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.

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.

Deep neck flexors stretch Conventional Therapy: Moist heat therapy for 10 minutes, TENS 10 min, cervical active ROMS, Non-thrust mobilizations

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

Hold for 10 sec and repeated 10 times.Patients will be treated 3 times a week for 4 consecutive weeks

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

Measurements of cervical flexion, extension, lateral flexion, and rotation will be measured using inclinometer

For measurement of cervical posture, photographs taken from the side were used for objective measurement of forward head posture

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.