Impact of Adding Jones Technique to Mulligan Therapy in Patients With Cervicogenic Headache

Impact of Adding Jones Technique to Mulligan Therapy in Patients With Cervicogenic Headache

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

Inclusion Criteria:

• 20 to 60 years old patient with unilaterally of the head pain
• pain triggered by external pressure over the upper cervical joints (c1-c3)
• pain elicited by the neck movements, and/or sustained awkward positions with reduced neck ROM
• headache intensity pain score of at least 20mm on the Visual analogue scale (VAS)
• headache frequency of at least once a week for at least 3 months
• minimum neck disability index score of 10 points or greater

Exclusion Criteria:

• Migraine, tension- type headache, tumor, osteoporosis, fracture, rheumatoid arthritis and metabolic diseases.
• Prolonged history of steroid use.
• Resting blood pressure greater than 140/90 mmhg.
• cervical spinal stenosis, diminished sensation and central nervous system involvement,
• previous head or neck surgery or whiplash injury history within the last 6 weeks