ORIGINAL PAPER
Effectiveness of dural tube myofascial release on suboccipital muscle thickness, cervical flexion-rotation range and clinical metrics for cervicogenic headache – a protocol of a pragmatic randomised controlled trial
1
Department of Orthopedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi, Karnataka, India
2
Department of Radiology, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, Karnataka, India
Submission date: 2025-04-14
Acceptance date: 2025-08-09
Online publication date: 2026-05-28
Corresponding author
Aarti Welling
Department of Orthopedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi, Karnataka, India
Department of Orthopedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi, Karnataka, India
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Cervicogenic headache (CGH) is linked to impairments in the cervical region, including muscles, joints, and neural structures. Muscle imbalances can transfer tension to the dura via the myodural bridge, worsening CGH. There is supporting literature on the effectiveness of sustained natural apophyseal glides (SNAGs) and low-load exercises, however their impact on muscle dysfunction and the myodural bridge remains underexplored. The role of the dural tube and its connection to suboccipital muscles, particularly regarding dural tube myofascial release (MFR) is not known. This study protocol will compare the effects of dural tube MFR versus sham release alongside standard therapy on muscle thickness and CGH symptoms.
Methods:
This randomised, open-label, assessor-blinded controlled study will involve 64 individuals (aged 18–50 years) with CGH. Participants will be randomly assigned to either dural tube release or the control group (sham release) with both groups receiving standard therapy (SNAGs and low-load exercises) three times weekly for four weeks. Afterwards, participants will continue home exercises for 12 weeks. Outcomes include ultrasonography to assess suboccipital muscle thickness and flexion-rotation range at baseline and after four weeks. Intensity, frequency, duration, and quality of life will be evaluated at four time points: pre-treatment, week 4, week 8, and week 12.
Discussion:
The outcomes will indicate whether dural tube MFR has an added effect over standard physical therapy care or is merely a placebo effect in managing CGH. A positive outcome may lead to the inclusion of dural tube MFR in physical therapy clinical guidelines, reducing reliance on medications.
Cervicogenic headache (CGH) is linked to impairments in the cervical region, including muscles, joints, and neural structures. Muscle imbalances can transfer tension to the dura via the myodural bridge, worsening CGH. There is supporting literature on the effectiveness of sustained natural apophyseal glides (SNAGs) and low-load exercises, however their impact on muscle dysfunction and the myodural bridge remains underexplored. The role of the dural tube and its connection to suboccipital muscles, particularly regarding dural tube myofascial release (MFR) is not known. This study protocol will compare the effects of dural tube MFR versus sham release alongside standard therapy on muscle thickness and CGH symptoms.
Methods:
This randomised, open-label, assessor-blinded controlled study will involve 64 individuals (aged 18–50 years) with CGH. Participants will be randomly assigned to either dural tube release or the control group (sham release) with both groups receiving standard therapy (SNAGs and low-load exercises) three times weekly for four weeks. Afterwards, participants will continue home exercises for 12 weeks. Outcomes include ultrasonography to assess suboccipital muscle thickness and flexion-rotation range at baseline and after four weeks. Intensity, frequency, duration, and quality of life will be evaluated at four time points: pre-treatment, week 4, week 8, and week 12.
Discussion:
The outcomes will indicate whether dural tube MFR has an added effect over standard physical therapy care or is merely a placebo effect in managing CGH. A positive outcome may lead to the inclusion of dural tube MFR in physical therapy clinical guidelines, reducing reliance on medications.
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