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Cervicogenic Dizziness

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, a sensation that they are swaying, or sometimes being pulled to the side. Some individuals may experience a sensation of vertigo; however, patients with cervicogenic dizziness typically feel as though they are spinning in the room versus true vertigo in which they see the room spin around them.

Symptoms may last for minutes to hours with 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 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.

Cause

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.

Clinical findings

- 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. - 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. Neck stiffness, tenderness and guarding may be experienced. Muscle tightness is typically noted in the sternocleidomastoid, levator scapula, and upper trapezius muscles. Walking with a wide base of support or uncoordinated gait pattern. Difficulty Maintaining an upright posture, may experience increased swaying when standing or with eyes closed in the shower. -Difficulty maintaining an upright posture or maintaining the neck in a neutral position.

Pathophysiology

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.

Diagnostic tests

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.

Treatment

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. Find a therapist in your area.

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