Effects of Shi Style Cervical Mobilization Versus Sustained Natural Apophyseal Glides on Pain, Strength and Functional Disability in Patients with Cervicogenic Headache

Background: Cervicogenic headache is a secondary headache disorder originating from cervical spine dysfunction, commonly associated with pain, reduced mobility, dizziness, and functional disability, with manual therapy representing a key conservative management strategy. Objective: To compare the effectiveness of Shi-style cervical mobilization and Sustained Natural Apophyseal Glides (SNAGs) on pain intensity, cervical muscle strength, dizziness-related disability, functional disability, and quality of life in patients with cervicogenic headache. Methods: A randomized controlled trial was conducted on 40 participants allocated equally into two groups receiving either Shi-style cervical mobilization or SNAGs over a two-week period, alongside standardized physiotherapy. Outcomes including Numeric Pain Rating Scale (NPRS), pressure biofeedback, Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), and SF-36 were assessed at baseline and post-intervention. Non-parametric statistical tests were applied with significance set at p < 0.05. Results: Both groups demonstrated statistically significant improvements across all outcomes (p < 0.001). However, Shi-style mobilization resulted in greater reductions in pain (median 6.0 to 2.0 vs 3.0), disability (NDI: 32.0 to 7.0 vs 17.0), and dizziness (DHI: 53.0 to 21.0 vs 23.5), with moderate to large effect sizes (r = 0.42–0.79). Conclusion: Both interventions are effective, but Shi-style cervical mobilization demonstrates superior clinical outcomes and may be considered a more effective treatment approach for cervicogenic headache.