Comparing the Effects of Sub-Occipital Myofascial Release With and Without SNAG on People With Cervicogenic Dizziness.

NCT ID: NCT07062809

Last Updated: 2025-07-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-24

Study Completion Date

2025-10-20

Brief Summary

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Cervicogenic dizziness is defined as a sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine.Sub-occipital Release, a type of Myofascial Release (MFR) is a form of manual therapy technique which can be used for the treatment of cervicogenic dizziness. Sub-occipital muscles, dura matter and C2 vertebrae are connected to each other through the fascia. Sustained natural apophyseal glides (SNAGs) are also an effective treatment for cervicogenic dizziness. This study aim to determine Comparative Effect of Sub-Occipital Myofascial release with and without Sustained Natural Apophyseal Glide among patients with Cervicogenic Dizziness.

Detailed Description

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This study will be a randomized controlled trial and will be conducted in Hameed Latif Teaching Hospital and National hospital \& Medical Center. Non-probability consecutive sampling will be used to collect the data. Subjects with age group between 22 to 54 years old will be taken. Data will be collected from the patients having present complaint of cervicogenic dizziness. Group A and Group B were the two randomly selected groups into which the participants were divided. Baseline assessment of pain, dizziness and Headache was taken using Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI) and Numeric Pain Rate Scale (NPRS) respectively, before the start of treatment by an assessor. Subjects will be selected on the basis of inclusion and exclusion criteria. Both the Groups will receive Hot Pack ,TENS , Ultrasound ,and also will receive Sternocleidomastoid, Trapezius, Scalene, and Pectoralis minor muscle stretching exercises, while Group A will receive Sub-Occipital Myofascial Release and Sustained Natural Apophyseal Glide (SNAG), and Group B will receive Sub Occipital Myofascial Release. Short term effects would be assessed after treatment for 3 sessions per week on alternate days for 4 weeks. Data analysis will be done by SPSS version 25.

Conditions

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Dizziness Cervicogenic Headache

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Sub Occipital Myofascial release and Sustained Natural Apophyseal Glide (SNAGS).

The patient will instruct to be seated then will turned his head toward direction that will cause his dizziness. when subject will turn his head, The manual therapist will perform a constant PA glide (using his thumbs one over the other) to upper cervical C1 or C2 vertebra (Oriented toward patient's eyeballs). If flexion or extension movement will provoke the dizziness, an anterior glide will apply to the C2 spinous process. If rotation will provoke dizziness, then an anterior glide will be applied to the C1 transverse process. The patient will be free from the symptoms and will be instructed to discontinue movement when somewhat vertigo happened through the glide Implementation. In the beginning treatment period, that procedure will repeat six times. During the following therapy , Mulligan SNAGs will perform ten repetitions and mild excess compression will be used only if no vertigo will feel.

Group Type ACTIVE_COMPARATOR

Sub Occipital Myofascial release and (SNAGS).

Intervention Type OTHER

The patient will instruct to be seated then will turned his head toward direction that will cause his dizziness. when subject will turn his head, The manual therapist will perform a constant PA glide (using his thumbs one over the other) to upper cervical C1 or C2 vertebra (Oriented toward patient's eyeballs). If flexion or extension movement will provoke the dizziness, an anterior glide will apply to the C2 spinous process. If rotation will provoke dizziness, then an anterior glide will be applied to the C1 transverse process.

Sub Occipital Myofascial release

When using the technique, the patient will be in Upward-facing position with their head fully aided on the therapist's hands. The therapist will put three middle fingers simply inferior to the nuchal line, raise the tips of the fingers in the direction of the ceiling, and then simply pull them upward. This process will be performed three times a week on different days for two to three minutes, with five to seven times.

Group Type ACTIVE_COMPARATOR

Sub Occipital Myofascial release.

Intervention Type OTHER

When using the technique, the patient will be in Upward-facing position with their head fully aided on the therapist's hands. The therapist will put three middle fingers simply inferior to the nuchal line, raise the tips of the fingers in the direction of the ceiling, and then simply pull them upward.

Interventions

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Sub Occipital Myofascial release and (SNAGS).

The patient will instruct to be seated then will turned his head toward direction that will cause his dizziness. when subject will turn his head, The manual therapist will perform a constant PA glide (using his thumbs one over the other) to upper cervical C1 or C2 vertebra (Oriented toward patient's eyeballs). If flexion or extension movement will provoke the dizziness, an anterior glide will apply to the C2 spinous process. If rotation will provoke dizziness, then an anterior glide will be applied to the C1 transverse process.

Intervention Type OTHER

Sub Occipital Myofascial release.

When using the technique, the patient will be in Upward-facing position with their head fully aided on the therapist's hands. The therapist will put three middle fingers simply inferior to the nuchal line, raise the tips of the fingers in the direction of the ceiling, and then simply pull them upward.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Cervicogenic dizziness patients both male and female.
* Age group between 22 to 54 Years old.
* Passive Accessory Assessment of the UCS (C0-1, C1-2, C2-3).
* Dizziness related to either movements or positions of the cervical spine, or occurring with a stiff or painful neck.
* Symptoms \> 3 months.
* Moderate disability score on the Dizziness Handicap Inventory (DHI) \[31-60 points\] .

Exclusion Criteria

* Conditions for which manual therapy is contraindicated
* Traumatic brain injury
* Previous surgery to the upper cervical spine and marked cervical spine disc protrusion
* By neurologist .Vestibular disorders (e.g. Benign Paroxysmal Positional Vertigo, Meniere's disease, peripheral vestibulopathy)

* CNS disorder (e.g.cerebellar ataxia, stroke, demyelination)
* Migraine associated vertigo
* Psychogenic dizziness
* Cardiovascular disorders
Minimum Eligible Age

22 Years

Maximum Eligible Age

54 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Riphah International University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Muzna Munir, PHD*

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

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Hameed Latif Hospital

Lahore, Punjab Province, Pakistan

Site Status

Countries

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Pakistan

Central Contacts

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Naseer Ahmad Naseer Mehravi, MS student

Role: CONTACT

03037272342

Muzna Munir, PHD scholar

Role: CONTACT

03344265125

Facility Contacts

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Nazeer Ahmad, MS

Role: primary

03338054247

References

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Hoppes CW, Romanello AJ, Gaudette KE, Herron WK, McCarthy AE, McHale CJ, Bares J, Turner R, Whitney SL. Physical therapy interventions for cervicogenic dizziness in a military-aged population: protocol for a systematic review. Syst Rev. 2020 Mar 23;9(1):62. doi: 10.1186/s13643-020-01335-4.

Reference Type BACKGROUND
PMID: 32293544 (View on PubMed)

Yaseen K, Hendrick P, Ismail A, Felemban M, Alshehri MA. The effectiveness of manual therapy in treating cervicogenic dizziness: a systematic review. J Phys Ther Sci. 2018 Jan;30(1):96-102. doi: 10.1589/jpts.30.96. Epub 2018 Jan 27.

Reference Type BACKGROUND
PMID: 29410575 (View on PubMed)

Chu EC, Zoubi FA, Yang J. Cervicogenic Dizziness Associated With Craniocervical Instability: A Case Report. J Med Cases. 2021 Nov;12(11):451-454. doi: 10.14740/jmc3792. Epub 2021 Nov 5.

Reference Type BACKGROUND
PMID: 34804305 (View on PubMed)

De Vestel C, Vereeck L, Van Rompaey V, Reid SA, De Hertogh W. Clinical characteristics and diagnostic aspects of cervicogenic dizziness in patients with chronic dizziness: A cross-sectional study. Musculoskelet Sci Pract. 2022 Aug;60:102559. doi: 10.1016/j.msksp.2022.102559. Epub 2022 Mar 26.

Reference Type BACKGROUND
PMID: 35364427 (View on PubMed)

Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022 Dec 5;58(12):1791. doi: 10.3390/medicina58121791.

Reference Type BACKGROUND
PMID: 36556992 (View on PubMed)

Kuculmez O, Coban K, Sukun A. Prevalence of cervicogenic dizziness in patients with neck pain and effectiveness of cervicogenic dizziness rehabilitation. 2024.

Reference Type BACKGROUND

Gill-Lussier J, Saliba I, Barthelemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med. 2023 Feb 27;12(5):1884. doi: 10.3390/jcm12051884.

Reference Type BACKGROUND
PMID: 36902670 (View on PubMed)

Reid SA, Callister R, Snodgrass SJ, Katekar MG, Rivett DA. Manual therapy for cervicogenic dizziness: Long-term outcomes of a randomised trial. Man Ther. 2015 Feb;20(1):148-56. doi: 10.1016/j.math.2014.08.003. Epub 2014 Aug 27.

Reference Type BACKGROUND
PMID: 25220110 (View on PubMed)

Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther. 2014 Apr;94(4):466-76. doi: 10.2522/ptj.20120483. Epub 2013 Dec 12.

Reference Type BACKGROUND
PMID: 24336477 (View on PubMed)

Carrasco-Uribarren A, Pardos-Aguilella P, Perez-Guillen S, Lopez-de-Celis C, Rodriguez-Sanz J, Cabanillas-Barea S. Combination of Two Manipulative Techniques for the Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial. Life (Basel). 2022 Jul 9;12(7):1023. doi: 10.3390/life12071023.

Reference Type BACKGROUND
PMID: 35888111 (View on PubMed)

Other Identifiers

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REC/RCR & AHS/24/0170

Identifier Type: -

Identifier Source: org_study_id

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