Association between Cervical Muscle Weakness and Functional Limitations due to Headache in Doctors

Main Article Content

Shehroz Masood
Sana Arif
Muhammad Mahmood Alam
Waseem Akhtar
Mahrukh Naseem
Sameer Ahmad


Background: Headaches and neck discomfort are prevalent issues, particularly among healthcare professionals, and are often related to muscular weaknesses and postural anomalies. The intricate relationship between cervical muscle strength and the frequency and intensity of headaches necessitates a deeper understanding for effective management and treatment strategies.

Objective: The primary objective of this study was to investigate the association between cervical muscle weakness and functional limitations due to headaches in doctors, considering the impact of long working hours and the physical demands of the medical profession.

Methods: A cross-sectional study was conducted among doctors working at Akhtar Saeed Trust Hospital, Farooq Hospital, and AMDC in Lahore from June to December 2022. Participants with conditions like fibromyalgia, history of head and neck trauma, or degenerative cervical spine disease were excluded. The strength of cervical muscles was assessed using Manual Muscle Testing, and the intensity of headaches was evaluated using the Headache Impact Test (HIT-6) questionnaire. The sample size was calculated to be approximately 150, with data analysis performed using SPSS version 25. The study employed descriptive statistics, Chi-square tests, and parametric tests to analyze the data.

Results: The study found significant correlations between cervical muscle strength and headache impact. Among participants with moderate cervical flexor strength, HIT scoring ranged from 30 in the 36-50 range to 28 in the 60-78 range. For strong cervical flexors, the range was 34 in the 36-50 to 6 in the 60-78 range. Similar patterns were observed in cervical extensors and side flexors. The Chi-square values were significant across all muscle groups (18.45 for flexors, 32.164 for extensors, 50.175 for right side flexors, and 45.30 for left side flexors), all with a p-value of 0.000.

Conclusion: The study demonstrates a significant association between cervical muscle strength and the impact of headaches, indicating that weaker cervical muscles are associated with higher headache frequency and severity. These findings suggest the need for targeted muscle strengthening and posture correction interventions among doctors to mitigate the risks of headache and neck discomfort.

Article Details

How to Cite
Masood, S., Arif, S., Alam, M. M., Akhtar, W., Naseem, M., & Ahmad, S. (2024). Association between Cervical Muscle Weakness and Functional Limitations due to Headache in Doctors. Journal of Health and Rehabilitation Research, 4(1), 54–59.
Author Biographies

Shehroz Masood, Farooq Hospital West Wood Branch- Lahore

Physical Therapist

Sana Arif, Akhtar Saeed Medical and Dental College- Lahore


Muhammad Mahmood Alam, Akhtar Saeed Medical and Dental College- Lahore

Principal ACRS

Waseem Akhtar, Akhtar Saeed Medical and Dental College- Lahore

Head of department

Mahrukh Naseem, Akhtar Saeed College of Rehabilitation Sciences- Lahore

Physical Therapist

Sameer Ahmad, Akhtar Saeed Medical and Dental College- Lahore

Student of MS sports and excercise science


Danish MI. Short textbook of medical diagnosis and management: Scientific International Pvt. Ltd; 2018.

Delen V, İlter S. Headache Characteristics in Chronic Neck Pain Patients with Loss of Cervical Lordosis: A Cross-Sectional Study Considering Cervicogenic Headache. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2023;29:e939427-1.

Burch RC, Buse DC, Lipton RB. Migraine: epidemiology, burden, and comorbidity. Neurologic clinics. 2019;37(4):631-49.

Abaspour O, Akbari M, Rezasoltani A, Ahmadi A. Relationship between thickness of deep neck muscles synergy and painful side in patients with cervicogenic headache. CRANIO®. 2021;39(6):465-71.

Lipton RB. Chronic migraine, classification, differential diagnosis, and epidemiology. Headache: The journal of head and face pain. 2011;51:77-83.

Lipton R, Bigal M, Steiner T, Silberstein S, Olesen J. Classification of primary headaches. Neurology. 2004;63(3):427-35.

Ezzati K, Ravarian B, Saberi A, Salari A, Reyhanian Z, Khakpour M. Prevalence of cervical myofascial pain syndrome and its correlation with the severity of pain and disability in patients with chronic non-specific neck pain. Archives of Bone and Joint Surgery. 2021;9(2):230.

Núñez‐Cabaleiro P, Leirós‐Rodríguez R. Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review. Headache: The Journal of Head and Face Pain. 2022;62(3):271-83.

Florencio LL, de Oliveira AS, Pinheiro CF, Will-Lemos T, Dach F, Fernández-de-Las-Peñas C, et al. Comparison of cervical muscle isometric force between migraine subgroups or migraine-associated neck pain: A controlled study. Scientific Reports. 2021;11(1):15434.

O'leary S, Falla D, Elliott JM, Jull G. Muscle dysfunction in cervical spine pain: implications for assessment and management. journal of orthopaedic & sports physical therapy. 2009;39(5):324-33.

García-Pérez-de-Sevilla G, Gónzalez-de-la-Flor Á, Martín-Vera D, Domínguez-Balmaseda D, del-Blanco-Muñiz JÁ. Deep cervical muscles and functionality in patients with chronic tension-type headache: an observational study. Medicina. 2022;58(7):917.

Mattoo B, Tanwar S, Bhatia R, Tripathi M, Bhatia R. Chronic tension-type headache: muscle overactivity versus deficient pain controls. Asian J Pharm Clin Res. 2018;11(8):143-6.

Petersen SM, Wyatt SN. Lower trapezius muscle strength in individuals with unilateral neck pain. journal of orthopaedic & sports physical therapy. 2011;41(4):260-5.

Ghamkhar L, Kahlaee AH. Is forward head posture relevant to cervical muscles performance and neck pain? A case–control study. Brazilian journal of physical therapy. 2019;23(4):346-54.

Florencio LL, de Oliveira AS, Carvalho GF, Tolentino GdA, Dach F, Bigal ME, et al. Cervical Muscle Strength and Muscle Coactivation During Isometric Contractions in Patients With Migraine: A Cross‐Sectional Study. Headache: The Journal of Head and Face Pain. 2015;55(10):1312-22.

Malhotra A, Pace A, Ruiz Maya T, Colman R, Gelb BD, Mehta L, et al. Headaches in hypermobility syndromes: A pain in the neck? American Journal of Medical Genetics Part A. 2020;182(12):2902-8.

Gorla C, Martins TdS, Florencio LL, Pinheiro-Araújo CF, Fernández-de-Las-Peñas C, Martins J, et al., editors. Reference values for cervical muscle strength in healthy women using a hand-held dynamometer and the association with age and anthropometric variables. Healthcare; 2023: MDPI.

Contreras EFR, Fernandes G, Ongaro PCJ, Campi LB, Gonçalves DAG. Systemic diseases and other painful conditions in patients with temporomandibular disorders and migraine. Brazilian oral research. 2018;32.

Kuć J, Żendzian-Piotrowska M. A pilot study evaluating the prevalence of cervical spine dysfunction among students of dentistry at the medical university. Frontiers in Neurology. 2020;11:200.

Liang Z, Thomas L, Jull G, Minto J, Zareie H, Treleaven J. Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction. Headache: The Journal of Head and Face Pain. 2021;61(6):882-94.

Mohyuddin M, Lodhi W, Khan R. Frequency And Factors Associated With Headache Among People Of Various Occupations. Journal of Bahria University Medical and Dental College. 2012;2(2):26-31.

Pinheiro CF, Marçal JC, Oliveira AS, Florencio LL, Dach F, Fernández-de-las-Peñas C, et al. Is there a correlation of cervical mobility with clinical variables and psychosocial factors in women with migraine? Applied Sciences. 2021;11(13):6077.

Borg-Stein J. Cervical myofascial pain and headache. Current pain and headache reports. 2002;6(4):324-30.

Satpute K, Bedekar N, Hall T. Cervical neuro-musculoskeletal impairments in people with cervicogenic headache: a systematic review and meta-analysis. Physical Therapy Reviews. 2023:1-23.

Wannaprom N, Treleaven J, Jull G, Uthaikhup S. Response rate and comparison of clinical features associated with positive or negative responses to a scapular positioning test in patients with neck pain and altered scapular alignment: a cross-sectional study. BMJ open. 2021;11(12).

Rafael C. How to Calculate Sample Size Using Taro Yamane’s Formula. 2014.

Ylinen J, Takala E-P, Kautiainen H, Nykänen M, Häkkinen A, Pohjolainen T, et al. Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain. European journal of pain. 2004;8(5):473-8.

Hermann KM, Reese CS. Relationships among selected measures of impairment, functional limitation, and disability in patients with cervical spine disorders. Physical therapy. 2001;81(3):903-12.

Carvalho GF, Chaves TC, Gonçalves MC, Florencio LL, Braz CA, Dach F, et al. Comparison between neck pain disability and cervical range of motion in patients with episodic and chronic migraine: a cross-sectional study. Journal of manipulative and physiological therapeutics. 2014;37(9):641-6.

Florencio LL, Chaves TC, Carvalho GF, Gonçalves MC, Casimiro EC, Dach F, et al. Neck pain disability is related to the frequency of migraine attacks: A cross‐sectional study. Headache: The Journal of Head and Face Pain. 2014;54(7):1203-10.

Bakal DA, Kaganov JA. Muscle contraction and migraine headache: psychophysiologic comparison. Headache: The Journal of Head and Face Pain. 1977;17(5):208-15.

Lampl C, Rudolph M, Deligianni CI, Mitsikostas DD. Neck pain in episodic migraine: premonitory symptom or part of the attack? The journal of headache and pain. 2015;16(1):1-5.

Vernon H. The Neck Disability Index: state-of-the-art, 1991-2008. Journal of manipulative and physiological therapeutics. 2008;31(7):491-502.

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