COMPARISON OF CONVENTIONAL PHYSICAL THERAPY AND MULLIGAN MOBILIZATION TECHNIQUE IN THE TREATMENT OF CERVICOGENIC HEADACHE

Abstract

Purpose: The aim of this investigate the effectiveness of the conventional physical therapy and Mulligan mobilization technique in the treatment of Cervicogenic Headache (CH) and to compare the effectiveness of these two methods. Methods: A total of 40 patients with CH were randomized into conventional physical therapy group (Group 1, n=20) and Mulligan mobilization group (Group 2, n=20). Neck lordosis, range of motion (ROM), Cervical Performance Tests, Visual Analogue Scale (VAS), Neck Disability Index, Beck Depression Scale measurements were recorded at baseline and at two weeks after the treatment. Results: VAS, Neck Disability Index and Beck Depression Scale decreased and ROM, cervical performance and lordosis angle increased significantly in both groups (p=0.010). Conclusions: Both treatments were found to have positive effects on radiological and clinical findings of CH, but Mulligan mobilization technique was found to be more effective in all evaluations except neck extension and right lateral flexion ROM measurements

Keywords

• Exercise Therapy
• Headache
• Musculoskeletal Manipulations
• Neck Pain
• Physical Therapy Modalities

SERVİKOJENİK BAŞ AĞRISI TEDAVİSİNDE KONVENSİYONEL FİZİK TEDAVİ İLE MULLIGAN MOBİLİZASYON TEKNİĞINİN KARŞILAŞTIRILMASI

Öz

Amaç: Bu çalışmanın amacı Servikojenik Baş Ağrısı (SBA) tedavisinde konvansiyonel fizik tedavi ve Mulligan mobilizasyon tekniğinin etkinliğini araştırmak ve bu iki yöntemin etkinliğini karşılaştırmaktır. Yöntem: SBA’lı toplam 40 hasta konvansiyonel fizik tedavi grubu (Grup 1, n=20) ve Mulligan mobilizasyon grubu (Grup 2, n=20) olarak randomize edildi. Boyun lordoz açısı, eklem hareket açıklığı (EHA), Servikal Performans Testleri, Visuel Analog Skalası (VAS), Boyun Özür İndeksi, Beck Depresyon Ölçeği ölçümleri tedavi öncesi ve tedaviden iki hafta sonra kaydedildi. Sonuçlar: Grup içi karşılaştırmada; VAS, Boyun Özür İndeksi ve Beck Depresyon Ölçeği her iki grupta da anlamlı olarak azaldı; EHA, servikal performans testleri, lordoz açısı ise anlamlı olarak arttı (p=0,010). Gruplar arası karşılaştırmada; servikal ekstansiyon ve sağ lateral fleksiyon hariç tüm boyun EHA değerleri grup 2'de servikal performans testi, boyun lordoz açısı daha fazla arttı. Ayrıca VAS, Boyun Özür İndeksi ve Beck Depresyon Ölçeği değerleri Grup 2'de daha fazla azaldı. Tartışma: Her iki tedavinin de SBA’nın radyolojik ve klinik bulguları üzerinde olumlu etkileri olduğu ancak Mulligan mobilizasyon tekniğinin boyun ekstansiyon ile sağ lateral fleksiyon ROM ölçümü dışındaki tüm değerlendirmelerde daha etkili olduğu bulundu.

Anahtar Kelimeler

• Egzersiz Tedavisi
• Baş Ağrısı
• Kas-İskelet Sistemi Manipülasyonları
• Boyun Ağrısı
• Fizik Tedavi Yöntemleri

References

1. 1. Levent İ. Servikojenik Baş Ağrıları. Turkiye Klinikleri. J Neurol Special Topics. 2008;1:60-6.
2. 2. Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011;6(3):254-66.
3. 3. Racicki S, Gerwin S, Diclaudio S, Reinmann S, Donaldson M. Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Man Manip Ther. 2013;21(2):113-24.
4. 4. Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. 2009;8(10):959-68.
5. 5. Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep. 2001;5(4):382-6.
6. 6. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001;1(1):31-46.
7. 7. Barmherzig R, Kingston W. Occipital Neuralgia and Cervicogenic Headache: Diagnosis and Management. Curr Neurol Neurosci Rep. 2019;19(5):20.
8. 8. Rinne M, Garam S, Häkkinen A, Ylinen J, Kukkonen-Harjula K, Nikander R. Therapeutic Exercise Training to Reduce Chronic Headache in Working Women: Design of a Randomized Controlled Trial. Phys Ther. 2016;96(5):631-40.

9. 9. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835-43.
10. 10. Ylinen J. Physical exercises and functional rehabilitation for the management of chronic neck pain. Eura Medicophys. 2007;43(1):119-32.
11. 11. Sayılır S. The short-term effects of TENS plus therapeutic ultrasound combinations in chronic neck pain. Complementary Therapies in Clinical Practice. 2018;31:278-81.
12. 12. Borman P, Keskin D, Ekici B, Bodur H. The efficacy of intermittent cervical traction in patents with chronic neck pain. Clin Rheumatol. 2008;27(10):1249-53.
13. 13. Garinis P, Nikova A, Birbilis T. Combination of TENS, Lidocaine Injections and Muscle Manipulations as a Therapeutic Method for Cervicogenic Headache -Pilot Study. Maedica. 2019;14(3):220-6.
14. 14. Dalkılınç M, Doymaz Küçük, F. Üst servikal bölge baş ağrıları. İçinde: Manuel Terapi NAGS, SNAGS, MWMS. Dalkılınç M, Elbasan B. editor. İstanbul: Hiper Tıp; 2017.
15. 15. Uzun M, İkidağ MA, Akbayrak T. Servikojenik baş ağrısında boyun mobilizasyonunun baş boyun kan akışı, kas sertliği ve boyun eklem hareket açıklığı üzerine akut etkisi: olgu sunumu. Journal of Exercise Therapy and Rehabilitation. 2020;7:74-9.
16. 16. Khan M, Shahzad A, Soomro R. Efficacy of C1-C2 Sustained Natural Apophyseal Glide (SNAG) Versus Posterior Anterior Vertebral Mobilization (PAVMs) in the Management of Cervicogenic Headache. Journal of Basic & Applied Sciences. 2014;10:226-30.
17. 17. Shin EJ, Lee BH. The effect of sustained natural apophyseal glides on headache, duration and cervical function in women with cervicogenic headache. J Exerc Rehabil. 2014;10(2):131-5.
18. 18. Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. J Orthop Sports Phys Ther. 2007;37(3):100-7.
19. 19. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, Cephalalgia. 2018(1):1-211.
20. 20. Caso ML, Clements JM. Assessing a Novel Method of Calculation of the Cobb Angle for Scoliosis: Interexaminer Reliability and Student Satisfaction. J Manipulative Physiol Ther. 2019;42(6):430-8.
21. 21. Otman S, Köse, N. Tedavi Hareketlerinde Temal Değerlendirme Prensipleri. Ankara: Hipokrat Yayınevi; 2019.
22. 22. Duymaz T, Yağcı N. Effectiveness of the mulligan mobilization technique in mechanical neck pain. Journal of Clinical and Analytical Medicine. 2018;9(4):304-9.
23. 23. Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, Salom-Moreno J, Fernández-de-Las-Peñas C, Ortega-Santiago R. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. J Manipulative Physiol Ther. 2013;36(7):403-411.
24. 24. Bronford G, Haas M, Evans RL, Goldsmith CH, Assendelf WL, Bouter LM. Noninvaive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev.2014;8.
25. 25. Khalil MA AH, Fadle S, Hefny AM, Ismail MA. Effect of Mulligan upper cervical manual traction in the treatment of cervicogenic headache: a randomized controlled trial. Physiotherapy Quarterly. 2019;27:13-20.
26. 26. McDonnell MK, Sahrmann SA, Van Dillen L. A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report. J Orthop Sports Phys Ther. 2005;35(1):3-15.
27. 27. Jordan K. Assessment of published reliability studies for cervical spine range-of-motion measurement tools. J Manipulative Physiol Ther. 2000;23(3):180-195.
28. 28. Frese A, Evers S. Biological markers of cervicogenic headache. Cephalalgia. 2008;28 Suppl 1:21-23. doi:10.1111/j.1468- 2982.2008.01613.x
29. 29. Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther. 2006;11(2):118-29. 30. O’Leary S, Falla D, Jull G, Vicenzino B. Muscle specificity in tests of cervical flexor muscle performance. Journal of Electromyography and Kinesiology. 2007;17:35- 40.
30. 31. Cagnie B, Dickx N, Peeters I, Tuytens J ve ark. The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises. J Appl Physiol 2008;104:230-235.
31. 32. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine 2004;29:1436-40.
32. 33. Fortner MO, Woodham TJ, Oakley PA, Harrison DE. Is the cervical lordosis a key biomechanical biomarker in cervicogenic headache?: a Chiropractic Biophysics® case report with follow-up. J Phys Ther Sci. 2022;34(2):167-171.
33. 34. Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016;17:64.
34. 35. Mohamed AA, Shendy WS, Semary M, Mourad HS, Battecha KH, Soliman ES, et al. Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache. J Phys Ther Sci. 2019;31(4):376-81.
35. 36. Pourahmadi M, Mohseni-Bandpei MA, Keshtkar A, Koes BW, Fernández-de-Las-Peñas C, Dommerholt J, et al. Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: protocol for a systematic review. Chiropr Man Therap. 2019;27:43.
36. 37. Karataş Ö, Öztürk B, Zincir S, Tok F, Çelik C, Odabaşı Z. Servikojenik Baş Ağrılı Hastalarda Botulinum Toksin Tip A Tedavisi İle Anksiyete ve Depresyon Düzeylerinin Değerlendirilmesi. Klinik Psikofarmakoloji Bülteni. 2011;21(3):232-6.
37. 38. Farina S, Granella F, Malferrari G, Manzoni GC. Headache and cervical spine disorders: classification and treatment with transcutaneous electrical nerve stimulation. Headache. 1986;26(8):431-3.