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Cervicogenic DizzinessNCT07646327

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

A study testing SNAGs with FRT and SNAGs in people with Cervicogenic Dizziness, run by Riphah International University at 1 site in Pakistan.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

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. Read more about this study

Who is it for?
Ages 18 to 35 years
Conditions the study is for
Cervicogenic Dizziness
What is being tested?
SNAGs with FRT and SNAGs
Could I receive a placebo?
No, everyone receives an active treatment
How many people
42 participants
Where
1 sitePakistan
Study dates
30 May 2026to 30 Aug 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 35 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

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

Who cannot join

  • • 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
Show all 11Show fewer
  • Diagnosed psychological disorders
  • History of cervical spine surgery
  • Vertebral Fractures
  • Spine disorders such as cervical spondylosis and disc herniation
  • Presence of tumor

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Samrood Akram, PhD* contact

03324806143

samrood.akram@riphah.edu.pk

Pakistan1 site
  • Government Teaching Hospital Shahdara

    Lahore, Punjab Province, 54920

    Rahat Afzal, MS-OMPT, 0316 4333853, rahatafzal850@gmail.com

Other trials in Pakistan

About this study

Official title: 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

Read the 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.

Being tested
SNAGs with FRT, SNAGs
Keywords
Dizziness, neck pain, range of motion
Medical subject headings
Dizziness, Neck Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SNAGs with FRTOther

    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.

  • SNAGsOther

    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.

Study groups in NCT07646327
Study groupRoleWhat they receive
SNAGs along with Functional positional Release TechniqueExperimentalSNAGs (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.
Receives: Other: SNAGs with FRT
SNAGsActive comparatorSNAGs (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
Receives: Other: SNAGs

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Numeric Pain Rating Scale (NPRS) for Pain

    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

    Measured: Upto 4 weeks

  2. Dizziness Handicap Inventory Scale (DHI) for dizziness

    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

    Measured: Upto 4 weeks

  3. Universal Goniometer for ROM

    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

    Measured: Upto 4 weeks

  4. Neck Disability Index (NDI) for disability

    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

    Measured: Upto 4 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Jun 2026
  2. Study start30 May 2026 (estimated)
  3. Primary completion30 Jul 2026 (estimated)
  4. Study completion30 Aug 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
42 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07646327
Sponsor's protocol ID
REC/RCR&AHS/25/0122 Aqsa
Status last verified
Jun 2026
First submitted
8 Jun 2026
Last updated
12 Jun 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • 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.

    PubMed 11153554
  • 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.

    PubMed 24521903
  • 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.

    PubMed 35141479
  • 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.

    PubMed 36882720
  • 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.

    PubMed 29875897
  • Sung Y-H. Classification of cervicogenic dizziness. Hearing, Balance and Communication. 2023;21(1):10-5.

  • Li Y, Peng B. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain Physician. 2015 Jul-Aug;18(4):E583-95.

    PubMed 26218949
  • 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.

    PubMed 34078529
  • Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022 Dec 5;58(12):1791. doi: 10.3390/medicina58121791.

    PubMed 36556992

Questions about this trial

What is this clinical trial studying?

A study testing SNAGs with FRT and SNAGs in people with Cervicogenic Dizziness, run by Riphah International University at 1 site in Pakistan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 12 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Samrood Akram, PhD* (03324806143, samrood.akram@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Numeric Pain Rating Scale (NPRS) for Pain (time frame: Upto 4 weeks). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07646327, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jun 2026; AzTrials last refreshed its copy on 6 Nov 2026.

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