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

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

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.

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