Effectiveness of kinesiotherapy for tension-type headache and chronic non-specific back pain: A prospective randomized study

Introduction. Kinesiotherapy is effective in the complex treatment of patients with tension-type headache (TTH) and patients with chronic nonspecific back pain (CNBP). However, few randomized studies have been conducted on the effectiveness of kinesiotherapy in patients with TTH and CNBP.

Aim. To evaluate the effectiveness of complex treatment, including kinesiotherapy, in patients with TTH and CNBP.

Materials and methods. The study included 100 patients (23 men, 77 women, mean age 38.8 ± 9.3 years). Patients were randomized into two groups. Group 1 received complex treatment (specialized kinesiotherapy, standard drug and non-drug therapy), group 2 – standard therapy. All patients were assessed for clinical and psychological parameters at baseline and after 3 and 6 months of treatment.

Results. After 3 months of treatment, the clinical effect (CE) in the treatment of TTH (decrease in headache (H) frequency by 50% or more) and CNBP (decrease in back pain (BP) intensity according to the numeric rating scale, the Oswestry questionnaire indicator by 30% or more) in group 1 was achieved by 88% of patients, which is statistically significantly (p < 0.05) greater than in group 2 (44% of patients). More than a third (36%) of patients in group 1 did not have H and BP after 3 months, while there were no such patients in group 2. After 6 months of observation, all achieved CEs were maintained in group 1, 38% of patients achieved complete remission of H and BP; in group 2, CE was maintained only in 33% of patients, and no patient showed complete regression of HB and BP.

Conclusion. Complex treatment, including kinesiotherapy, in patients with TTH in combination with CNBP leads to a rapid (after 3 months) positive effect, which lasts for a long time (6 months).

1. Parfenov VA, Yakhno NN, Davydov OS, Kukushkin ML, Churyukanov MV, Golovacheva VA et al. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):7–16. (In Russ.) https://doi.org/10.14412/2074-2711-2019-2S-7-16.

2. Ashina S, Lipton RB, Bendtsen L, Hajiyeva N, Buse DC, Lyngberg AC et al. (Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study. Eur J Pain. 2018;22(5):904–914. https://doi.org/10.1002/ejp.1176.

3. Yoon MS, Manack A, Schramm S, Fritsche G, Obermann M, Diener HC et al. Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: results of the German Headache Consortium study. Pain. 2013;154(3):484–492. https://doi.org/10.1016/j.pain.2012.12.010.

4. Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, Torres-Costoso A, Pozuelo-Carrascosa DP, Reina-Gutiérrez S et al. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther. 2022;52(8):505–521. https://doi.org/10.2519/jospt.2022.10671.

5. Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother. 2021;67(4):252–262. https://doi.org/10.1016/j.jphys.2021.09.004.

6. Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020;54(21):1279–1287. https://doi.org/10.1136/bjsports-2019-100886.

7. Anheyer D, Klose P, Lauche R, Saha FJ, Cramer H. Yoga for Treating Headaches: a Systematic Review and Meta-analysis. J Gen Intern Med. 2020;35(3):846–854. https://doi.org/10.1007/s11606-019-05413-9.

8. Varangot-Reille C, Suso-Martí L, Romero-Palau M, Suárez-Pastor P, Cuenca-Martínez F. Effects of Different Therapeutic Exercise Modalities on Migraine or Tension-Type Headache: A Systematic Review and Meta-Analysis with a Replicability Analysis. J Pain. 2022;23(7):1099–1122. https://doi.org/10.1016/j.jpain.2021.12.003.

9. Machado-Oliveira L, da Silva Gauto YO, de Santana Neto FJ, da Silva MG, Germano-Soares AH, Diniz PRB. Effects of Different Exercise Intensities on Headache: A Systematic Review. Am J Phys Med Rehabil. 2020;99(5):390–396. https://doi.org/10.1097/PHM.0000000000001349.

10. Krøll LS, Hammarlund CS, Linde M, Gard G, Jensen RH. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinicaltrial. Cephalalgia. 2018;38(12):1805–1816. https://doi.org/10.1177/0333102417752119.

11. Азимова ЮЭ, Алферова ВВ, Амелин АВ, Артеменко АР, Ахмадеева ЛР, Екушева ЕВ и др. Головная боль напряжения: клинические рекомендации. 2021. Режим доступа: https://cr.minzdrav.gov.ru/schema/162_2.

12. Azimova YE, Alferova VV, Amelin AV, Artemenko AR, Akhmadeeva LR, Ekusheva EV et al. Clinical Guidelines for Headache Stress (HBS). Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2022;122(2-3):4–28. (In Russ.) https://doi.org/10.17116/jnevro20221220234.

13. Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine. 2019;98(26):e16173. https://doi.org/10.1097/MD.0000000000016173.

14. Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):998. https://doi.org/10.1186/s12891-021-04858-6.

15. Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L et al. Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022;23(1):801. https://doi.org/10.1186/s12891-022-05722-x.

16. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. https://doi.org/10.1177/0333102417738202.

17. Modarresi S, Lukacs MJ, Ghodrati M, Salim S, MacDermid JC, Walton DM. A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain. Clin J Pain. 2021;38(2):132–148. https://doi.org/10.1097/AJP.0000000000000999.

18. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res. 2011;63:467–472. https://doi.org/10.1002/acr.20561.

19. Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory. A review. Psychopathology. 1998;31(3):160–168. https://doi.org/10.1159/000066239.

20. Darnall BD, Sturgeon JA, Cook KF, Taub CJ, Roy A, Burns JW et al. Development and Validation of a Daily Pain Catastrophizing Scale. J Pain. 2017;18(9):1139–1149. https://doi.org/10.1016/j.jpain.2017.05.003.

21. Weermeijer JD, Meulders A. Clinimetrics: Tampa Scale for Kinesiophobia. J Physiother. 2018;64(2):126. https://doi.org/10.1016/j.jphys.2018.01.001.

22. Smeets R, Köke A, Lin CW, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res. 2011;63:158–173. https://doi.org/10.1002/acr.20542.

23. Zandifar A, Banihashemi M, Haghdoost F, Masjedi SS, Manouchehri N, Asgari F et al. Reliability and Validity of the Persian HIT-6 Questionnaire in Migraine and Tension-type Headache. Pain Pract. 2014;14(7):625–631. https://doi.org/10.1111/papr.12120.

24. Castien R, Duineveld M, Maaskant J, De Hertogh W, Scholten-Peeters G. Pericranial Total Tenderness Score in Patients with Tension-type Headache and Migraine. A Systematic Review and Meta-analysis. Pain Physician. 2021;24(8):E1177–E1189. Available at: https://pubmed.ncbi.nlm.nih.gov/34793636.

25. Hvedstrup J, Kolding LT, Younis S, Ashina M, Schytz HW. Ictal neck pain investigated in the interictal state – a search for the origin of pain. Cephalalgia. 2020;40(6):614–624. https://doi.org/10.1177/0333102419896369.

26. Golovacheva VA, Golovacheva AA. Chronic neck pain and combined tension headache: a unified effective treatment approach. Neurology, Neuropsychiatry, Psychosomatics. 2024;16(4):76–84. (In Russ.) https://doi.org/10.14412/2074-2711-2024-4-76-84.

27. Parfenov VA, Golovacheva VA, Isaikin AI, Golovacheva AA, Silina EV. Treatment of chronic non-specific (musculoskeletal) back pain. Neurology, Neuropsychiatry, Psychosomatics. 2024;16(3S):1–16. (In Russ.) https://doi.org/10.14412/2074-2711-2024-3S-1-16.

28. Golovacheva VA, Golovacheva AA, Belyaeva SD. Cervicobrachialgia and lumboischialgia: A single effective approach to solving the problem. Meditsinskiy Sovet. 2024;18(12):86–94. (In Russ.) https://doi.org/10.21518/ms2024-309.

29. Golovacheva VA, Golovacheva AA. An effective complex approach to the management of patients with chronic musculoskeletal low back pain and pains in other body sites. Meditsinskiy Sovet. 2024;18(3):108–116. (In Russ.) https://doi.org/10.21518/ms2024-139.

30. Golovacheva VA, Golovacheva AA, Tarshilova AR. Chronic musculoskeletal low back pain: mistakes in patient management and optimization issues. Neurology, Neuropsychiatry, Psychosomatics. 2024;16(3):103–109. (In Russ.) https://doi.org/10.14412/2074-2711-2024-3-103-109.

31. Golovacheva VA, Golovacheva AA. Successful combinations of drug and non-drug therapy for low back pain. Russian Journal of Pain. 2024;22(1):57–67. (In Russ.) https://doi.org/10.17116/pain20242201157.

32. Golovacheva AA, Golovacheva VA. Kinesiotherapy in chronic back pain and combined tension type headache. Russian Neurological Journal. 2023;28(3):61–68. (In Russ.) https://doi.org/10.30629/2658-7947-2023-28-3-61-68.

33. Golovacheva VA, Tabeeva GR, Golovacheva AA. Non-specific low back pain: principles and algorithms for successful management of patients in real clinical practice. Neurology, Neuropsychiatry, Psychosomatics. 2023;15(3):85–94. (In Russ.) https://doi.org/10.14412/2074-2711-2023-3-85-94.

34. Zinovyeva OE, Golovacheva AA. Cognitive functional therapy and non-steroidal anti-inflammatory drugs in the treatment of low back pain. Meditsinskiy Sovet. 2022;16(23):78–85. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-23-78-85.

35. Golovacheva AA, Golovacheva VA, Parfenov VA. Kinesiotherapy and non-steroidal anti-inflammatory drugs for nonspecific lumbago. Neurology, Neuropsychiatry, Psychosomatics. 2022;14(1):89–96. (In Russ.) https://doi.org/10.14412/2074-2711-2022-1-89-96.

36. Ibrahim AA, Akindele MO, Ganiyu SO. Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial. BMC Musculoskelet Disord. 2023;24(1):142. https://doi.org/10.1186/s12891-022-06108-9.

37. Gorji SM, Mohammadi Nia Samakosh H, Watt P, Henrique Marchetti P, Oliveira R. Pain Neuroscience Education and Motor Control Exercises versus Core Stability Exercises on Pain, Disability, and Balance in Women with Chronic Low Back Pain. Int J Environ Res Public Health. 2022;19(5):2694. https://doi.org/10.3390/ijerph19052694.

38. Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J PhysTher. 2018;22(2):144–153. https://doi.org/10.1016/j.bjpt.2017.09.003.

39. Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N et al. Feasibility and impact of sit-stand workstations with and without exercise in office workers at risk of low back pain: A pilot comparative effectiveness trial. Appl Ergon. 2019;76:82–89. https://doi.org/10.1016/j.apergo.2018.12.006.

40. Gobbo S, Bullo V, Bergamo M, Duregon F, Vendramin B, Battista F et al. Physical Exercise Is Confirmed to Reduce Low Back Pain Symptoms in Office Workers: A Systematic Review of the Evidence to Improve Best Practices in the Workplace. J Funct Morphol Kinesiol. 2019;4(3):43. https://doi.org/10.3390/jfmk4030043.

41. Rota E, Evangelista A, Ceccarelli M, Ferrero L, Milani C, Ugolini A et al. Efficacy of a workplace relaxation exercise program on muscle tenderness in a working community with headache and neck pain: a longitudinal, controlled study. Eur J Phys Rehabil Med. 2016;52(4):457–465. Available at: https://pubmed.ncbi.nlm.nih.gov/26745361.