SNAGs (Sustained Natural Apophyseal Glides) and Functional Release Techniques (FRT) are highly effective, non-invasive manual therapy methods used to treat cervicogenic dizziness. They target the faulty biomechanics, joint restrictions, and muscle hypertonicity in the upper cervical spine (C1-C3) that disrupt cervical proprioception and trigger dizziness.

SNAGs (Sustained Natural Apophyseal Glides) are targeted manual therapy techniques that combine sustained joint glides with active patient movement. Highly effective for cervicogenic dizziness, they reduce neck pain, improve cervical range of motion, and decrease dizziness by restoring proper upper cervical spine biomechanics and alleviating joint restrictions

SNAG :

The therapist will place the palmar aspect of the thumb reinforced by the opposite thumb over the spinous process of C2. The other fingers will apply light pressure on both sides of the face to stabilize the head The therapist will apply anterior glide to C2. Instruct the patient to move his/her neck in the offending direction.

FRT:

The therapist will palpate the upper trapezius tender point. After palpation, the patient's neck will be brought into a neutral position. The therapist will apply a gentle axial facilitating force (compressive force) through the head towards the feet and will quickly turn the patient's head in side flexion towards the tender point in a position of maximum relaxation.

The therapist will maintain this position for 3 to 5 seconds, and the patient's neck will be turned into a neutral position.

It is the most frequently used pain outcome measure. It consists of a horizontal 10 cm straight line with 2 marks that have "no pain" (score of 0) and a "worst imaginable pain" (score of 10) at either end of the line. On this scale, respondents will be asked to rate their level of pain before and after the treatment. The test-retest reliability of NPRS is (ICC = 0.72), and the construct validity is (AUC = 0.78-0.93). The Minimal Clinically Important Difference (MCID) is 2.5 points, suggesting a reduction of at least 2.5 points on the NPRS is clinically significant

The DHI questionnaire consists of 25 items with physical, emotional, and functional subscales. This scale evaluates the self-perceived handicap from dizziness. Patients will be asked to answer the questions considering their condition before and after the treatment. Each item on the questionnaire ranges from 0 to 4. Scores of 16-34 indicate mild, 36-52 indicate moderate, and 54 points or more represent severe handicap. The test-retest reliability of DHI is high (r = 0.92 to 0.97) and high internal consistency (alpha = 0.72 to 0.89). The MCID for DHI is reported as ≥ 10 points

It was used to measure the cervical range of motion. It is a less expensive and easy-to-use instrument. It has two arms, one of which is stationary and the other is a movable arm. The center of the UG is the fulcrum. The test-retest reliability of the goniometer is excellent (ICC ≥ 0.98), and the inter-rater reliability is (ICC ≥ 0.94). The Minimal Detectable Change (MDC ≤ 5.23% (≈ 2-3°) is considered a true change in ROM

The NDI questionnaire consists of 10 items designed to measure neck-specific disability. Out of 10 items, 7 correlated with daily living activities, 2 with pain, and 1 with concentration. Each item on the questionnaire ranges from 0 to 5, with higher scores indicating greater disability. The test-retest reliability of NDI is high (r = 0.89), and the Construct validity is (r ≥ 0.70). The MCID for NDI is >5 Points, meaning a reduction of 5 or more points is considered clinically meaningful