Sustained Natural Apophyseal Glides With and Without Facilitated Positional Release Technique in Cervicogenic Dizziness
8 de junho de 2026 atualizado por: 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
Visão geral do estudo
Status
Ainda não está recrutando
Condições
Intervenção / Tratamento
Descrição detalhada
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.
Tipo de estudo
Intervencional
Inscrição (Estimado)
42
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Contato de estudo
- Nome: Samrood Akram, PhD*
- Número de telefone: 03324806143
- E-mail: samrood.akram@riphah.edu.pk
Locais de estudo
-
-
Punjab Province
-
Lahore, Punjab Province, Paquistão, 54920
- Government Teaching Hospital Shahdara
-
Contato:
- Rahat Afzal, MS-OMPT
- Número de telefone: 0316 4333853
- E-mail: rahatafzal850@gmail.com
-
-
Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
Aceita Voluntários Saudáveis
Não
Descrição
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
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
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.
|
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. |
|
Comparador Ativo: 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
|
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.
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Numeric Pain Rating Scale (NPRS) for Pain
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Investigadores
- Investigador principal: Rahat Afzal, MS-OMPT, Governement Teaching Hospital Shahdara Lahore.
Publicações e links úteis
A pessoa responsável por inserir informações sobre o estudo fornece voluntariamente essas publicações. Estes podem ser sobre qualquer coisa relacionada ao estudo.
Publicações Gerais
- Li Y, Peng B. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain Physician. 2015 Jul-Aug;18(4):E583-95.
- Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther. 2000 Dec;30(12):755-66. doi: 10.2519/jospt.2000.30.12.755.
- Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022 Dec 5;58(12):1791. doi: 10.3390/medicina58121791.
- Luscher M, Theilgaard S, Edholm B. Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. J Laryngol Otol. 2014 Feb;128(2):128-33. doi: 10.1017/S0022215114000188. Epub 2014 Feb 13.
- Vural M, Karan A, Albayrak Gezer I, Caliskan A, Atar S, Yildiz Aydin F, Coskun Benlidayi I, Goksen A, Koldas Dogan S, Karacan G, Erdem R, Eda Kurt E, Kesiktas FN, Aydin T, Sahin N, Aydin Z, Ordahan B, Turkoglu G, Resorlu H, Doner D, Yilmaz F, Bertan H, Dulgeroglu D, Karaahmet OZ, Sonel Tur B, Moustafa E, Borman P, Iskender O, Ay S, Kurtaran A, Sirzai H, Evcik D, Capan N, Erhan B, Alptekin HK, Ural HI. Prevalence, etiology, and biopsychosocial risk factors of cervicogenic dizziness in patients with neck pain: A multi-center, cross-sectional study. Turk J Phys Med Rehabil. 2021 Dec 1;67(4):399-408. doi: 10.5606/tftrd.2021.7983. eCollection 2021 Dec.
- Bayraklı BB, Kuzu Ö, ÇElİK C. A Rare Cause of Vertigo: Cervicogenic Dizziness. Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi. 2025;28:90-2.
- Moen U, Knapstad MK, Wilhelmsen KT, Goplen FK, Nordahl SHG, Berge JE, Natvig B, Meldrum D, Magnussen LH. Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study. BMC Musculoskelet Disord. 2023 Mar 8;24(1):173. doi: 10.1186/s12891-023-06279-z.
- Takahashi S. Importance of cervicogenic general dizziness. J Rural Med. 2018 May;13(1):48-56. doi: 10.2185/jrm.2958. Epub 2018 May 29.
- Sung Y-H. Classification of cervicogenic dizziness. Hearing, Balance and Communication. 2023;21(1):10-5.
- Moon KM, Kim J, Seong Y, Suh BC, Kang K, Choe HK, Kim K. Proprioception, the regulator of motor function. BMB Rep. 2021 Aug;54(8):393-402. doi: 10.5483/BMBRep.2021.54.8.052.
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Estimado)
30 de maio de 2026
Conclusão Primária (Estimado)
30 de julho de 2026
Conclusão do estudo (Estimado)
30 de agosto de 2026
Datas de inscrição no estudo
Enviado pela primeira vez
8 de junho de 2026
Enviado pela primeira vez que atendeu aos critérios de CQ
8 de junho de 2026
Primeira postagem (Real)
12 de junho de 2026
Atualizações de registro de estudo
Última Atualização Postada (Real)
12 de junho de 2026
Última atualização enviada que atendeu aos critérios de controle de qualidade
8 de junho de 2026
Última verificação
1 de junho de 2026
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- REC/RCR&AHS/25/0122 Aqsa
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Não
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Não
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .