Effects of MET on PPDH, Neck Pain and Disability After Cesarean Section

Study Overview
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Brief Summary
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The goal of this clinical trial is to determine the effect of Muscle Energy Techniques on post dural puncture headache, neck pain and disability after Cesarean Section. .

Detailed Description
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Caesarean section (CS) is the worldwide process of pregnancy termination that delivers live or dead fetuses with an incision on the abdominal wall and uterine wall. It is performed under neuraxial anesthesia (spinal and epidural anesthesia). Post- dural puncture headache (PDPH) is a major complication of neuraxial anesthesia which presents as a dull throbbing pain in a frontal-occipital distribution, aggravates on sitting or standing, and is reduced by lying down. This study will be a randomized clinical trial. Subjects with PPDH meeting the predetermined inclusion and exclusion criteria will be divided into two groups: i.e. treatment and control group. Both groups will receive baseline treatments i.e. (heating pads & TENS). In addition, treatment group will receive post-isometric relaxation of METs. Each subject will receive a total of 4 treatment sessions, with 2 treatment sessions per day Pre-treatment will be done at day 1 and post-treatment will be done at day 2, using Headache Disability Index (HDI), Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI) as subjective measurements. Recorded values will be analysed for any change using SPSs

Official Title
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Effects of Muscle Energy Technique on Post-Dural Puncture Headache, Neck Pain and Disability After Cesarean Section

Conditions
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Post-Dural Puncture Headache, Cesarean Section Complications

Intervention / Treatment
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* Other: Traditional Physical Therapy
* Other: Muscle Energy Technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18 to 40 years Both Primiparous and multiparous Both elective and emergency Lower Section Cesarean Section Headache occurring within 24-72 hours post C-section Headache aggravates on getting in upright position Exclusion Criteria: History of Trauma/fracture of head and neck region History of cervical spine surgery Had previous diagnostic Lumbar Puncture (LP) Any kind of infection, malignancy, inflammation and structural deformity present in head and neck region. Other serious forms of headaches including Migraine, Cluster, thunderclap, hypnic etc. Cervical Radiculopathies and spondylolisthesis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional physical therapy<br>TENS and Heating pads | Other: Traditional Physical Therapy<br>* TENS (transcutaneous electrical nerve stimulation) on continuous mode at 80-120 Hz for 15-20 min and Heating pads for 10-15 min Total 4 sessions will be given in 2 days<br>|
| Experimental: Muscle Energy Technique<br>Muscle Energy Technique protocol in along with TENS and Heating pads | Other: Muscle Energy Technique<br>* Muscle energy technique (Post Isometric relaxation) along with TENS and Heating pads. MET of the scaleni MET of Sternocleidomastoid MET of Levator Scapulae MET of Upper fibers of Trapezius Total 4 sessions will be given in 2 days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | Numeric pain rating scale (NPRS) is an outcome measure that is a segmented numeric version of visual analogue scale in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of patient's pain. The common format is horizontal bar or line and NPRS is anchored by terms describing pain and severity extremes | 2nd day | 
| Neck Disability Index | The NDI is a 10-item scaled self-administered questionnaire covering pain, concentration, and activities of daily living. Each of the ten items is scored from 0 to 5, and the total is calculated and multiplied by two to produce a percentage score of the maximal score; higher score indicates greater disability. Vernon and Mior defined 0-8 as none, 10-28 as mild, 30-48 as moderate, 50-68 as severe, and over 68 as complete disability | 2nd day | 
| Headache Disability Index | The Henry Ford Hospital Headache Disability Questionnaire (HDI) is a 25-item questionnaire that examines the effects of headache on daily life. This questionnaire has a two-factor structure emotionally and functionally. Scoring (No: 0, Sometimes:2, Yes:4) varies between 0 and 100. The higher the score, the more headache disability | 2nd day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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post dural puncture headache, neck pain, Cesarean Section