Intracranial membrane release and Unwinding vs Suboccipital Release Technique in chronic neck pain. A Randomized Controlled Trial

Patients fulfilling the inclusion criteria will be assigned to Group A or B randomly. Experimental group (Group A) will receive intracranial membrane release and unwinding while Control group (Group B) will receive suboccipital inhibition release and thermotherapy. The intervention will be provided for 3 days a week, 30 mins per session for 8 weeks. Experimental group (Group A): 1. Intracranial Membrane Release: A gentle pressure of 5 gram will be used and each treatment technique will be applied for 5 mins. Patient will be in supine position. • Frontal Lift Technique (Anterior-Posterior Cranial Membrane Traction): The therapist will place ring and little fingers along the outer edges of the frontal bone, near the zygomatic processes while middle and index fingers are positioned adjacent to the midline of the frontal bone. Gentle posterior pressure will be applied using the index fingers on the midline, while the ring fingers will simultaneously move in an anterior and downward (caudal) direction. • Sphenoid Lift Technique (Anterior-Posterior Cranial Membrane Traction): The therapist places the index finger on the greater wing of the sphenoid bone, the middle finger on the pterion, the ring finger behind the ear over the asterion, and the little finger on the lateral angle of the occiput. Both thumbs will be placed together on the midline of the head. A gentle distraction force will be applied. • Parietal Lift Technique (Superior-Inferior Cranial Membrane Traction): The Therapist will be seated at the head of the patient placing the fingertips gently to contact the lateral aspects of the parietal bones while fifth fingers rest near asterion, avoiding pressure on temporal bones. Thumbs will cross but do not touch the patient’s scalp. A steady pressure will be maintained. • Temporal Ear Pull Technique (Transverse Cranial Membrane Traction): The therapist will place hands over the parietal and temporal bones. The therapist will gently palpate the temporal bones as they rock forward, backward, inward, and outward. The therapist will lightly grasp the earlobes with thumbs and forefingers on each side, applying gentle traction by pulling backward, downward, and apart to release tension in the cranial sutures. 2. Unwinding: The patient lies supine with their shoulders at the head of the table. The therapist will sit at the head of the table and holds the patient’s head. One hand will support the head, while the other will lightly hold the frontal bone. The head will be allowed to move naturally and spontaneously while resisting backtracking to encourage new movement patterns. The treatment will be applied for 5 mins. An independent assessor blinded to the treatment will assess all the patients for treatment outcome assessment at baseline, after 1st session, after 4th week and post treatment (i.e. post-completion of 8-week treatment program). Adherence to the intervention will be monitored by an independent assessor who is blinded to group allocation. The assessor will use standardized session attendance checklists to record participant attendance, session completion, and duration of participation without knowledge of the treatment condition. Session logs will be reviewed regularly by one of the co-investigators not involved in treatment allocation to ensure compliance with the intervention protocol. Any missed or incomplete sessions will be documented, along with reported reasons, to minimize assessment bias and enhance methodological validity.