Mulligan SNAG Versus Active Release Technique in Cervicogenic Headache

NCT ID: NCT07132047

Last Updated: 2025-11-18

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 72 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-01
• Study Completion Date: 2025-08-29

Brief Summary

This study is designed to compare two different manual therapy approaches for individuals with cervicogenic headaches, a type of headache that originates from the neck. Participants will be randomly assigned to one of two groups.

The first group will receive Mulligan mobilization using sustained natural apophyseal glides (SNAG) along with a home program of Mobilization self-SNAG exercises.

The second group will receive the Active Release Technique (ART) combined with a home program of stretching and strengthening exercises for the neck and shoulder muscles. Each participant will attend treatment sessions three times per week for four weeks. Pain levels, headache impact, and neck function will be evaluated at the start, after four weeks of treatment, and again at eight weeks to determine which method provides better outcomes.

Detailed Description

Cervicogenic headache is a form of secondary headache caused by dysfunction in the cervical spine. It is often associated with neck pain, restricted mobility, and limitations in daily activities. Manual therapy, combined with targeted exercises, is frequently used in rehabilitation to reduce pain and improve neck function. This randomized controlled trial aims to compare the effectiveness of Mulligan mobilization with sustained natural apophyseal glides (SNAG) versus the Active Release Technique (ART) in the treatment of cervicogenic headache.

Group A - Mulligan Mobilization SNAG and Home Exercise:

Participants in this group will receive the Headache SNAG technique, which involves a gentle, sustained postero-anterior glide of the second cervical vertebra for 10 to 30 seconds to help reduce headache intensity. If relief is noted, up to six repetitions may be performed. In addition, each participant will be prescribed a home program consisting of C1-C2 self-SNAG rotation using a towel to apply pressure on the posterior arch of C1 during active cervical rotation. The exercise will be completed twice daily, with 10 repetitions per session. Written instructions will be given to ensure correct performance and better compliance.

Group B - Active Release Technique and Home Exercise Program:

Participants allocated to this group will receive the Active Release Technique (ART), a hands-on treatment aimed at releasing tight muscles and improving soft tissue mobility. During ART, controlled pressure is applied to specific muscles while the neck is moved to restore normal function and reduce discomfort. Target muscles include the pectoralis major, upper trapezius, levator scapulae, rhomboids, deep neck flexors, and serratus anterior.

The intervention will also include a structured exercise program designed to stretch and strengthen the neck and shoulder muscles, reduce tension, and enhance posture. Stretches will consist of sitting chair stretch, Brugger's stretch, wall angles, and doorway stretches. Strengthening activities such as the Kibler squeeze and head/neck retractions will also be incorporated. The home program will begin with gentle neck stretches, such as tilting the head toward one shoulder and holding the position for 20-30 seconds, repeating three times on each side. Chin tucks will be performed by gently retracting the chin without tilting the head, holding for 5 seconds, and repeating 10 times for 2-3 sets. These exercises aim to relieve muscle tightness, improve alignment, and help alleviate headache symptoms.

Conditions

Cervicogenic Headache

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

1. Mulligan Mobilization SNAG with Home Exercise

Participants in this arm will receive Headache SNAG Mulligan mobilization, a postero-anterior mobilization of the second cervical vertebra sustained for 10-30 seconds to reduce headache intensity. A maximum of six repetitions will be performed if headache reduction occurs during the first application. In addition, participants will follow a home exercise program consisting of C1-C2 self-SNAG in rotation using a towel to apply pressure to the posterior arch of C1 while actively rotating the cervical spine. Each position will be held for 10 seconds and repeated 10 times twice daily. Written instructions will be provided to ensure compliance.

Group Type: EXPERIMENTAL

Mulligan Mobilization SNAG with Home Exercise

Intervention Type: OTHER

This intervention combines manual mobilization and self-exercise. The therapist applies sustained postero-anterior glides to the second cervical vertebra for 10-30 seconds, up to six repetitions if pain decreases. The home program involves C1-C2 self-SNAG with a towel, maintaining end-range rotation for 10 seconds before returning to neutral. Exercises are completed twice daily for 10 repetitions each session. Participants receive illustrated instructions to promote correct execution and compliance.

Active Release Technique with Home Exercise

Participants will receive Active Release Technique (ART) targeting neck and shoulder soft tissues. The program includes sitting chair stretch, Brugger's stretch, wall angles, and doorway stretches for pectoralis major, upper trapezius, and levator scapulae. Additional movements include head and neck retractions and strengthening of rhomboids, deep neck flexors, and serratus anterior through the Kibler squeeze. A home program of neck stretches hold 20 to 30 sec, 3 times and chin tucks hold 5 sec, 10 times for 2 to 3 sets. posture-improving exercises will be performed to relieve tension, improve alignment, and lessen headache symptoms.

Group Type: EXPERIMENTAL

Active Release Technique with Home Exercise

Intervention Type: OTHER

This approach integrates manual soft tissue release with targeted exercise. ART is applied to the neck and shoulder region, focusing on pectoralis major, upper trapezius, and levator scapulae. Exercises include wall angles, doorway stretches, Brugger's stretch, and head/neck retractions. Strengthening activities target rhomboids, deep neck flexors, and serratus anterior. The home routine consists of neck stretches, chin tucks, and postural drills, performed regularly to enhance muscle balance, posture, and headache relief.

Interventions

Mulligan Mobilization SNAG with Home Exercise

This intervention combines manual mobilization and self-exercise. The therapist applies sustained postero-anterior glides to the second cervical vertebra for 10-30 seconds, up to six repetitions if pain decreases. The home program involves C1-C2 self-SNAG with a towel, maintaining end-range rotation for 10 seconds before returning to neutral. Exercises are completed twice daily for 10 repetitions each session. Participants receive illustrated instructions to promote correct execution and compliance.

Intervention Type: OTHER

Active Release Technique with Home Exercise

This approach integrates manual soft tissue release with targeted exercise. ART is applied to the neck and shoulder region, focusing on pectoralis major, upper trapezius, and levator scapulae. Exercises include wall angles, doorway stretches, Brugger's stretch, and head/neck retractions. Strengthening activities target rhomboids, deep neck flexors, and serratus anterior. The home routine consists of neck stretches, chin tucks, and postural drills, performed regularly to enhance muscle balance, posture, and headache relief.

Intervention Type: OTHER

Other Intervention Names

Mulligan Mobilization SNAG; Self-SNAG Exercise Program; Active Release Technique with Cervical and Shoulder Exercise Program; Soft Tissue Release and Postural Exercise

Eligibility Criteria

Inclusion Criteria

• * Aged between 20-50 years

• Both Male and females
• Individuals diagnosed with neck pain accompanied by headaches.
• Individuals with Unilateral or Bilateral cervicogenic headache.
• Headache at least 3 times during the last 3 months.

Exclusion Criteria

• * History of inflammatory disorders (e.g Rheumatoid Arthritis).

• History of trauma to the cervical region.
• History of Neurological conditions (myelopathy, radiculopathy or disc problems).
• Taking medications for headache.
• Pregnancy.

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Lahore

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

The University Of Lahore Teaching Hospital

Lahore, , Pakistan

Countries

Pakistan

Other Identifiers

UOL/IREB/25/09/0028

Identifier Type: -

Identifier Source: org_study_id