The Somatic Connection  |   October 2014
Manual Therapy Effects in Patients With Cervicogenic Dizziness
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   October 2014
Manual Therapy Effects in Patients With Cervicogenic Dizziness
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 810. doi:
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 810. doi:
Reid SA, Callister R, Katekar MG, Rivett DA. Effects of cervical spine manual therapy on range of motion, head positioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial [published online May 2, 2014]. Arch Phys Med Rehabil. doi:10.1016/j.apmr.2014.04.009.  
Australian physical therapy researchers used 2 manual therapy interventions compared with placebo in patients with cervicogenic dizziness to assess the effects of therapy on cervical range of motion (ROM), head repositioning accuracy, and balance. The study was part of a clinical trial that showed that the Mulligan sustained natural apophyseal glide (SNAG) and Maitland passive joint mobilization (PJM) both reduced dizziness intensity and frequency after intervention and at 12 weeks compared with baseline.1 These results are consistent with osteopathic research, which showed that osteopathic manipulative treatment (OMT) reduced dizziness and vertigo2 and improved balance in healthy elderly adults.3 
This article was selected for review in “The Somatic Connection” to highlight the outcome measures of cervical ROM and head repositioning, which to my knowledge have never been assessed in osteopathic research, and the uniqueness of the placebo, all of which in my opinion should be considered in future osteopathic research. The SNAG intervention is similar to articulatory forces being sustained through the ROM in upper cervical segments with the patient seated, and the PJM intervention appears equivalent to soft tissue and myofascial release to the cervical spine with the patient supine.1 
Participants were included if they had cervicogenic dizziness for 3 months or longer and did not have symptoms consistent with other forms of dizziness such as vertigo. Participants (N=86) were randomly assigned to the SNAG, PJM, or placebo intervention groups. The placebo consisted of a deactivated laser device that emitted a light and beeping sound; the “laser probe was positioned 0.5 to 1 cm from the skin for 2 minutes to each of 3 sites on the neck.” 
Each participant received the assigned intervention 2 to 6 times over 6 weeks, the average being approximately 4 times per participant in each group. Outcome measures were made at baseline and immediately, 6 weeks, and 12 weeks after intervention. Sustained natural apophyseal glide improved cervical ROM (P≤.05) in all 6 cervical planes of motion immediately after intervention and at 12 weeks compared with placebo. Passive joint mobilization improved only left rotation. There was no change in head repositioning accuracy nor in balance improvement. These finding may be limited by the nature of cervicogenic dizziness, but they do provide precedent for further study. 
Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of Mulligan sustained natural apophyseal glides and Maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther. 2014;94(4):466-476. doi:10.2522/ptj.20120483. [CrossRef] [PubMed]
Fraix M, Gordon A, Graham , Hurwitz E, Seffinger MA. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness. J Am Osteopath Assoc. 2013;113(5):394-403. [PubMed]
Lopez D, King HH, Knebl JA, Kosmopoulos V, Collins D, Patterson RM. Effects of comprehensive osteopathic manipulative treatment on balance in elderly patients: a pilot study. J Am Osteopath Assoc. 2011;111(6):382-388. [PubMed]