Sustained Natural Apophyseal Glide and Deep Friction Massage in Patients With Cervicogenic Headache
Condition: Headache Disorders
MeSH terms: Post-Traumatic Headache; Headache Disorders; Headache
Study type: Interventional

Summary: 
      The aim of this randomized controlled trial is to compare the effects of sustained natural
      apophyseal glide and deep friction massage in patients with cervicogenic headache for
      reducing pain, enhancing cervical range of motion and improving sleep quality.
    

Detailed description: 
      Cervicogenic headache CGH is defined as the headache which arises from lesion occurring in
      the upper three cervical vertebrae and its associated soft tissue structures. Sleep
      disturbance has been continuously associated with headaches. CGH is a secondary type of
      headache as classified by the International Classification of Headache Disorders IHD.
      Physical and manual modes of therapy are important therapeutic modalities for the acute
      rehabilitation of cervicogenic headache.

      The "mobilization with movement" concept, known as the Mulligan concept, is entirely distinct
      from other forms of manual therapy. Mulligan described the sustained natural apophyseal glide
      (SNAG) on the joint with active movement done by the patient in the direction of the
      symptoms. This glide should be pain-free, with proper force applied by a trained person).
      Efficacy of SNAG C1-C2 has been proven in patients experiencing acute to subacute CGH for
      both short and long-term periods. Mulligan recommended that mobilization should be done
      towards the restricted site or in the direction of symptom reproduction, which is difficult
      to find in patients experiencing headache and dizziness in only one direction. There is
      evidence that mobilizing symptomatic and asymptomatic cervical levels result in immediate
      improvement of pain and segmental mobility at the same level as well as adjacent areas.

      James Cyriax proposed a treatment technique, Deep friction massage which has a significant
      effect in pain relieving. Cyriax friction massage is a widely known and used technique in the
      field of chronic pain management. It is a type of connective tissue massage applied to the
      soft tissue structures such as tendon, muscle bellies, musculotendinous junction, ligaments
      and joint capsules. This approach targets muscles both superficial and deep that can be
      contributing to headache. Muscles (such as trapezius, sternocleidomastoid, levator scapulae,
      and deep neck flexors) that contribute in developing CGH can be targeted using this
      technique.

      Mulligan's SNAG is a sustained glide that includes a sustained facet glide and active
      movement simultaneously; this technique targets the joint as well as muscle's active
      contraction. This reinforces the cervical lesion thus reducing CGH. Deep friction massage
      enables the skin, fascia; muscles to be involved in order to improve circulation thus promote
      healing. These techniques will help relieve cervicogenic headache and a proper comparison
      will be made which is novel. The effectiveness of these techniques in relieving headache,
      improving ROM and sleep quality will be investigated.
    

Intervention name(s): sustained natural apophyseal glide; deep friction massage
Intervention type(s): Other; Other
Intervention description(s): Mulligan's C1-C2 self-SNAG+ strengthening exercises for anterior and posterior neck muscles (extension, flexion, rotation, lateral flexion) Frequency: 2-3 times/week for 3 weeks Intensity: moderate intensity (pain free) Time: 20 minutes/session Type: Mobilization with movement SNAG Conventional PT including strengthening exercises neck muscles 10 repetitions, 1 set Resisted neck flexion, extension, lateral flexion, rotation Frequency: 2-3 times/week for 3 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 10 minutes/session Type: Strengthening Exercise; Cyriax deep friction massage+ strengthening exercises for anterior and posterior neck muscles (extension, flexion, rotation, lateral flexion) Frequency: 2-3 times/week for 3 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 20 minutes/session Type: Deep soft tissue massage Conventional PT including strengthening exercises neck muscles 10 repetitions, 1 set Resisted neck flexion, extension, lateral flexion, rotation Frequency: 2-3 times/week for 3 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 10 minutes/session Type: Strengthening Exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Sustained natural apophyseal glide/SNAG; deep friction massage; Cervicogenic headache