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

September 15, 2022 updated by: Riphah International University

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

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Actual)

38

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • KPK
      • Peshawar, KPK, Pakistan, 25000
        • Lady Reading Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: sustained natural apophyseal glides
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
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: SNAGS with thoracic postural correction techniques
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
Active Comparator: SNAGS with thoracic postural correction techniques
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
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: SNAGS with thoracic postural correction techniques
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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Visual Analog scale (VAS)
Time Frame: four weeks
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)
Time Frame: for four weeks
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
Time Frame: for four weeks
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
Time Frame: four weeks
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

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 20, 2022

Primary Completion (Actual)

August 1, 2022

Study Completion (Actual)

August 20, 2022

Study Registration Dates

First Submitted

August 5, 2021

First Submitted That Met QC Criteria

August 5, 2021

First Posted (Actual)

August 6, 2021

Study Record Updates

Last Update Posted (Actual)

September 19, 2022

Last Update Submitted That Met QC Criteria

September 15, 2022

Last Verified

September 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/01008 Urooj Sajjad

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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