The video is in Italian with the possibility of selecting English subtitles

Cervical pain and tecar therapy: an integrated treatment

Every approach – manual therapy, chiropractic, osteopathy, physical exercise – has its validity. It’s their synergy that allows us to create treatments that focus on the global aspects of the problem to solve. 

The Italian Tecar Therapy Academy has been providing courses focusing on this global vision for many years. 

In our Facebook live, we talked about treating cervical pain using manual techniques, specific exercises, and tecar therapy. 

As cervical pain is such a broad topic, we decided to focus on cervicogenic headaches.

What are the most frequently treated cervical spine conditions?

We treat many cervical spine conditions at our physiotherapy centres, including disc conditions (e.g. disc herniation), joint dysfunction (e.g. facet syndrome), and myofascial pain syndrome (trigger points). 

When treating headaches, all these aspects need to be considered to create a specific therapeutic programme based on the dysfunction.

 

What type of headaches can physiotherapy help with?

According to the World Health Organisation, migraine is the most common disease in the world after dental caries. Apparently, 70% of the world’s population suffers from some form of headache. 

According to the Italian Neurological Association for Headache Research (ANCIREF), 26 million Italians suffer from migraine.

Physiotherapy can help with 5 types of headache:

  1. tension headache
  2. migraine
  3. TMJ headache 
  4. occipital neuralgia
  5. cervicogenic headache

What is a cervicogenic headache?

Cervicogenic headache is the most common secondary headache accounting for 50% of headaches caused by cervical spine problems.

Its main characteristics are:

  1. reduced upper cervical joint mobility 
  2. cervical and thoracic spine muscle tension
  3. trigger points in specific cervical spine muscles
  4. altered cervical neuromotor control

 

What are the causes of a cervicogenic headache?

This type of headache is caused by neuromusculoskeletal dysfunction. Here are a few examples:

  • a head or neck injury (e.g. whiplash)
  • Poor posture that strains the cervical spine joints and muscles
  • strenuous sports or work activities

What are the symptoms of a cervicogenic headache?

There are three main signs and symptoms:

  • Unilateral pain starting from the posterior head and spreading to the front (from the occipital to the frontal region)
  • Symptoms are caused by specific movements or cervical spine postures
  • palpating specific areas helps relieve the patient’s symptoms (manual provocation)
Artropatie Cervicali

How can you treat a cervicogenic headache with Fisiowarm?

Integrated treatment with Fisiowarm

With its 28 accessories and multiple functions, Fisiowarm 7.0 perfectly integrates high-frequency stimulation with manual techniques and exercises.

Fisiowarm and Manual techniques

Manual techniques help restore the cervical spine’s range of motion, which is limited in people with a cervicogenic headache. Posteroanterior mobilisation and mobilisation with movement are the most common techniques. 

Physiotherapists can integrate neuromusculoskeletal stimulation ensured by these techniques with tecar therapy’s biological stimulation by using the Profile resistive bipolar electrode. 

The bipolar electrode is not bound to the plate; therefore, it allows for performing mobilisation techniques with the patient either lying down or sitting down, just like they taught us in manual therapy courses. You can also adjust the distance between the two leads of the bipolar electrode to adapt it to the patient’s neck. The leads move smoothly, thanks to springs. This way, therapists will never lose contact with the patient’s body when performing mobilisation techniques.

Fisiowarm and myofascial treatments

An increasing number of physiotherapists uses IASTM (instrument-assisted soft tissue mobilisation) for myofascial tissue treatments (e.g. trigger point therapy).

IASTM is a value-added solution for patients and ensures more safety for the operator, reducing stress on their hands.

We integrated myofascial treatment with IASTM and radiofrequency stimulation using a mobilisation instrument – Fascial Full – as a unipolar electrode to deliver energy during mechanical stimulation. This electrode can be used in combination with the plate or with the 4 “return” points of the static automatic electrode kit.

If you want to work on a specific area, you can use the Unipointer electrode. Unipointer is a pen-shaped unipolar resistive electrode with a rounded surface specifically designed for trigger point therapy.

The recommended treatment for this kind of treatment ranges between 500 and 800 kHz, depending on how deep the target tissue is.

Tecarterapia, trattamento miofasciale del trapezio superiore
Tecarterapia e Trigger Point

Fisiowarm and specific exercises

Exercise is an essential part of the treatment of musculoskeletal disorders, as demonstrated by a large number of recent studies. Exercise helps speed up recovery, prevents recurrence, and reduces central sensitisation (which occurs in all persistent pain conditions).

One of the main goals of an exercise programme for patients with cervicogenic headache is restoring cervical motion control and cervical extensor and deep flexor strength/endurance.

Here are 3 of the most commonly prescribed exercises:

  • Posture Correction: the patient sits in front of a mirror and corrects their posture by extending the thoracic spine keeping the chin tucked in. 
  • Chin Retractions: this exercise (also known as chin tucks) can be performed while standing or sitting. It consists in retracting the chin to strengthen the deep cervical flexors and extend the atlanto-occipital joint.
  • Neck Strength Exercises: the patient sits in front of a mirror with a correct posture and performs counter-resistance isometric exercises.

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Fisiowarm allows for an integrated treatment using either the resistive bipolar electrode (if the patient needs to perform an active assist exercise) or the static automatic electrode kit.

What is the static automatic electrode kit?

It’s a 4-lead unipolar resistive electrode. The leads are all of the same size and can be taped on the patient. The 4 leads are placed on the cervical spine and the adhesive plate on a shoulder, allowing the patient to perform exercises while the radiofrequency stimulates the tissue. This way, physiotherapists can observe the patient’s movements and use both hands whenever they need to correct a movement.

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What operating modes and frequencies should be used?

Fisiowarm 7.0 has several operating modes: continuous, sensitive, and superpulsed, depending on the intensity and thermal stimulation you want to obtain. As we’ve seen in other Facebook lives, the continuous mode develops a more intense thermal effect than the sensitive and superpulsed modes. The thermal effect must be calibrated according to an accurate assessment of the patient’s clinical condition. 

For treatments focusing on the deeper structures – intervertebral discs, zygapophyseal joints – physiotherapists can set a frequency ranging between 300 and 500 kHz. For myofascial treatments, the frequency will be higher (up to 800 kHz) to stimulate the more superficial structures. As we often explain during our courses, it’s virtually impossible to standardise power and frequency settings because they depend on every condition and every patient. That’s why physiotherapists need to be suitably trained to use this unit effectively.

Andrea Pettirossi
Physiotherapist, Expert in Orthopaedic Manual Therapy. Specialised in Chiropractic Techniques.

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