Dry Needling Versus Instrumented Assisted Soft Tissue Mobilization In the Patient With Cervicogenic Treatment Headache

Study Overview
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Brief Summary
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the aim of this study is to investigate the efficacy of Dry Needling Versus Instrumented Assisted Soft Tissue Mobilization In the Patient With Cervicogenic Treatment Headache

Detailed Description
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Cervicogenic headache has been classified as a secondary type headache, and it is usually associated with cervical myofascial pain sources as myofascial trigger points . It also could be related to any joint, disc, and ligament disease of the upper region of the neck.physiotherapist use trigger point dry needling as an invasive treatment for CGH where a solid filament needle is inserted into a myofascial trigger point . The advantages of Dry needling are increasingly documented .Instrument-assisted soft tissue mobilization technique has been reported to decrease pain, improve overall function, and increase range of motion . It enhances the ability of physical therapists to detect altered tissue properties, through the vibration sense within the instrument, and to treat soft tissue dysfunction. It also enhances the patient's awareness of altered sensations within the treated tissues.

Official Title
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Dry Needling Versus Instrumented Assisted Soft Tissue Mobilization In the Patient With Cervicogenic Treatment Headache; Randomized Controlled Trial

Conditions
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Cervicogenic Headache

Intervention / Treatment
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* Other: dry needling
* Other: instrumented assisted soft tissue mobilization
* Other: conventional therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 20 to 60 years old patient with unilaterally 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 with reduced neck ROM headache intensity pain score of at least 20mm on the Visual analogue scale (VAS) 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 and central nervous system involvement, previous head or neck surgery or whiplash injury history within the last 6 weeks

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: dry needling and instrumented assisted soft tissue mobilization
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: dry needling<br>the patient will receive dry needling and conventional therapy three times per week for four weeks | Other: dry needling<br>* the patient will be in comfortable position .and clean the area over upper trapezius and sub occipital muscles. detect the trigger point then Perpendicular needling into the bulk of the muscle is the safest technique for this area.<br>Other: conventional therapy<br>* patients will be received traditional physiotherapy (stretching and strengthening cervical muscles and postural correction exercise)<br>|
| Experimental: instrumented assisted soft tissue mobilization<br>the patient will receive instrumented assisted soft tissue mobilization and conventional therapy three times per week for four weeks | Other: instrumented assisted soft tissue mobilization<br>* the patients will be in sitting position. The appropriate IASTM technique instrument will be selected to scan, and then treat the affected area for 30 to 60 seconds per treated area. The procedure will be applied to the superficial cervical fascia and investing the layers of deep cervical fascia that surround all the structures in the neck. Strokes will be applied on the sub occipital and upper fibers of trapezius muscle. The IASTM technique will be applied at a 45° angle in a direction parallel to the treated muscle fibers for 20 seconds, followed immediately by an additional 20 seconds application at a 45° angle in a perpendicular direction to the muscle fibers, resulting in a total treatment time of approximately 40 seconds. The patients will be advised that they might be sore, bruised, or have small red dots called petechiae, on the treated area. Ice will be applied for 15 to 20 min after the treatment if there will be a massive soreness.<br>Other: conventional therapy<br>* patients will be received traditional physiotherapy (stretching and strengthening cervical muscles and postural correction exercise)<br>|
| Active Comparator: conventional therapy<br>the patient will receive conventional therapy three times per week for four weeks | Other: conventional therapy<br>* patients will be received traditional physiotherapy (stretching and strengthening cervical muscles and postural correction exercise)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity | visual analogue scale will be used to asses pain intensity which patient will be instructed to put point on line from no pain to tolerable pain. The scale consists of a line, usually 10 cm long, ranging from no pain or discomfort (zero) , to the worst pain that could possibly feel . | up to four weeks | 
| neck disability | will be measured by Arabic neck disability index. It contains ten category/classes. Each category contains six choices (zero-five).Score from zero to four no disability, from five to 15 this is mild, From 15 to 24 this is moderate, from 25 to 34 this is severe, more than 34 this is a complete disability | up to four weeks | 
| pressure pain threshold | pressure pain threshold will be assessed by commander algometer | up to four weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| range of motion | range of motion will be measured by inclinometer CROM. The CROM (deluxe version - Performance Attainment Associates, Roseville, MN, USA) measures the cervical range of motion5- for ﬂexion, extension, lateral ﬂexion, and rotation using separate inclinometers. These inclinometers are attached to a frame similar to that for eyeglasses one in the sagittal plane for ﬂexion - extension, second in the frontal plane for lateral ﬂexion and a third in the horizontal plane for rotation. | up to four weeks | 
| headache frequency | the number of days the subjects feel headache (headache frequency). | up to four weeks | 
| medication intake | from the patients' diary in the last week , medications intake will be recorded as follow: 1) not at all; 2) once a week; 3) once every couple of days; 4) once or twice a day; or 5) three or more times a day | up to four weeks | 
| headache duration | the total hours of headache (headache duration). | up to four weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dry needling, cervicogenic headache, instrumented assisted soft tissue mobilization