Title: The treatment of cervicogenic dizziness with Mulligan sustained natural apophyseal glides and Maitland mobilisations:which is more effective?
Reid SA¹, Callister R², Katekar M², Rivett DA²
¹ The Australian Catholic University, North Sydney
² The University of Newcastle, Newcastle
ABSTRACT
Question: What are the comparative effects of Mulligan sustained natural apophyseal glides (SNAGs) and Maitland passive joint mobilisationsin reducing symptoms of cervicogenic dizziness?Design: Randomised placebo-controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants:Eighty-six individuals withchronic cervicogenic dizziness. Intervention: Participants received 2-6 treatments of either SNAGswith self-SNAG exercises (n=29) orpassive joint mobilisations with range of motion exercises (n=29) or a placebo intervention of detuned laser (n=28). Outcome measures: The primary outcome wasintensity of dizziness measuredon a visual analogue scale. Secondary outcomes were frequency of dizziness, the Dizziness Handicap Inventory andcervical range of motion.Measures were taken at baseline, immediately post-treatment, 12 weeks and at 12 months.Results:Both manual therapy groups had less dizziness intensity(p < 0.05) than the placebo group post-treatment and at 12 weeks, and less frequent dizziness at 12 weeks and 12 months. There were no differencesin these dizziness measures between the two manual therapy groups at any point.The mobilisation group had a lower dizziness handicap score(p < 0.05) than the SNAG group at 12 weeks. The SNAG group had significantly greater extension movement (p < 0.05) than the mobilisation group at all post-intervention points and greater right rotation post-treatment. There were no adverse effects. Conclusion:Manual therapy has an immediate and sustained (12 month) effect in reducing cervicogenic dizziness. There was no difference between the two manual therapy groups for dizziness but SNAGs had a greater effect on range of motion.
Trial registration: ACTRN12611000073909
Key Practice Points:
•Maitland mobilisations and Mulligan SNAGs reducecervicogenic dizziness immediately post-treatment and the effect is maintained for 12months.
•SNAGs are more beneficial than Maitland mobilisations in improving some cervical ranges of motion in patients with cervicogenic dizziness.
•Manual therapy has no common adverse effects on patients with cervicogenic dizziness.
Presenting author biography: Sue Reid is a lecturer at the Australian Catholic University, North Sydney, Australia. She has completed a research master’s degree on cervicogenic dizziness and is currently undertaking her PhD on this topic. Sue has presented at several international Physiotherapy conferences. Sue has worked in clinical practise as a titled musculoskeletal physiotherapist for over 25 years.