title: Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness.
  
  
  METHODS
  Randomized controlled trial with 12-week follow-up using blinded outcome assessment.
  
  
  METHODS
  University School of Health Sciences.
  
  
  METHODS
  Participants (N=86; mean age ± SD, 62.0 ± 12.7 y; 50% women) with chronic cervicogenic dizziness.
  
  
  METHODS
  Participants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks.
  
  
  METHODS
  Cervical ROM, head repositioning accuracy, and balance.
  
  
  RESULTS
  SNAG therapy resulted in improved (P ≤.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, -7.5°; 95% confidence interval [CI], -13° to -2.0°) and right rotation (mean difference, -6.8°; 95% CI, -11.5° to -2.1°) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy.
  
  
  CONCLUSIONS
  SNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.
authors.affiliation: School of Physiotherapy, Australian Catholic University, North Sydney, Australia. Electronic address: Sue.Reid@acu.edu.au.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Reid
authors.affiliation: Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Callister
authors.affiliation: Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Katekar
authors.affiliation: Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia.
authors.forename: Darren A
authors.initials: DA
authors.lastname: Rivett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries / Q000503:physiopathology*; D002908:Chronic Disease; D004244:Dizziness / Q000209:etiology / Q000534:rehabilitation*; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000534:rehabilitation; D019547:Neck Pain / Q000150:complications / Q000534:rehabilitation*; D004856:Postural Balance; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical vertebrae; Musculoskeletal manipulations; Neck pain; Rehabilitation