Mohamed Adham A, Shendy Wael S, Semary Moataz, Mourad Husam S, Battecha Kadrya H, Soliman Elsadat S, Sayed Shereen H El, Mohamed Ghada I
Department of Physical Therapy for Neuromuscular Disorders, Faculty of Physical Therapy, Cairo University: Dokki, Giza, Egypt.
Department of Neurology, Faculty of Medicine, Cairo University, Egypt.
J Phys Ther Sci. 2019 Apr;31(4):376-381. doi: 10.1589/jpts.31.376. Epub 2019 Apr 1.
[Purpose] Cervicogenic headache is a major problem in patients with upper cervical dysfunction. However, its physical therapy management is a topic of debate. This study aims to determine the effect of C1-C2 Mulligan sustained natural apophyseal glide mobilizations on cervicogenic headache and associated dizziness. [Participants and Methods] This study included 48 patients with cervicogenic headache, who were randomly assigned to three equal groups: Group A (Headache SNAG), group B (C1-C2 SNAG rotation), and group C (combined). Neck Disability Index was used to examine neck pain intensity and cervicogenic headache symptoms. The 6-item Headache Impact Test scale was used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test was used to assess rotation range of motion at the level of C1-C2 and confirmed by a cervical range of motion device. Dizziness Handicap Inventory scale was used to evaluate dizziness. The evaluation was done pre- and post-treatment and compared between the groups. [Results] Group C showed significant improvement in all variables compared with groups A and B. [Conclusion] Sustained natural apophyseal glide mobilizations used in the study were effective in reducing cervicogenic headache and dizziness in all groups with a greater improvement in the combined group. The use of cervical SNAG mobilizations is encouraged as a noninvasive intervention depending on the therapist's assessment, findings, and clinical reasoning.
[目的] 颈源性头痛是上颈椎功能障碍患者的一个主要问题。然而，其物理治疗管理是一个有争议的话题。本研究旨在确定C1-C2 Mulligan持续自然关节突滑动松动术对颈源性头痛及相关头晕的影响。[参与者与方法] 本研究纳入48例颈源性头痛患者，随机分为三组，每组16例：A组（头痛SNAG组）、B组（C1-C2 SNAG旋转组）和C组（联合组）。采用颈部残疾指数评估颈部疼痛强度和颈源性头痛症状。采用6项头痛影响测试量表评估头痛严重程度及其对社会生活和功能的不良影响。采用屈伸旋转试验评估C1-C2水平的旋转活动度，并通过颈椎活动度测量仪进行确认。采用头晕残障量表评估头晕情况。在治疗前后进行评估，并在组间进行比较。[结果] 与A组和B组相比，C组在所有变量上均有显著改善。[结论] 本研究中使用的持续自然关节突滑动松动术在所有组中均能有效减轻颈源性头痛和头晕，联合组改善更明显。根据治疗师的评估、检查结果和临床推理，鼓励将颈椎SNAG松动术作为一种非侵入性干预措施使用。
