Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness

Man Ther. 2008 Aug;13(4):357-66. doi: 10.1016/j.math.2007.03.006. Epub 2007 Oct 22.


<Cervicogenic dizziness is dizziness described as imbalance occurring together with cervical pain or headache. This study aimed to determine the efficacy of sustained natural apophyseal glides (SNAGs) in the treatment of this condition. A double-blind randomised controlled clinical trial was undertaken. Thirty-four participants with cervicogenic dizziness were randomised to receive four to six treatments of SNAGs (n=17) or a placebo of detuned laser (n=17). Participants were assessed by a blinded assistant before treatment, after the final treatment and at 6- and 12-week follow-ups. The primary outcome measures were severity of dizziness, disability, frequency of dizziness, severity of cervical pain, and global perceived effect; balance and cervical range of motion were secondary measures. At post-treatment, 6- and 12-week follow-ups compared to pre-treatment, the SNAG group had less (P<0.05) dizziness, lower (P<0.05) scores on the Dizziness Handicap Inventory (DHI), decreased (P<0.05) frequency of dizziness, and less (P<0.05) cervical pain. The placebo group had significant (P<0.05) changes only at the 12-week follow-up in three outcome measures: severity of dizziness, DHI, and severity of cervical pain. Compared to the placebo group at post-treatment and 6-week follow-up, the SNAG group had less (P<0.05) dizziness, lower (P < or =0.05) scores on DHI, and less (P<0.05) cervical pain. Balance with the neck in extension improved (P < or =0.05) and extension range of motion increased (P<0.05) in the SNAG group. No improvements in balance or range of motion were observed in the placebo group. The SNAG treatment had an immediate clinically and statistically significant sustained effect in reducing dizziness, cervical pain and disability caused by cervical dysfunction.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cervical Vertebrae
  • Dizziness / classification
  • Dizziness / etiology
  • Dizziness / therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Manipulation, Spinal / methods*
  • Middle Aged
  • Neck Pain / complications
  • Pain Measurement
  • Range of Motion, Articular
  • Severity of Illness Index
  • Treatment Outcome