Impact of Adding Instrument-assisted Soft Tissue Mobilization to Mulligan Therapy in Patients With Cervicogenic Headache (CGH)

this study will be conducted to investigate the impact of adding Instrument assisted soft tissue mobilization technique to mulligan therapy in patients with cervicogenic headache

Study Overview

• Status: Not yet recruiting
• Conditions: Cervicogenic Headache
• Intervention / Treatment: Other: instrumeted assissted soft tissue mobilization and mulligan therapy; Other: mulligan therapy; Other: postural correction exercises

Detailed Description

Cervicogenic headache (CGH) has seen a notable rise in prevalence in recent years, substantially impairing patients' daily functioning and occupational productivity. Despite its considerable burden, CGH remains frequently underdiagnosed and inadequately managed, often progressing to a chronic state that heightens the risk of work absenteeism and long-term disability and as the most common type of pain disorders, affecting 66% of the global population, represent a major public health concern due to their detrimental impact on quality of life and economic productivity . Epidemiological data indicate that CGH affects 4.1% of the general population, with prevalence escalating to 17.5% among individuals with severe headaches.Instrument Assisted Soft Tissue Mobilization using Graston (GT®) tool is regarded as one the most advanced and promising methods ,utilizing a specially designed instrument to adress a variety of soft tissue pathologies such as myofascial adhesions , scar tissue restriction , tissue thickenings, ridges, fibrotic nodules, crystalline deposits . this technique works by generating a mobilizing effect ,which contributes to pain reduction ,enhanced range of motion and improved overall function.The Mulligan manual technique is considered one of the most effective forms of manipulations. In contrast to conventional mobilization, which depends entirely on the therapist, Mulligan proposed that applying pressure to the spinous processes while the patient is in a weight-bearing position would cause the facet joints to glide in a coordinated ,parallel direction . simultaneously ,this approach involve the patient's active participation during movemwnt in order to achieve the perfect therapeutic outcomes

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: doaa youssef, master; Phone Number: 01113279369; Email: Doaa10997youssef@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

-Unilateral CGH presentation

• Age group above 18 years' old
• History of chronic CGH (>3 months)
• CGH owing to cervical spine (neck) dysfunction
• Reduced cervical motion
• Neck stiffness and movement restriction

Exclusion Criteria:

• Participants with other types of headache (migraine headache)
• Headache owing to other causes (sinus, tumor, neural, and tempero-mandibular joint issues)
• Any contraindications to manual and manipulative therapy (fracture, instability, osteoporosis and neural symptoms)
• Taking analgesics or corticosteroids and migraine-specific medications, such as triptans
• Metastasis
• Cardiac conditions (stroke and syncope)
• Neurological conditions (radiculopathy, myelopathy)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: instrumeted assissted soft tissue mobilization and mulligan therapy; twenty patients will receive IASTM, mulligan therapy and postural correction exercises three times per week for 6 weeks.	Other: instrumeted assissted soft tissue mobilization and mulligan therapy; the patients will receive IASTM tools over the length of targeted muscles (descending fiber of trapezius, suboccipitalis muscles ) for 5 minutes. also, SNAG technique; Each patient will be asked to sit comfortably, and the treating therapist will stand beside the patient. The patient's head will be free and cradled between the therapist's right forearm and body, and the therapist stand at the patient's right side. The therapist then will place his right index, middle, and ring fingers at the base of the occiput and kept his right little finger over the spinous process of C2. Next, with the lateral border of his left thenar eminence, gentle pressure will be applied in a ventral and upward direction(45 degrees) over the right little finger. finally postural correction execises; Other: mulligan therapy; SNAG technique; Each patient will be asked to sit comfortably, and the treating therapist will stand beside the patient. The patient's head will be free and cradled between the therapist's right forearm and body, and the therapist stand at the patient's right side. The therapist then will place his right index, middle, and ring fingers at the base of the occiput and kept his right little finger over the spinous process of C2. Next, with the lateral border of his left thenar eminence, gentle pressure will be applied in a ventral and upward direction(45 degrees) over the right little finger. Finally, postural correction exercises will be addedd; Other: postural correction exercises; the exercises will incluse, Stretching exercises for the sternocleidomastoids,the Scalenes,upper fibers of trapezius and strengthening exercises for cervical muscles
Experimental: mulligan therapy; Twenty patients will receive Mulligan therapy and postural correction exercises three times per week for 6 weeks.	Other: mulligan therapy; SNAG technique; Each patient will be asked to sit comfortably, and the treating therapist will stand beside the patient. The patient's head will be free and cradled between the therapist's right forearm and body, and the therapist stand at the patient's right side. The therapist then will place his right index, middle, and ring fingers at the base of the occiput and kept his right little finger over the spinous process of C2. Next, with the lateral border of his left thenar eminence, gentle pressure will be applied in a ventral and upward direction(45 degrees) over the right little finger. Finally, postural correction exercises will be addedd; Other: postural correction exercises; the exercises will incluse, Stretching exercises for the sternocleidomastoids,the Scalenes,upper fibers of trapezius and strengthening exercises for cervical muscles
Active Comparator: postural correction exercises; Twenty patients will receive postural correction exercises three times per week for 6 weeks.	Other: postural correction exercises; the exercises will incluse, Stretching exercises for the sternocleidomastoids,the Scalenes,upper fibers of trapezius and strengthening exercises for cervical muscles

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
neck disability	Assessment of neck function was performed by Arabic neck disability index. It is a valid and reliable tool in the assessment of neck function. 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 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity	The scale will be used is the VAS, which consists of a line, usually 10 cm long, ranging from no pain or discomfort (zero) , to the worst pain that could possibly feel (10)	up to 6 weeks
cervical range of motion	The CROM device will be used to assess cervical range of motion. it is headmounted equipment consists of a plastic frame placed on the head over the nose and the ears, secured by a Velcro strap. Two independent inclinometers, 1 in the sagittal plane and 1 in the frontal plane, are attached to the frame and indicate the position of the head with respect to the line of gravity. A third inclinometer is positioned in the horizontal plane and indicates the position of the head in rotation, with respect to a reference position	up to six weeks
muscle stiffness	The MyotonPRO (Myoton AS, Tallinn, Estonia) is a recently introduced device that can objectively measure the mechanical properties of muscles including analyzing muccsle stiffness (N/m). The measurement procedure involved pressing the device against the skin, with a force of 0.18 N and instantly applying an impulse of 0.4 N for duration of 15 ms. The skin surface oscillation induced by the\ MyotonPRO was measured	up to six weeks
headache frequency	the number of days the subjects experienced headaches (frequency)	up to six weeks
headache duration	the total number of hours they experienced headaches (duration)	up to six weeks
medication intake	The frequency with which they used painkillers (medication intake) for their headaches were also noted	up to 6 weeks

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: January 21, 2026
• First Submitted That Met QC Criteria: January 21, 2026
• First Posted (Actual): January 28, 2026

Study Record Updates

• Last Update Posted (Actual): January 28, 2026
• Last Update Submitted That Met QC Criteria: January 21, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Instrument Assisted Soft Tissue Mobilization; mulligan therapy
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Headache Disorders; Headache Disorders, Secondary; Post-Traumatic Headache
• Other Study ID Numbers: P.T.REC/012/006193

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No