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

Official title

Comparative Effects of Sub-Occipital Myofascial Release With and Without Sustained Natural Apophyseal Glide Among Patients With Cervicogenic Dizziness.

Overview

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

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.

Interventions

• Other 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 appl
• 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.

Primary outcome measures

• Visual Analogue Scale (VAS) [Time frame: 4 weeks]

Secondary outcome measures (1)

• Dizziness Handicap Inventory (DHI) [Time frame: 4 weeks]

Eligibility criteria

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

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Hameed Latif Hospital — Lahore

Publications

• 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
• 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
• 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
• 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
• Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022 Dec 5;58(12):1791. doi: 10.3390/medicina58121791. PMID 36556992
• Kuculmez O, Coban K, Sukun A. Prevalence of cervicogenic dizziness in patients with neck pain and effectiveness of cervicogenic dizziness rehabilitation. 2024.
• 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
• 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

Identifiers

NCT: NCT07062809 · REC/RCR & AHS/24/0170

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗