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Effects of Strain Counterstrain Versus Post Isometric Relaxation on Pain, Headache Frequency, and Quality of Life in Females With Cervicogenic Headache.
Sponsor: Qurat Ul Ain Ashfaq
Summary
Cervicogenic headache is a secondary headache disorder associated with dysfunction of the cervical spine and surrounding muscles. It may cause neck pain, muscle tenderness, recurrent headaches, and limitations in daily activities, ultimately affecting quality of life. The study aimed to determine whether Strain Counterstrain (SCS) or Post-Isometric Relaxation (PIR) produces better outcomes in reducing pain intensity, decreasing headache frequency, and improving headache-related quality of life. A randomized clinical trial was conducted in the Physiotherapy Department of Sir Ganga Ram Hospital, Lahore, involving 34 female participants who were randomly allocated into two equal groups of 17 participants each. Group A received Strain Counterstrain, while Group B received Post-Isometric Relaxation. Strain Counterstrain is a passive manual therapy technique in which the therapist positions the affected cervical tissues in a comfortable position to reduce tenderness and abnormal muscle activity. Participants were assessed using three outcome measures: the Numeric Pain Rating Scale (NPRS) to measure pain intensity, a Headache Frequency Diary to record headache episodes, and the Headache Impact Test (HIT-6) to assess the effect of headaches on daily functioning and quality of life. Assessments were conducted at baseline, after six weeks, and at twelve weeks, as reported in the results section. The study aimed to determine whether Strain Counterstrain (SCS) or Post-Isometric Relaxation (PIR) produces better outcomes in reducing pain intensity, decreasing headache frequency, and improving headache-related quality of life.
Key Details
Gender
FEMALE
Age Range
18 Years - 45 Years
Study Type
INTERVENTIONAL
Enrollment
34
Start Date
2025-10-22
Completion Date
2026-07-17
Last Updated
2026-10-27
Healthy Volunteers
No
Conditions
Interventions
Post Isometric Relaxation
Post-Isometric Relaxation (PIR) was provided over a period of six weeks, and the outcomes were assessed at baseline, at the end of the third week, and at the end of the sixth week. During each treatment session, the physiotherapist positioned the participant's cervical spine toward the first restrictive barrier in the direction of the identified movement restriction. The participant was then instructed to perform a gentle isometric contraction against the therapist's manual resistance, using approximately 10-25% of maximum voluntary effort, for 7-10 seconds while breathing normally and avoiding movement of other body parts. After the contraction, the participant was asked to relax the involved muscles completely for 2-3 seconds. The therapist then gently moved the cervical segment toward the new restrictive barrier without causing pain or overstretching. This contraction-relaxation cycle was repeated 3-5 times per treatment session, depending on the participant's tolerance and clinical
Strain Counterstrain
Strain Counterstrain (SCS) was provided over a period of six weeks, and the outcomes were assessed at baseline, the end of the third week, and the end of the sixth week. During each treatment session, the physiotherapist identified tender myofascial points in the upper cervical region, particularly around C1-C3, including the suboccipital, upper trapezius, and levator scapulae muscles. The therapist then gently positioned the participant's neck into a comfortable position of ease using appropriate side-bending, rotation, flexion, or extension, depending on the location of the tender point. The position was adjusted until tenderness decreased by approximately 70% or more and was maintained for about 90 seconds while the participant remained relaxed and avoided voluntary muscle movements
Locations (1)
Sir Ganga Ram Teaching Hospital
Lahore, Punjab Province, Pakistan