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Study aim:
Comparison of the Effectiveness of SNAG Mobilization Combined with Mulligan Cervical Traction on Pain Intensity and Frequency, Cervical ROM, Disability, and Treatment Sustainability in Adult Patients with Cervicogenic Headache Compared to Maitland Mobilization in 2025
Design:
This single-center, single-blind randomized trial (1:1) enrolls 54 participants, blinded to group assignment. Both participants and assessors are blinded to group assignment.They are randomly allocated to the Mulligan or Maitland group using four-block balanced randomization via www.sealedenvelope.com by an independent researcher.
Settings and conduct:
The study is conducted in physiotherapy clinics under Iran University of Medical Sciences in Tehran. Assessment and treatment are performed by separate individuals to maintain blinding. The Mulligan group receives SNAG mobilization and Mulligan traction, while the Maitland group receives Maitland mobilization and traction. Both groups undergo six 20-minute sessions, twice a week for three weeks.
Participants/Inclusion and exclusion criteria:
Main Inclusion Criteria
Unilateral headache, or headache predominantly on one side without side-shifting
Headache accompanied by neck stiffness and pain that worsens with neck movement
FRT restriction greater than 10 degrees
Main Exclusion Criteria
Headache originating from sources other than the cervical spine
Any cervical fracture or history of neck surgery
Any physiotherapy or chiropractic treatment received in the past 3 months
Any contraindication to manual therapy
Intervention groups:
Mulligan Group: Participants in this group will receive SNAG mobilization combined with traction according to the Mulligan approach.
Maitland Group: Participants in this group will receive mobilization combined with traction according to the Maitland approach.
Main outcome variables:
Pain frequency and pain intensity