Sustained Natural Apophyseal Glides With and Without Facilitated Positional Release Technique in Cervicogenic Dizziness

June 8, 2026 updated by: Riphah International University

Effects of Sustained Natural Apophyseal Glides With and Without Facilitated Positional Release Technique on Pain, Dizziness, Range of Motion, and Functional Status Among Patients With Cervicogenic Dizziness

Cervicogenic Dizziness is characterized by non-rotatory dizziness and a sense of disequilibrium associated with neck pain, stiffness, and decreased range of motion. It arises from the abnormal afferent inputs from the upper cervical spine. Patients may experience lightheadedness and neck pain triggered by neck movements, leading to functional limitations. The present study aims to compare the effects of sustained natural apophyseal glides only and in combination with the facilitated positional release technique on pain intensity, severity of dizziness, range of motion, and functional status among patients with cervicogenic dizziness

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

A double-blinded randomized clinical trial will be conducted at the Government Teaching Hospital, Shahdara, Lahore. A total of 42 patients (21 in each group) will be enrolled in this study, and a non-probability, purposive sampling technique will be used for data collection. Patients will be allocated to Group A and Group B after randomization using an online randomization tool. After obtaining informed consent, Group A will receive treatment of SNAGs along with FPRT, while Group B will receive SNAGs only, three times a week for four weeks. Outcome measures will include the Numeric Pain Rating Scale (NPRS) for pain, the Dizziness Handicap Inventory Scale (DHI) for dizziness, a goniometer for range of motion, and the Neck Disability Index (NDI) for functional status. Assessment will be conducted on the first day and after four weeks of treatment. Data will be analyzed using SPSS version 27. Descriptive statistics will be presented, and the data normality will be assessed using the Shapiro-Wilk test to determine whether a parametric or non-parametric test will be used within or between-group analyses.

Study Type

Interventional

Enrollment (Estimated)

42

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 54920
        • Government Teaching Hospital Shahdara
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age group between 18 and 35 years
  • Both male and female participants
  • Non-traumatic cervicogenic dizziness with positive cervical torsion test

Exclusion Criteria:

  • • History of cervical trauma or head/face injury

    • Vestibular disorder, i.e., BPPV
    • Vertebrobasilar Insufficiency
    • Positive Dix-Hallpike Maneuver, Alar Ligament Stress Test, and Vertebral Artery Test
    • History of cardiovascular disorders
    • Pregnancy
    • Diagnosed psychological disorders
    • History of cervical spine surgery
    • Vertebral Fractures
    • Spine disorders such as cervical spondylosis and disc herniation
    • Presence of tumor

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: SNAGs along with Functional positional Release Technique
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.
Other: SNAGs with FRT

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.
Active Comparator: SNAGs
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
Other: SNAGs
The patient will be seated. The therapist will stand behind the patient. 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Numeric Pain Rating Scale (NPRS) for Pain
Time Frame: Upto 4 weeks
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
Upto 4 weeks
Dizziness Handicap Inventory Scale (DHI) for dizziness
Time Frame: Upto 4 weeks
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
Upto 4 weeks
Universal Goniometer for ROM
Time Frame: Upto 4 weeks
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
Upto 4 weeks
Neck Disability Index (NDI) for disability
Time Frame: Upto 4 weeks
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
Upto 4 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Rahat Afzal, MS-OMPT, Governement Teaching Hospital Shahdara Lahore.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 30, 2026

Primary Completion (Estimated)

July 30, 2026

Study Completion (Estimated)

August 30, 2026

Study Registration Dates

First Submitted

June 8, 2026

First Submitted That Met QC Criteria

June 8, 2026

First Posted (Actual)

June 12, 2026

Study Record Updates

Last Update Posted (Actual)

June 12, 2026

Last Update Submitted That Met QC Criteria

June 8, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/RCR&AHS/25/0122 Aqsa

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Cervicogenic Dizziness

Clinical Trials on SNAGs with FRT

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Peru

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe