Deep Neck Flexors Training Versus Muscle Energy Technique on Cervicogenic Headache

Effects of Deep Neck Flexors Training Versus Muscle Energy Technique on Cervicogenic Headache

Aim of this study is to compare the effects of deep neck flexors stretching versus muscles energy technique on pain, cervical range of motion, sleep disturbance and cervical spine posture in patients with Cervicogenic headache and interpret which technique is better among both.A randomized control trial that will include total 28 participants.The first group will receive deep neck flexors stretching along with conventional therapy and 2nd group will receive muscles energy technique along with conventional therapy.Data collected will be analyzed through SPSS 25.

Study Overview

• Status: Completed
• Conditions: Cervicogenic Headache
• Intervention / Treatment: Other: Deep neck flexors training + Conventional therapy; Other: Muscles energy techniques + conventional therapy

Detailed Description

Cervicogenic headache is a disabling condition associated with musculoskeletal impairment of the cervical region.Cervicogenic headache is a clinical syndrome characterized by primarily unilateral pain that originates in the neck, typically provoked by neck movement or pressure over tender points in the neck, with reduced range of movement of the cervical spine.Cervicogenic Headache is pain referred to the head from a source in the cervical spine. It can influence the patient's quality of life in addition to a loss of functions when compared with the groups with other headache disorders.

A variety of invasive and noninvasive therapeutic modalities are used in the treatment of cervicogenic headache.Physical therapy is considered as most effective treatment of cervicogenic headache including modalities, manual therapy, muscle stretching, Muscle Energy Techniques, deep neck flexors training, Instrument-Assisted Soft Tissue Mobilization , therapeutic exercises and kinesiology tapping.Deep cervical flexor exercise is a low-load exercise focused on deep cervical flexor muscles, as described by Jull et al. This exercise targets the deep flexor muscles of the cervical region, rather than the superficial flexor muscles. Deep neck flexor training is said to improve the Cervicogenic headache according to the literature review.

According to the Literature review, in cervicogenic headache 2 group of muscles are involved i.e. deep cervical flexors (longus colli, longus capitis, Rectus capitis and Longus capitus) gets weakened and cervical extensors (suboccipital and upper trapezius) gets tightened. It is evident that deep neck flexor training is effective in improving pain, cervical range of motion and posture in Cervicogenic headache. Muscle Energy techniques are also proven to reduce pain and improve range of motion so post isometric relaxation will use in this study. Limited literature is available which compares the effects of post isometric relaxation deep neck flexors and specifically on Cervicogenic headaches. Aim of this study is to compare the effects of these techniques on pain, cervical range of motion, sleep disturbance and cervical spine posture in patients with Cervicogenic headache and interpret which technique is better among both. I hope that this study will add valuable literature and scope for future researchers to work on this topic.

• Study Type: Interventional
• Enrollment (Actual): 28
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 44000
      • Railway General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 55 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Subjects aged 18 - 55 years.
• Both male and female subjects will be recruited in the study.
• Unilateral headache (without side shift) related by pain, movement and sustaining
• position of neck started from the occiput spread to the tempro-frontal region for more than 3 months
• >20 degree movement restriction in cervical ROM, especially in the upper cervical rotation.
• Positive flexion rotation test to confirm Cervicogenic headache.
• Subjects with rounded shoulders having distance between on the table and the acromion>2.5 cm

Exclusion Criteria:

• Fracture or previous surgery on vertebral column
• History of spinal stenosis or disc prolapse
• dysfunction or headache with autonomic involvement
• Other types of headache including migraine, tension type etc.
• laxity of alar ligaments
• vertebra basilar artery insufficiency
• Patients with a history of physiotherapy at least 3 months prior to the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: deep neck flexor group; Deep neck flexors stretch Conventional Therapy: Moist heat therapy for 10 minutes, TENS 10 min, cervical active ROMS, Non-thrust mobilizations	Other: Deep neck flexors training + Conventional therapy; Hold for 10 sec and repeated 10 times.Patients will be treated 3 times a week for 4 consecutive weeks
Active Comparator: muscle energy technique; Post isometric stretch on trapezious and suboccipital muscles Conventional Therapy: Moist heat therapy for 10 minutes, TENS 10 min, cervical active ROMS, Non-thrust mobilizations	Other: Muscles energy techniques + conventional therapy; position of patient is in maximal comfort and lengthening After engaging the barrier use of an isometric contraction Feel the release and lengthen the muscle repeated for 4 time per session Patients will be treated 3 times a week for 4 consecutive weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain rating scale	The Numeric Pain Rating Scale (NPRS) measures the subjective intensity of pain.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inclinometer	Measurements of cervical flexion, extension, lateral flexion, and rotation will be measured using inclinometer	4 weeks
Cervical posture	For measurement of cervical posture, photographs taken from the side were used for objective measurement of forward head posture	4 weeks
Insomnia Severity Index (ISI)	It is a brief self-report questionnaire that measures the patient's perception of insomnia severity	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Madiha Ali, MSOPMT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): March 15, 2023
• Primary Completion (Actual): August 15, 2023
• Study Completion (Actual): September 15, 2023

Study Registration Dates

• First Submitted: February 23, 2023
• First Submitted That Met QC Criteria: February 23, 2023
• First Posted (Actual): March 6, 2023

Study Record Updates

• Last Update Posted (Actual): March 13, 2024
• Last Update Submitted That Met QC Criteria: March 12, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Neck Muscles; Cervicogenic Headache; exercise muscle stretch; postures
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Headache Disorders; Headache Disorders, Secondary; Headache; Post-Traumatic Headache
• Other Study ID Numbers: Hirah Naseem

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