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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 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. |
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| 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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 |
| Measure | Description | Time Frame |
|---|---|---|
| Dizziness Handicap Inventory (DHI) | The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI). The DHI contains 25 items, and a total score (0-100 points) is obtained by summing ordinal scale responses, higher scores indicating more severe handicap. The scale was developed to capture various sub-domains of self-perceived handicap and comprises 7 physical, 9 functional, and 9 emotional questions |
| Measure | Description | Time Frame |
|---|---|---|
| Numerical Pain Rating Scale (NPRS) | This scale will be used to measure the patient's level of pain. The numbers on this scale go from 0 to 10. "No pain" is denoted by a score of 0, and "worst pain" by a score of 10. High test-retest reliability has been demonstrated using NPRS (r = 0.96 and 0.95, respectively) | 4 weeks |
Inclusion Criteria:
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)
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Naseer Ahmad Naseer Mehravi, MS student | Contact | 03037272342 | na992311@gmail.com | |
| Muzna Munir, PHD scholar | Contact | 03344265125 | muznafmh@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Muzna Munir, PHD* | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hameed Latif Hospital | Lahore | Punjab Province | 57000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32293544 | Background | 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. | |
| 29410575 | Background |
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| 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. |
|
| 4 weeks |
| 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. |
| 34804305 | 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. |
| 35364427 | 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. |
| 36556992 | Background | Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022 Dec 5;58(12):1791. doi: 10.3390/medicina58121791. |
| Background | Kuculmez O, Coban K, Sukun A. Prevalence of cervicogenic dizziness in patients with neck pain and effectiveness of cervicogenic dizziness rehabilitation. 2024. |
| 36902670 | 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. |
| 25220110 | 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. |
| 24336477 | 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. |
| 35888111 | 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. |
| ID | Term |
|---|---|
| D004244 | Dizziness |
| D051298 | Post-Traumatic Headache |
| D010146 | Pain |
| ID | Term |
|---|---|
| D012678 | Sensation Disorders |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D051271 | Headache Disorders, Secondary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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