Cervicogenic dizziness is defined as a sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine.Sub-occipital Release, a type of Myofascial Release (MFR) is a form of manual therapy technique which can be used for the treatment of cervicogenic dizziness. Sub-occipital muscles, dura matter and C2 vertebrae are connected to each other through the fascia. Sustained natural apophyseal glides (SNAGs) are also an effective treatment for cervicogenic dizziness. This study aim to determine Comparative Effect of Sub-Occipital Myofascial release with and without Sustained Natural Apophyseal Glide among patients with Cervicogenic Dizziness.
Cervicogenic dizziness patients both male and female.
Age group between 22 to 54 Years old.
Passive Accessory Assessment of the UCS (C0-1, C1-2, C2-3).
Dizziness related to either movements or positions of the cervical spine, or occurring with a stiff or painful neck.
Conditions for which manual therapy is contraindicated
Traumatic brain injury
Previous surgery to the upper cervical spine and marked cervical spine disc protrusion
By neurologist .Vestibular disorders (e.g. Benign Paroxysmal Positional Vertigo, Meniere's disease, peripheral vestibulopathy)
Parallel
Sub Occipital Myofascial release and (SNAGS).
Other interventionThe patient will instruct to be seated then will turned his head toward direction that will cause his dizziness. when subject will turn his head, The manual therapist will perform a constant PA glide (using his thumbs one over the other) to upper cervical C1 or C2 vertebra (Oriented toward patient's eyeballs). If flexion or extension movement will provoke the dizziness, an anterior glide will apply to the C2 spinous process. If rotation will provoke dizziness, then an anterior glide will be applied to the C1 transverse process.
Sub Occipital Myofascial release.
Other interventionWhen using the technique, the patient will be in Upward-facing position with their head fully aided on the therapist's hands. The therapist will put three middle fingers simply inferior to the nuchal line, raise the tips of the fingers in the direction of the ceiling, and then simply pull them upward.
Visual Analogue Scale (VAS)
The dizziness intensity was registered with a VAS, a valid and reliable tool for measuring dizziness intensity (reliability test-retest of this VAS is r = 0.85-0.96) .A continuous vertical line of 100 mm was anchored by two verbal descriptors ("no dizziness" and "worst imaginable dizziness"), and each end of the line had a mark; the subjects had to mark on the line the worst perceived dizziness since the last appointment (wVAS). Although it is a subjective and individual scale of the patient, it allows us to register the intensity of dizziness quickly, and its use in the clinic is widespread.
Dizziness Handicap Inventory (DHI)
The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI). The DHI contains 25 items, and a total score (0-100 points) is obtained by summing ordinal scale responses, higher scores indicating more severe handicap. The scale was developed to capture various sub-domains of self-perceived handicap and comprises 7 physical, 9 functional, and 9 emotional questions
Numerical Pain Rating Scale (NPRS)
This scale will be used to measure the patient's level of pain. The numbers on this scale go from 0 to 10. "No pain" is denoted by a score of 0, and "worst pain" by a score of 10. High test-retest reliability has been demonstrated using NPRS (r = 0.96 and 0.95, respectively)
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