Hall Toby, Chan Ho Tak, Christensen Lene, Odenthal Britta, Wells Cherie, Robinson Kim
School of Physiotherapy, Curtin University, Perth, Western Australia.
J Orthop Sports Phys Ther. 2007 Mar;37(3):100-7. doi: 10.2519/jospt.2007.2379.
Randomized, double-blind, placebo controlled trial.
To determine the effect of a C1-C2 self-sustained natural apophyseal glide (SNAG) on cervicogenic headache.
Cervicogenic headache is a common condition causing significant disability. Recent studies have shown a high incidence of C1-C2 dysfunction, evaluated by the flexion-rotation test (FRT), in subjects with cervicogenic headache. To manage this dysfunction, Mulligan has described a C1-C2 self-SNAG, though no studies have investigated the efficacy of this intervention approach.
A sample of 32 subjects (mean _ SD age, 36 +/- 3 years) with cervicogenic headache and FRT limitation were randomized into a C1-C2 self-SNAG or placebo group. After an initial instruction and practice visit in the clinic, interventions consisted of exercises applied independently by the subject twice daily at home on a continual basis. FRT range was measured twice, before and immediately after the instruction and practice visit. Headache symptoms were determined by a headache index over time, assessed by questionnaire preintervention, at 4 weeks postintervention, and at 12 months postintervention.
No differences were found in baseline measures between groups. Immediately after the initial instruction and practice visit performed with the supervision of the therapist, FRT range increased by 15 degrees (SD, 9) for the C1-C2 self-SNAG group (P < .001), which was significantly more than 5 degrees (SD, 5) for the placebo intervention (P < .001). There was also a significant interaction for the variable headache index between group and time (P < .001), indicating that group difference was dependent on time. There was no difference in headache index scores at baseline between groups. Headache index scores were substantially less in the C1-C2 self-SNAG group (mean +/- SD points at 4 weeks, 31 +/- 9; mean +/- SD points at 12 months, 24 +/- 9) compared to the placebo group (mean +/- SD points at 4 weeks, 51 +/- 15; mean +/- SD points at 12 months, 44 +/- 13) at 4 weeks (P < .001) and 12 months (P < .001), with an overall (+/-SD) reduction of 54% (+/-17%) for the individuals in the C1-C2 self-SNAG group.
These results provide evidence for the efficacy of the C1-C2 self-SNAG technique in the management of individuals with cervicogenic headache.
随机、双盲、安慰剂对照试验。
确定C1 - C2自我维持自然关节突滑动（SNAG）对颈源性头痛的影响。
颈源性头痛是一种常见疾病，会导致严重残疾。最近的研究表明，通过屈伸旋转试验（FRT）评估，颈源性头痛患者中C1 - C2功能障碍的发生率很高。为了处理这种功能障碍，穆利根描述了一种C1 - C2自我SNAG，但尚无研究调查这种干预方法的疗效。
将32名患有颈源性头痛且FRT受限的受试者（平均±标准差年龄，36±3岁）随机分为C1 - C2自我SNAG组或安慰剂组。在诊所进行初次指导和练习就诊后，干预措施包括受试者在家中每天独立进行两次持续的锻炼。在指导和练习就诊前及就诊后立即测量FRT范围两次。头痛症状通过一段时间内的头痛指数来确定，在干预前、干预后4周和干预后12个月通过问卷调查进行评估。
两组之间的基线测量无差异。在治疗师监督下完成初次指导和练习就诊后，C1 - C2自我SNAG组的FRT范围立即增加了15度（标准差，9）（P <.001），这明显大于安慰剂干预组的5度（标准差，5）（P <.001）。组和时间之间的变量头痛指数也存在显著交互作用（P <.001），表明组间差异取决于时间。两组在基线时的头痛指数评分无差异。与安慰剂组相比，C1 - C2自我SNAG组在4周时（P <.001）和12个月时（P <.001）的头痛指数评分显著更低（4周时平均±标准差分数，31±9；12个月时平均±标准差分数，24±9），而安慰剂组在4周时（平均±标准差分数，51±15；12个月时平均±标准差分数，44±13），C1 - C2自我SNAG组个体的总体（±标准差）降低了54%（±17%）。
这些结果为C1 - C2自我SNAG技术在治疗颈源性头痛患者中的疗效提供了证据。
