information of the head position(the muscular receptors send information to the nervous system about how the head is positioned, and receive information to position it). Therefore, this muscular system is key in posture.

In many cases it is not known whether this muscle atrophy is the cause or the consequence of neck pain and headaches, but what is clear is that it is a perpetuating factor.

Therefore, in chronic cervical pain and headaches secondary to cervical contracture, therapeutic exercise is a fundamental pillar of treatment.

Several studies demonstrate the efficacy of physiotherapy treatment including passive techniques and active techniques of
therapeutic exercise. Ettekoven and ^Lucas2 investigated the effects of therapeutic exercise. They conducted a study on patients suffering from chronic headaches of cervical origin. One group was treated with conventional passive physiotherapy techniques (stretching, mobilizations) and the other group was treated with the same passive techniques and active therapeutic exercise techniques. Significant short and long term changes were observed in people who did the active exercise program. The frequency, intensity and duration of cervical pain and headaches decreased. .

Therefore, physical therapy treatment in these cases should include active techniques on the part of the patient, such as specific exercises of the deep neck muscles and postural re-education.

The exercise program should be designed, guided and graded by a physiotherapist, always adapting it to each particular case. It consists of specific exercises of the deep muscles of the neck, precise and low load. The objective is not only to gain muscle strength, but also to achieve proper control of movement and posture. Motor re-education is carried out progressively, first with simple and selective exercises that will later be integrated into global posture and functional activities. It is advisable to add global postural reeducation exercises and ergonomic guidelines and measures to the rehabilitation program.

It is essential that the exercises are specific and designed on a case-by-case basis since the improvement in cervical muscle function is directly related to the exercise protocol performed.

• C Fernández de las Peñas, A Bueno, J Ferrando. Magnetic Resonance Imaging study of the morphometry of cervical extensor muscles in chronic tension-type headache. Cephalalgia, 2007, 27, 355-362.

• H van Ettekoven, C Lucas. program for tension type headache; a randomized clinical trial. Cephalalalgia, 2006, 26, 989-991.

In the Neurology Service we have a multidisciplinary team that ensures that the problems are addressed in an integrated, coordinated, personalized and continuous way. If you would like to receive information, please contact us.

Beatriz Martín Rojo

Physiotherapist specialized in neurorehabilitation and member of the Neurorehabilitation Unit team.