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

8 juni 2026 uppdaterad av: 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

Studieöversikt

Status

Har inte rekryterat ännu

Betingelser

Intervention / Behandling

Detaljerad beskrivning

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.

Studietyp

Interventionell

Inskrivning (Beräknad)

42

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studiekontakt

Studieorter

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

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

  • Vuxen

Tar emot friska volontärer

Nej

Beskrivning

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

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Enda

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: 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.
Övrig: 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.
Aktiv komparator: 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
Övrig: 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.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Numeric Pain Rating Scale (NPRS) for Pain
Tidsram: 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
Tidsram: 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
Tidsram: 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
Tidsram: 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

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Riphah International University

Utredare

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

Publikationer och användbara länkar

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Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Beräknad)

30 maj 2026

Primärt slutförande (Beräknad)

30 juli 2026

Avslutad studie (Beräknad)

30 augusti 2026

Studieregistreringsdatum

Först inskickad

8 juni 2026

Först inskickad som uppfyllde QC-kriterierna

8 juni 2026

Första postat (Faktisk)

12 juni 2026

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

12 juni 2026

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

8 juni 2026

Senast verifierad

1 juni 2026

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • REC/RCR&AHS/25/0122 Aqsa

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