Cervicogenic dizziness is a controversial diagnosis in the medical community and is often a diagnosis of exclusion, which means everything else must be ruled out before this diagnosis will be ruled in. Individuals with cervicogenic dizziness will usually present with neck pain and may also experience headaches (tension type headaches or cervicogenic headaches ). Neck pain may only occur with palpation (when touching certain areas of the neck); therefore, many people may not realize that their neck is a problem.
Dizziness is a very subjective term; in our experience people with cervicogenic dizziness often describe their symptoms as a sensation of disorientation, lightheadedness, fogginess, haziness, spaciness, floating, a sensation of being disconnected or distant, or a sensation that they are swaying. Some individuals may experience a sensation of vertigo; however, patients with cervicogenic dizziness typically feel as though they are spinning or swaying versus true vertigo in which they see the room spin around them.
Symptoms may last for minutes to hours and can range from mild to severe. Individuals may experience relief with lying down or sitting back with their neck supported. Symptoms will typically increase with activities and positions such as: looking down, looking up, keeping your head turned to one side for increased periods of time, bending forward, working on a computer, reading, or performing overhead arm activities. There is no test to determine that someone has cervicogenic dizziness. X-rays, MRIs, CT scans will often be negative as this is a condition involving tight muscles and mechanical dysfunction of the neck. A physical therapist specializing in this type of condition will be able to identify muscle tightness, asymmetry of the vertebrae, and well as faulty neck mechanics.
Cervicogenic dizziness may occur in the absence of an injury; however, may occur after a recent head or neck injury or may occur months to years after an injury. Approximately 20-50% of people who have sustained a whiplash injury will experience symptoms of dizziness, vertigo, or decreased balance. These symptoms can be coming from the vestibular system, central nervous system, or neck. Cervicogenic dizziness may also occur as a result of arthritic changes, herniated disc, instability of the cervical vertebrae, muscle spasm, or postural adaptations such as scoliosis or kyphosis . Cervicogenic dizziness may occur gradually with continual worsening of symptoms or the onset may be rapid.
- Neck Pain - Neck pain may be present in conjunction with dizziness, or may only be present only on palpation. Neck pain may precede dizziness by weeks or months. Pain may be experienced at the base of the skull, in the jaw region, behind the ear, in the temple region, and in the upper shoulders. Headaches may be experienced, and will often start at the base of the head and radiate to the temple region.
- Decreased Range of motion - Limitations with rotation, side bending, flexion or extension may be present. Deviations with flexion and extension may also be noted. Many individuals will turn their entire body instead of just their head.
- Increased muscle tightness - Neck stiffness, tenderness and guarding may be experienced. Muscle tightness is typically noted in the sternocleidomastoid, levator scapula, and upper trapezius muscles.
- Ataxia/unsteady gait - Walking with a wide base of support or uncoordinated gait pattern.
- Disequilibrium - Difficulty Maintaining an upright posture, may experience increased swaying when standing or with eyes closed in the shower.
- Postural Imbalance - Difficulty maintaining an upright posture or maintaining the neck in a neutral position.
Faulty mechanics of the neck due to injury, muscle tightness, or poor posture may cause a sensation of dizziness. This is due to the connection between the nerve receptors in the upper neck and the vestibular system (inner ear). The nerve receptors in the neck supply information about your head position and help with balance. This balance information works together with information from your eyes and inner ears to tell you what position your body is in with relationship to gravity and the ground. This gives you a sense of balance.
If the neck receptors are not providing the correct information and do not agree with the signals coming from the eyes and inner ears, the brain may get confused. This can result in the symptoms associated with cervicogenic dizziness. This connection between your neck, eyes, and inner ear also helps to improve your hand eye coordination, postural control, and balance. Therefore, damage or altered mechanics of the neck receptors may result in a sense of dizziness or disequilibrium and may decrease your coordination.
There is no definitive diagnostic test for cervicogenic dizziness, which makes it a difficult diagnosis. The neck torsion test may help to identify cervicogenic dizziness and is performed by keeping the head stationary while the body is rotated underneath. If the test is positive dizziness may be reproduced, and nystagmus or eye movement may be present. The neck vibration test is performed by introducing vibration to certain muscle groups in the cervical region. Again, if the test is positive dizziness may be reproduced and nystagmus or eye movement may be present.
Once cervicogenic dizziness is identified, it can be properly treated. Restoring normal upper cervical spine mechanics is the key to improving this condition. The treatment of choice for cervicogenic dizziness is a combination of manual and vestibular therapy. Manual therapy is performed to; decrease muscle tightness, improve cervical range of motion, restore proper cervical spine mechanics, reduce trigger points, strengthen musculature, and correct posture and body mechanics. Read more about manual therapy below. Vestibular therapy is performed to improve cervical proprioceptive awareness, improve the ability to focus while moving the head, improve coordination, and improve balance. To find a therapist in your area click here .
Note : Cervicogenic dizziness may complicate vestibular rehabilitation for those individuals with other types of vestibular disorders such as disorders resulting in vestibular hypofunction. This is because increased head movement is required during many vestibular rehabilitation exercises. Increased head movement may inadvertently result in increased symptoms of dizziness and increased muscle tightness.
In our experience, a number of individuals with vestibular disorders develop cervicogenic dizziness. Certain muscles in the neck (sternocleidomastoid and upper trapezius muscles) actually respond to dizziness and become tighter. Tightness in these muscles can in turn cause dizziness. The sternocleidomastoid muscle connects to the mastoid bone behind the ear, when this muscle becomes tight an individual may experience a sensation of ear pressure or fullness. Manual therapy is directed at decreasing the tightness in these muscles and may help to alleviate symptoms associated with cervicogenic dizziness. Therapy may consist of the following: soft tissue massage, gentle mobilization, gentle stretching, and trigger point release.
Individuals with cervicogenic dizziness may experience rapid relief in their symptoms with the initiation of manual therapy, other individuals require several treatment sessions before results are noted. Some individuals may initially experience an increase in their symptoms; however, should not be alarmed as this is not uncommon.
Medical management may consist of muscle relaxers; however, muscle relaxers may results in a fatigue and drowsiness. More research is being done on the use of botulism toxin injected into the muscle to reduce muscle spasm.
Manual Therapy Intervention for Cervicogenic Dizziness
Different techniques and methods are utilized for intervention. A combination of manual therapy and therapeutic exercise is utilized to achieve the best results. Manual physical therapy should be performed by a skilled physical therapist specializing in treatment of cervical disorders and headaches. A few of the key interventions used may include the following:
Soft Tissue Mobilization : Increased muscle tone (tightness) or muscle spasm may contribute to cervicogenic headaches and dizziness. Click here to read more about cervicogenic headaches. When the muscles that attach to the base of the skull are tight, they may compress the neurovascular bundle resulting in a sensation of pressure of dizziness. Headaches may also occur. These headaches can start at the base of your skull and radiate toward your forehead in the shape of a banana. There are multiple soft tissue mobilization techniques utilized to decrease muscle tone and improve flexibility in these muscles. A few of these techniques include: cross fiber stretching, myofascial release, trigger point release, and contract relax techniques. Decreasing muscle tone and improving muscle flexibility may decrease the frequency and intensity of symptoms, and may resolve the condition.
Joint Mobilization : Decreased joint mobility or altered joint mechanics in the upper part of your neck may result in cervicogenic headaches and dizziness. Treatment for this is achieved through gentle joint mobilization techniques, strain counter strain techniques, and muscle energy techniques. Joint mobilizations are pain free techniques that improve the joint mechanics. This is not aggressive and is not manipulation. Joint mobility is also promoted throughout the lower cervical and thoracic spine, as restrictions in these areas may contribute to your cervical condition.
Muscle Strength & Stabilization : Proper joint mechanics in the cervical and thoracic spine depend on muscle strength and tension relationships. When neck muscles are too weak or too tight more stress is placed on the ligaments and joint capsules. Tightening or shortening of the neck muscles can result in increased compression of the spine which may cause pain in the neck and head and may result in wearing away of the joint surfaces.
Generalized Strength, Conditioning & Stretching Program : Exercise and physical conditioning programs are established in order to promote long-term prevention and control of neck conditions. Gentle stretching programs are included to promote flexibility and proper muscle length tension relationships. Strengthening exercises help to stabilize the cervical and thoracic spine; improving the mechanics of your neck and upper back (including your shoulders and shoulder blades). Conditioning programs help to decrease stress and tension in the neck and shoulder regions.
Posture & Body Mechanic Education : Education is provided on posture correction, proper ergonomics, and proper body mechanics in order to decrease repetitive stress and muscle strain throughout the spine. Performing activities with proper posture and body mechanics helps to prevent re-injury and recurrence of condition. Click here to read more about posture and body mechanics.
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- Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Ortho Sports Phys Ther. 2000 Dec;30(12):755-66.