The use of SNAG (sustained natural apophyseal glide) mobilizations may increase patient compliance and improve your clinical outcomes. A recent publication by Mohamed et al. (2019) utilized cervical SNAGs to treat cervicogenic headaches and dizziness related to upper cervical joint dysfunction. Incorporation of two special SNAGs provided significant symptomatic relief:
“Sustained natural apophyseal glide mobilizations used in the study were effective in reducing cervicogenic headache and dizziness in all groups with a greater improvement in the combined group. The use of cervical SNAG mobilizations is encouraged as a noninvasive intervention depending on the therapist’s assessment, findings, and clinical reasoning.” (1)
Check out this video blog demonstration of the SNAGs utilized in this study.
What are SNAGs?
Sustained natural apophyseal glide (SNAG) is a treatment technique developed by Mulligan. (2) SNAG movements are primarily for self-care or at-home exercise plans. The patient will actively move into the direction of symptoms until end range. At end range, a towel or strap is used to provide gentle overpressure to increase ROM in the desired direction. This movement should be pain-free; with minimal use of force.
What conditions respond to SNAGs?
Mobilizations with patient-led movements have been shown to be highly effective for many diagnoses. SNAGs effectively decrease symptoms, including cervicogenic headache and vertigo. (3-5) Chiropractic care, i.e., joint manipulation, promotes joint mobility. SNAGs may be used for at home care to retain or increase these gains in intervertebral motion.
How can I incorporate SNAGs into my practice?
First, don’t forget about what works for headaches and dizziness. Spinal manipulation is one of the most effective tools that evidence-based chiropractors employ for these conditions.
A survey of 381 chiropractors found that over 80% of plans for recent onset headache (less than 3 months duration) required less than 10 visits scheduled at 1-2 visits per week for less than 8 total weeks. (6)
One randomized controlled trial demonstrated that 6-8 of SMT sessions produced good outcomes. (7)
A Spine Journal study found that spinal manipulation cuts the number of CGH symptomatic days in half, and the number of treatments has a linear dose response to improvement (8).
“In no field is manipulation more effective than in the treatment of disturbances of equilibrium.” (9)
Fitz-Ritson demonstrated a 90.2 success rate when utilizing manipulation for the treatment of post-traumatic cervicogenic vertigo. (10)
Second, consider the exercises for C1-C2 SNAG rotation and Headache SNAG in your treatment plans.
Subscribers – The SNAG exercises have already been added to your ChiroUp exercise database. Add them to your condition reports individually or customize your condition reports to automatically include these exercises every time.
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- Mohamed AA, Shendy WS, Semary M, Mourad HS, Battecha KH, Soliman ES, Sayed SHE, Mohamed GI. Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache. J Phys Ther Sci.2019 Apr;31(4):376-381.
- Mulligan BR: Mobilisations with movement and other techniques, 4th ed. Brühl: H. Müller-Frank, 1999, p 114
- Racicki S, Gerwin S, Diclaudio S, et al.: Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Manual Manip Ther, 2013, 21: 113–124.
- Gross A, Kay TM, Paquin JP, et al. Cervical Overview Group: Exercises for mechanical neck disorders. Cochrane Database Syst Rev, 2015, 1: CD004250.
- Lystad RP, Bell G, Bonnevie-Svendsen M, et al.: Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropr Man Therap, 2011, 19: 21.
- Moore C, Leaver A, Sibbritt D, Adams J. The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC Neurol. 2018;18(1):171. Published 2018 Oct 17.
- Dunning JR, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17(1):64
- Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23.
- Lewit K. Disturbed balance due to lesions of the cranio-cervical junction. J Orthop Med 1998; 3:58-61.
- Fitz-Ritson D. Assessment of cervicogenic vertigo. JMPT 1991;14:193-198.
About the Author
Dr. Brandon Steele
DC, DACODr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.
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