The Efficacy of Manual Therapy and Pressure Biofeedback Guided Strength Training on Pain and Functional Limitations
Condition: Cervicogenic Headache
MeSH terms: Post-Traumatic Headache; Headache
Study type: Interventional

Summary: 
      Cervicogenic headache (CGH) is a widespread illness that results in excruciating pain and a
      sizable functional handicap. Deep cervical flexor muscle (DCFM) strength and endurance were
      also worse in CGH patients. This study aimed to determine the efficacy of manual therapy and
      pressure biofeedback-guided DCFM strength training on pain intensity and functional
      limitations in individuals with CGH.
    

Detailed description: 
      The study followed a two-arms parallel group randomized comparative design, including sixty
      individuals with CGH, and they were allocated into two groups at random. For three
      consecutive weeks, in addition to the conventional treatment common to both groups, groups 1
      and 2 received pressure biofeedback-guided DCFM strength training and manual therapy,
      respectively. At baseline, the first week, the second week, and the third week post
      intervention, pain intensity and functional limitations were evaluated using the visual
      analog scale (VAS), the number of headache days per week, and the headache disability
      inventory (HDI) questionnaire. The main effects of the intervention were evaluated for a
      between-group factor, within-group factor, and interaction between time and groups over/at
      multiple time points. Data was analyzed using an independent t-test, mixed design 2-way
      ANOVA, with keeping the level of significance 'p' at 0.05.
    

Intervention name(s): Pressure biofeedback guided DCFM strength training; Manual therapy; Conventional intervention
Intervention type(s): Other; Other; Other
Intervention description(s): A pressure biofeedback guided DCFM strength training was carried out according to the Jull protocol. Keeping the participant's cervical spine in a neutral position and ensuring a stabilizer pressure biofeedback unit placed beneath the cervical lordosis. The pressure sensor was inflated at 20mm Hg. The participants were asked to nod their heads slowly. As the DCFM is activated, the cervical lordosis gently flattens, and the pressure sensor measures an increase in pressure. The activation score is the maximum pressure that can maintain for 10 seconds.; A manual therapy, including a slow, sustained elongation of muscles with a holding period of 7-10 seconds and a superficial oscillatory mobilization (grade-I) with 1-2 oscillations per second for 30 seconds per session was performed on the DCFM and at the cervical spine (C0-C5), respectively. The participants were asked to lie supine and prone while delivering stretching and mobilization, respectively.; A hot pads was applied for 20minutes underneath the cervical spine covering either side of shoulder in a relaxed supine position.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pressure biofeedback; Deep cervical flexor muscles; Muscle Strengthening; Manual therapy; Pain; Disability