Effects of SNAGS Along With Thoracic Postural Correction Techniques in Patients With Chronic Cervicogenic Headache

Study Overview
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Brief Summary
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The aim of this study is to find out the effects of Mulligan SNAGs along with thoracic postural correction techniques on patients with chronic cervicogenic headache. Patients suffering from cervicogenic headache are often associated with muscle imbalance. This study will be significant in determining the effects of SNAGs along with thoracic postural correction techniques to improve pain, level of disability and functional status in patients of cervicogenic headache. It will be Randomized controlled trial study design Data will be collected from Lady reading Hospital Peshawar Purposive sampling, group randomization using lottery method will be used in this study.

Detailed Description
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Headaches are a common condition affecting 47% of the global population,1,2 with cervicogenic headaches (CGHs) accounting for 15-20% of all chronic and recurrent headaches. The International Headache Society has classified a cervicogenic headaches as a secondary headache with 'pain referred from a source in the neck and perceived in one or more regions of the head and/or face. In the case of cervicogenic headache, the cause is a disorder of the cervical spine and its component bone, disc and/or soft tissue elements. The term cervicogenic headache is commonly misused and does not simply apply to a headache associated with neck pain; many headache disorders, including migraine and tension-type headache, can have associated neck pain/tension. Rather, there must be evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause a headache (1). It is often worsened by neck movement, sustained awkward head position or external pressure over the upper cervical or occipital region the symptomatic side (2). The prevalence of Chronic headache has been reported to be between 0.4 and 20 % of the headache population (3). In recent years, there has been an increasing knowledge in the pathogenesis and better management of chronic headaches. Current scientific evidence supports the role of manual therapies in the management of tension type and cervicogenic headache (4). Individuals with Chronic headache are frequently treated with spinal manipulative therapy including both mobilization and manipulation. Spinal mobilization consists of slow, rhythmical, oscillating techniques (5) Cervical sustained natural apophyseal glides (SNAGs) are 'mobilization with movement' technique in which a sustained accessory facet glide is applied together with active physiological movement. The therapist may apply the glide over the spinous process (central SNAGs) or over the articular pillar on one side (unilateral SNAGs). SNAGs have been advocated for the treatment of neck pain and range of movement (ROM) restriction. SNAGs have been shown to be effective for the treatment of neck pain, cervicogenic headaches, and cervicogenic dizziness (6).mobilization with movement utilize the dual role of bot therapist force (accessory glides) and patient effort (active physiological or functional movement) and techniques are often carried out in a variety of weight bearing positions, with treatment belts, and either additional therapist, assistant or patient applied overpressure A thorough clinical examination is performed and appropriate level is identified, the glide is then performed parallel to the perceived facet plane and the degree of glide is determined by patient's active movement response (8). Many studies on the short-term effectiveness and manual therapy to the cervical spine (mobilization and manipulative therapy) have found it beneficial in reducing headache pain or disability, intensity, frequency, and duration.

Official Title
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Effects of Sustained Natural Apophyseal Glides Along With Thoracic Postural Correction Techniques in Patients With Chronic Cervicogenic Headache

Conditions
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Cervicogenic Headache

Intervention / Treatment
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* Other: sustained natural apophyseal glides
* Other: SNAGS with thoracic postural correction techniques


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients having headache for the last three months Patients having unilateral neck pain along with stiffness. A headache that is more frequent periorbitally, spreading to the temporal and ocular region and in the low occipital and less frequent in the frontal, parietal and facial region. Pain that is usually elicited by applying external pressure on at least 1 of the upper cervical joints (C0-C3) and moderate to severe non throbbing pain Exclusion Criteria: Other types of headaches Congenital conditions of the cervical spine Disc herniation Cervical Fractures Degenerating disease of the cervical spine. Patients with contraindications to mobilization techniques and those with dizziness due to vertebrobasilar insufficiency or vestibular dysfunctions

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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Female

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
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: sustained natural apophyseal glides<br>SNAGS will be applied in flexion, extension and rotation for a few seconds with 3 repetitions on the first day and 10 repetitions from the next visit. | Other: sustained natural apophyseal glides<br>* SNAGS will be applied in flexion, extension and rotation for a few seconds with 3 repetitions on the first day and 10 repetitions from the next visit.<br>Other: SNAGS with thoracic postural correction techniques<br>* thoracic extension in sitting, Wall angle stretch and Corner stretch, while the therapist-facilitated stretches will be seated mid-thoracic stretch and prone mid thoracic stretch. Stretches will be maintained for 15-20 seconds with 10 repetitions of each stretch per session<br>|
| Active Comparator: SNAGS with thoracic postural correction techniques<br>active as well as therapist-facilitated stretches.thoracic extension in sitting, Wall angle stretch and Corner stretch, while the therapist-facilitated stretches will be seated mid-thoracic stretch and prone mid thoracic stretch. Stretches will be maintained for 15-20 seconds with 10 repetitions of each stretch per session | Other: sustained natural apophyseal glides<br>* SNAGS will be applied in flexion, extension and rotation for a few seconds with 3 repetitions on the first day and 10 repetitions from the next visit.<br>Other: SNAGS with thoracic postural correction techniques<br>* thoracic extension in sitting, Wall angle stretch and Corner stretch, while the therapist-facilitated stretches will be seated mid-thoracic stretch and prone mid thoracic stretch. Stretches will be maintained for 15-20 seconds with 10 repetitions of each stretch per session<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog scale (VAS) | The VAS is a 10- cm graduated line. Each participant will self-assess the intensity of her pain. Patients in each group will be instructed to point to the position on the line between the faces to indicate how much pain they are currently feeling. The far-left end indicates no pain and the far right end indicates worst pain ever | four weeks | 
| Neck Disability Index (NDI) | The NDI can be scored as a raw score or doubled and expressed as a percent. Each section is scored on a 0 to 5 rating scale, in which zero means 'No pain' and 5 means 'Worst imaginable pain. | for four weeks | 
| Headache Impact Test | Headache Impact Test is a tool used to measure the impact headaches have on your ability to function on the job, at school, at home and in social situations. Your score shows you the effect that headaches have on normal daily life and your ability to function. | for four weeks | 
| Cervical ROM --Universal Goniometer | A large universal goniometer having a stationary arm and a moving arm of 12 inch and full circle body will be used for measuring cervical range of motion. | four weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cervicogenic headache, thoracic posture correction, SNAGS