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

NCT07062809 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/24/0170
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Dizziness; Cervicogenic Headache

Keywords

Cervicogenic Dizziness; Pain; Suboccipital Myofascial Release

Outcome Measures

Primary Outcomes (1)

• Visual Analogue Scale (VAS)

  The dizziness intensity was registered with a VAS, a valid and reliable tool for measuring dizziness intensity (reliability test-retest of this VAS is r = 0.85-0.96) .A continuous vertical line of 100 mm was anchored by two verbal descriptors ("no dizziness" and "worst imaginable dizziness"), and each end of the line had a mark; the subjects had to mark on the line the worst perceived dizziness since the last appointment (wVAS). Although it is a subjective and individual scale of the patient, it allows us to register the intensity of dizziness quickly, and its use in the clinic is widespread.

  4 weeks

Secondary Outcomes (1)

• Dizziness Handicap Inventory (DHI)

  4 weeks

Other Outcomes (1)

• Numerical Pain Rating Scale (NPRS)

  4 weeks

Study Arms (2)

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

ACTIVE COMPARATOR

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.

Other: Sub Occipital Myofascial release and (SNAGS).

Sub Occipital Myofascial release

ACTIVE COMPARATOR

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.

Other: Sub Occipital Myofascial release.

Interventions

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

Sub Occipital Myofascial release. 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.

Sub Occipital Myofascial release

Eligibility Criteria

• Age: 22 Years - 54 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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) \[31-60 points\] .

You may not qualify if:

• 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

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Hameed Latif Hospital

Lahore, Punjab Province, 57000, Pakistan

Location

Related Publications (10)

• 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.

  PMID: 32293544 BACKGROUND

• 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.

  PMID: 29410575 BACKGROUND

• 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.

  PMID: 34804305 BACKGROUND

• 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.

  PMID: 35364427 BACKGROUND

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

  PMID: 36556992 BACKGROUND

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

  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.

  PMID: 36902670 BACKGROUND

• 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.

  PMID: 25220110 BACKGROUND

• 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.

  PMID: 24336477 BACKGROUND

• 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.

  PMID: 35888111 BACKGROUND

MeSH Terms

Conditions

Dizziness; Post-Traumatic Headache; Pain

Condition Hierarchy (Ancestors)

Sensation Disorders; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Headache Disorders, Secondary; Headache Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Study Officials

• Muzna Munir, PHD*

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Naseer Ahmad Naseer Mehravi, MS student

CONTACT

03037272342; na992311@gmail.com

Muzna Munir, PHD scholar

CONTACT

03344265125; muznafmh@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 3, 2025
• First Posted: July 14, 2025
• Study Start: July 24, 2025
• Primary Completion: September 20, 2025
• Study Completion: October 20, 2025
• Last Updated: July 14, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)