Effect of Instrument-Assisted Soft Tissue Mobilization on Proprioception and Disability in Patients With Cervicogenic Headache

This study will be conducted to investigate the effect of instrument assisted soft tissue mobilization technique In pain intensity, frequency of headache, medication Uptake, Suboccipital movement in flexion and extension, rounded shoulder, forward head posture and proprioception of cervical spine in cases of cervicogenic headache related to trigger points and myofascial restrictions when combined with conventional physical therapy modalities.

The International Headache Society has classified the cervicogenic headache as a secondary headache type that is hypothesized to originate due to nociception in the cervical area. The main difference between these patients with and without cervicogenic headache is the lateralization of pressure hyperalgesia to the painful side of the head and neck, there is a unilateral pattern of pressure hyperalgesia in the head and neck that typifies the altered sensory processing in patients with cervicogenic headache. Cervicogenic headache pain has been mostly related to joint, disc and ligament disease of the upper cervical spine. However, the upper cervical nerves also receive afferent inputs from the muscle tissues.

Several physical therapy techniques are proposed for this type of headache. Strength and endurance exercises, when accompanied by stretching exercises, were shown to be an effective treatment for cervicogenic headache patients. The lack of solid evidence of positive effects and risks of serious complications for spinal manipulation should be considered in favor of other physical therapy options associated with less risk. Graston Technique is an instrument assisted soft tissue mobilization (IASTM) treatment method using a tool that generates mechanical micro-traumatic damage to the treated area. It thus creates an inflammatory response to accelerate the healing process and restore flexible, normal tissue. This technique seems to have the therapeutic effects of inhibiting the adhesion of tissue, increasing the number of fibroblasts, and promoting collagen synthesis. eighty patients with carcinogenic headache will be allocated randomly to two equal group. one group will receive IASTM and traditional therapy and other will receive traditional only for eight weeks.

Eligibility Criteria:
Inclusion Criteria:

* 35 to 50 years old
* unilaterality of the head pain
* pain triggered by external pressure over the upper cervical joints (C1-C3)
* pain elicited by the neck movements, and/or sustained awkward positions, reduced neck ROM
* headache intensity pain score of at least 20mm on the Visual Analogue Scale,
* headache frequency of at least once a week for at least 3 months
* minimum neck disability index score of 10 points or greater.

Exclusion Criteria:

* migraine
* tension-type headache
* tumor
* osteoporosis
* fracture
* rheumatoid arthritis and metabolic diseases
* prolonged history of steroid use
* resting blood pressure greater than 140/90 mmHg
* cervical spinal stenosis
* diminished sensation
* central nervous system involvement
* previous head or neck surgery
* whiplash injury history within the last 6 weeks
* head or neck pain treatment within the last month from any practitioner and PT approach for head or neck pain within the last 3 months
* open wounds and psychiatric/cognitive disorders
* patients contraindicated to carotid artery massage