Mulligan SNAG Versus Active Release Technique in Cervicogenic Headache

NCT07132047 | Completed DMC

• 1 other identifier: UOL/IREB/25/09/0028
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

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.

Conditions

Cervicogenic Headache

Keywords

Mulligan mobilization; Active release Technique; Cervicogenic headache; physiotherapy; Neck pain; Manual therapy; Sustained natural apophyseal glide SNAG; range of motion, Articular

Outcome Measures

Primary Outcomes (1)

• Neck Disability Index (NDI) score

  The purpose of the Neck Disability Index (NDI) questionnaire is to gather data on how your neck pain has impacted your capacity to function in daily life. The NDI is divided into ten categories, each of which is rated from 0 to 5, where 5 represents "worst imaginable pain" and 0 represents "no pain". The sum of the points determines the final score, with 0 denoting no activity constraints and 50, or 100%, denoting entire activity limitations.

  Baseline, 4 weeks, and 8 weeks after start of intervention

Secondary Outcomes (2)

• Numeric Pain Rating Scale (NPRS) score.

  Baseline, 4 weeks, and 8 weeks after start of intervention

• Headache Disability Index (HDI) score

  Baseline, 4 weeks, and 8 weeks after start of intervention

Study Arms (2)

1. Mulligan Mobilization SNAG with Home Exercise

EXPERIMENTAL

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.

Other: Mulligan Mobilization SNAG with Home Exercise

Active Release Technique with Home Exercise

EXPERIMENTAL

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.

Other: Active Release Technique with Home Exercise

Interventions

Mulligan Mobilization SNAG with Home Exercise 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.

Also known as: Mulligan Mobilization SNAG, Self-SNAG Exercise Program

1. Mulligan Mobilization SNAG with Home Exercise

Active Release Technique with Home Exercise 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.

Also known as: Active Release Technique with Cervical and Shoulder Exercise Program, Soft Tissue Release and Postural Exercise

Active Release Technique with Home Exercise

Eligibility Criteria

• Age: 20 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• \* 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.

You may not qualify if:

• \* 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.

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

The University Of Lahore Teaching Hospital

Lahore, Pakistan

Location

MeSH Terms

Conditions

Post-Traumatic Headache; Neck Pain

Condition Hierarchy (Ancestors)

Headache Disorders, Secondary; Headache Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 12, 2025
• First Posted: August 20, 2025
• Study Start: July 1, 2025
• Primary Completion: August 29, 2025
• Study Completion: August 29, 2025
• Last Updated: November 18, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)