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this study will be conducted to investigate impact of adding jones technique to mulligan therapy in patients with cervicogenic headache
Cervicogenic headache (CeH) is a secondary headache attributed to dysfunctions of the cervical spine (international headache society. CGH is a non-throbbing, unilateral, side locked headache that originates in the cervical spine and gradually spreads to the occipital, temporal and orbital areas. It is associated with neck pain or stiffness and is often aggravated by sustained neck postures, repeated neck movements or physical activity. A survey published in 2003 found that strain-counterstrain was the forth most commonly used manipulative technique among providers of osteopathy in the US. The most common explanation for the effects of strain-counterstrain is that it influences aberrant neuromuscular activity mediated by muscle spindles, local circulation and inflammatory reactions. Clinical research into the effects of strain-counterstrain has only begun to emerge in recent years . The Mulligan manoeuvre is one of the best manipulations. Unlike traditional mobilization, which relies solely on the therapist, Mulligan posited that by exerting pressure on the spinous processes in a weight-bearing stance, the facet joints would undergo a synchronized sliding motion in a parallel manner. At the same time, It requires the patient to move actively in order to achieve the perfect therapeutic effect ,The Mulligan maneuver is highly efective in the manipulative treatment of CEH A systematic review have demonstrated the efficacy of the Mulligan maneuvre for CEH on clinical pain scales and cervical range of motion after treatment
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| jones and mulligan therapy | Experimental | thirty patients will receive the Jones technique puls mulligan and exercises programe three times a week for four weeks |
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| mulligan therapy | Experimental | thirty patients will receive mulligan therapy and exercise programs three times a week for four weeks |
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| exercises program | Active Comparator | thirty patients will receive exercise programs three times a week for four weeks |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| jones and mulligan therapy | Other | for jones technique in upper trapezius and suboccipital muscles, the participants supine , the therapist used manual palpation to locate the tender area in the UT and sub-ossipital muscles. Once detected, pressure to the tender area was progressively increased . The participant was then repositioned passively to decrease the stress under palpation, resulting in a 70% subjective decrement in pain. That position was maintained for 90 s. eventually, the participant returned to the neutral position slowly and passively. for mulligan SNAGS,The therapist held the patient with his trunk, and wrapped the patient's head lightly with his arm on the patient's side, and placed the ring finger on the trouble spot right above the small vertebral joint. The therapist placed the thenar eminence of his opposite hand on the ring finger, which was touching the lesion site. On the site, the therapist performed gliding in the upward direction of the front pupil (45 degrees) exercises |
| Measure | Description | Time Frame |
|---|---|---|
| pain intesnity | visual analogue scale will be used to asses pain intensity which patient will be instructed to put point on line from no pain to tolerable pain. The scale consists of a line, usually 100 mm long, ranging from no pain or discomfort (zero) , to the worst pain that could possibly feel . | up to four weeks |
| headache disability | The Headache spesific Disability Questionnaire was used to assess headcahe disability. it is a self-administered scale with 9 items that assesses pain intensity, work or school disruptions, and the effect on recreational activities in individuals with headache complaints. Higher scores reflect greater impairment. | up to four weeks |
| Measure | Description | Time Frame |
|---|---|---|
| neck disability | will be measured by Arabic neck disability index. 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 four weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| alshaymaa abd elazeim, phd | Contact | 01033771553 | alshaymaa.shaaban@pt.cu.edu.eg |
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| ID | Term |
|---|---|
| D051298 | Post-Traumatic Headache |
| ID | Term |
|---|---|
| D051271 | Headache Disorders, Secondary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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jones and mulligan therapy
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opaque sealed envelope
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| mulligan therapy | Other | mulligan SNAGS,The therapist held the patient with his trunk, and wrapped the patient's head lightly with his arm on the patient's side, and placed the ring finger on the trouble spot right above the small vertebral joint. The therapist placed the thenar eminence of his opposite hand on the ring finger, which was touching the lesion site. On the site, the therapist performed gliding in the upward direction of the front pupil (45 degrees). The hand, which was touching the spinous process, should be relaxed in order not to squeeze too hard. The source of the power of gliding on the joint surface must come from the opposite hand of the patient-contacting hand. Gliding was applied rhythmically (three times per second) and the width of gliding starts from the middle to the end+ exercises |
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| exercises program | Other | The exercise program will be in the form of stretching exercises for the sternocleidomastoids (SCM), the scalenes, and upper fibers of trapezius; strengthening isometric exercises for the neck flexors, extensors, lateral flexors, and neck rotators; and postural correction exercises. |
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| pressure pain threshold |
pressure pain threshold pressure pain threshold will be assessed by commander algometer |
| up to four weeks |
| cervical range of motion | range of motion will be measured by inclinometer CROM. The CROM (deluxe version - Performance Attainment Associates, Roseville, MN, USA) measures the cervical range of motion5- for fexion, extension, lateral fexion, and rotation using separate inclinometers. These inclinometers are attached to a frame similar to that for eyeglasses one in the sagittal plane for fexion - extension, second in the frontal plane for lateral fexion and a third in the horizontal plane for rotation. | up to four weeks |
| headache frequency | the number of days the subjects feel headache (headache frequency). | up to four weeks |
| medication intake | from the patients' diary in the last week , medications intake will be recorded as follow: 1) not at all; 2) once a week; 3) once every couple of days; 4) once or twice a day; or 5) three or more times a day | up to four weeks |
| headache duration | the total hours of headache (headache duration). | up to four weeks |
| D009422 | Nervous System Diseases |