Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache.
Adham A Mohamed, Wael S Shendy, Moataz Semary and 5 others
PMID 31037013WHAT IT FOUND
In people with cervicogenic headache and dizziness, combining a C2 headache SNAG with a C1-C2 rotation SNAG gave greater improvement in neck disability, headache impact, and rotation than either technique alone.
Dizziness improved in all groups.
Key findings
01All three treatment groups improved after SNAG mobilization on neck disability, headache impact, dizziness handicap, and cervical rotation.
02The combined group had significantly better post-treatment neck disability, headache impact, and rotation than either single-technique group.
03For dizziness, the C1-C2 rotation group scored lower than the C2 headache group, while the combined group was comparable to both.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The sample was small, with 16 patients in each group, so the results may not generalize. There was no untreated or sham group, so improvement cannot be separated from time, attention, or natural variation. Blinding of patients or assessors is not described, and several outcomes were self-report scales. The authors note that the Dizziness Handicap Inventory is subjective and may be affected by personality, mood, and psychological support. The authors note that some patients had difficulty becoming familiar with the questions on the scales. Treatment was delivered by a certified Mulligan expert physiotherapist under supervision, so it may not transfer to less trained therapists.
Declared interests
The authors report no funding and no conflicts of interest.
The easy way to misread this
Do not conclude that combined SNAG is better than doing nothing. All 48 patients received active manual therapy, and the study had no untreated or sham group. The sample was small, with 16 patients per group.