The effect of suboccipital muscles release, using Instrument Assisted Soft Tissue Mobilization technique on pain, range of motion of the upper cervical region, function of the deep flexor muscles of the neck, sense of force, balance and neck disability index in cervicogenic headache subjects

Investigating the effect of suboccipital muscles release, on pain, range of motion of the upper cervical region, function of the deep flexor muscles of the neck, sense of force, balance and neck disability index in cervicogenic headache subjects

Individuals with cervicogenic headaches will be randomly assigned to two equal groups.One group will receive suboccipital muscle release using an instrument along with routine physiotherapy,the other group will receive a sham instrument along with routine physiotherapy. this study will be conducted as a pilot on 10 participants to determine the sample size.

This study will be conducted at the Physiotherapy Clinic of Shahid Beheshti University of Medical Sciences. In this study, a stainless-steel instrument will be used for the release of the suboccipital muscles in individuals with cervicogenic headache. Prior to entering the study, all participants will be informed, through the informed consent form, about the existence of two study groups and the possibility of being randomly assigned to either group. In addition, all measurements will be performed by a blinded assessor who is unaware of the participants’ treatment group.

Inclusion Criteria: Having diagnostic criteria for cervicogenic headache confirmed by a neurologist. Exclusion Criteria: Inability to tolerate study interventions.

1)Suboccipital muscle release group using Instrument Assisted Soft Tissue Mobilization tools Along with routine physiotherapy 2)Sham Suboccipital muscle release group Along with routine physiotherapy

Pain intensity; pain frequency; duration of pain; range of motion of the upper cervical region; function of the deep flexor muscles of the neck; sense of force; balance; Neck disability index

Following confirmation of the patient's eligibility (based on the inclusion criteria) and obtaining informed consent, baseline assessments including age and BMI will be performed to determine the relevant stratum. The block randomization list (with blocks of 4, comprising six possible sequences: AABB, ABAB, ABBA, BBAA, BABA, BAAB) will be generated in advance, separately for each stratum, by an independent individual who has no role in the visits, treatment, or assessment of patients. (A represents the first group and B represents the second group.) The result of this pre-determined allocation is placed in opaque, sealed envelopes, numbered sequentially in order of enrollment. When each eligible patient enters the study, the enrolling researcher (who has no knowledge of the content of the randomization list) opens the next envelope corresponding to that patient's stratum, in order, and the patient is assigned to the IASTM or Sham IASTM group according to the code inside the envelope. In this way, patients enter the randomization list sequentially, with no possibility of predicting the assigned group before the envelope is opened, and the process of sequence generation (by the independent individual) is kept completely separate from the process of allocation implementation (by the enrolling researcher).

All study measurements are performed by a blind examiner who is unaware of the conditions of the subjects, during the study, patients will remain unaware of which specific intervention (real or sham) they are receiving