The Effect of Normal Cervical Sagittal Configuration in the Management of Cervicogenic Dizziness: A 1-Year Randomized Controlled Study

The patients in study group completed 3 x 1 hour sessions per week for 10 weeks, multimodal program in forms of physical pain relief methods, cervical spine mobilization, myofascial release, and therapeutic exercises. Physical pain relief methods: The patients received hot packs (15 minutes) and TENS therapy (20 minutes) to control pain and eliminate the causal role of muscle spasms and/or tightness in changing the posture parameters. The frequency was set to 80 Hz and pulse width to 50 micro due to its analgesic effect. Mobilization : We started with neck palpation to find the most dysfunctional joints .Next, we performed passive joint mobilizations to those joints according to Maitland et al's regimen. This regimen includes the use of low-velocity cervical joint mobilization techniques (pressures were applied through the thumbs in postero-anterior direction, postero-anterior pressure were performed centrally over spinous processes and unilateral postero-anterior pressures were performed over articular pillars). It is usually applied three times for 30 seconds to dysfunctional joints. Myofascial release technique, suboccipital release: Was performed with the patient in supine position. The therapist contacted the base of the occiput with the pads of the fingers to apply antero-cephalad traction, as the tissues started to relax, the pressure continued in the direction of ease (cephalad direction). The pressure is continued for 1 or 2 min until a release of the suboccipital tissues is obtained. Therapeutic exercise intervention: ( about 30 minutes) According to Jull et al's protocol, the exercise component of the program consisted of deep cervical flexor endurance training, scapular retraction exercises, postural education, and low-load cervical flexion and extension resistive exercise. Deep cervical flexor exercises focused on the tonic holding function of these muscles. Exercises were performed in supine position with the pressure sensor inflated to 20 mmHg and placed behind the neck. The patients instructed to achieve and maintain 30 mmHg for 10 sec for 10 repetitions. From prone lying position, the muscles of the scapula, particularly the serratus anterior and lower trapezius, were trained using inner range holding exercises of scapular adduction and retraction. The patients were instructed to complete three sets of 12 repetitions. Also, the patients were trained to sit with a natural lumbar lordosis while gently retracting and adducting their scapulae and gently elongating their cervical spine to facilitate the longus colli. Subsequently, isometric exercises using a low level of rotatory resistance were used to train the co-contraction of the neck flexors and extensors.the exercises was performed in three sets of 12 repetitions. Muscle lengthening exercises were conducted to address any muscle tightness assessed to be present. Three stretching exercises held for 30 seconds each. This multimodal programme was to be repeated three times per week for 10 weeks. The multimodal program was performed to participants at physiotherapy clinic. Patients were instructed to perform neck retraction/extension, scapular retraction, and deep upper cervical flexor strengthening exercises at home, twice daily as home routine (a pamphlet illustrating the exercises and a record sheet were distributed to the participants. the records sheets were collected every week and analysed to calculate the exercise frequency and time). The experimental group additionally received Deneroll cervical traction. The patient lies flat on their back on the ground with their legs extended and arms by their sides. The patient is encouraged to relax whilst lying on the Denneroll. The patient should place the Denneroll on the ground and position the neck roll depending on the area to be addressed. The apex of the Denneroll orthotic is placed in the upper cervical region (C2-C4) region. This position allows extension bending of the upper cervical segments while cause slight anterior head translation. The apex of the Denneroll orthotic is placed in the mid-cervical region (C4-C6) region. This position allows extension bending of the mid-upper cervical segments while creating a slight posterior head translation. The apex of the Denneroll orthotic is placed in the upper thoracic lower-cervical region (C6-T1) region. This position allows extension bending of the majority of cervical segments while creating a significant posterior head translation. The Denneroll cervical traction was administered by physiotherapist, and was performed to patients at physiotherapy clinic. The time of the Denneroll cervical traction was 3 minutes at the first session and increased by 1 minutes in every session till it reached 20 minutes.