Cervicogenic Dizziness, Cervical Vertigo, Neck Pain, Dizziness, Cervical Spine

It is without a doubt that treating a multi-system symptom of dizziness is challenging!  Not only can dizziness be a vague phrase for similar descriptions such as vertigo, lightheadiness, unsteadiness or even drunkenness, it is hard to “capture” objectively.

Cervicogenic Dizziness, Cervical Vertigo, Neck Dizziness

Vestibular rehabilitation principles that have been present since mid-1940s is by far one of the best ways to rehabilitate dizziness from vestibular lesions.  Prior to these approaches, the treatment of dizziness was usually wait-and-see, medication and/or manual therapies (i.e. chiropractic, acupuncture, osteopath — as physio didn’t really have much manual therapy at this time).

In the last half-decade, the understanding of correlating manual therapy and vestibular principles has yielded to be superior in the treatment of double entities (also known as double origin).  We are now seeing a trend towards a third pillar of rehabilitation for some dizziness disorders, called proprioceptive cervical training.

To bring this to real-life circumstances, I take you to the recent retrospective review by Hammerle et al in 2019.   In short, the study aimed to assess the outcomes of 2 treatments for patients with dizziness after mild traumatic brain injury (mTBI) who demonstrate abnormal cervical spine proprioception — vestibular rehabilitation or cervical spine proprioceptive re-training (CSPR) — alongside their facility’s standard manual therapy approach.

Here are some of the major results:

“The logistic regression analysis indicated treatment as a significant predictor of dizziness improvement, indicating that those who received the CSPR treatment were approximately 30 times more likely to report improved dizziness relative to those who received usual care.”

Cervicogenic Dizziness, Cervical Vertigo

85% of the individuals in the CSPR group and only 18% in the usual care group had dizziness improvement

The authors go on to state:

These findings suggest that treatment directed toward cervical proprioception may be important for individuals with dizziness after mTBIwhere signs of altered CSP are demonstrated and no clear peripheral vestibular or consistent central signs are present.

Furthermore, here is the direct conclusion:

“The study results demonstrated that active-duty military patients after mTBI with dizziness, abnormal CSP tests, no active vestibular pathology, and no consistent central signs who had treatment directed toward CSP seem to improve in their dizziness symptoms more than the patients who had the usual care (consisting of VRT). “

If you are looking to find the most consistent blend of manual therapy, vestibular and sensorimotor training; we offer our systematic approach based off of evidence as you just read with the art of therapeutic planning and progression with not just your mTBI patients, but also neck pain and vestibular dysfunctions.


You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course.  

Pertinent to this blog post, the 1st day includes the “Optimal Sequence Algorithm”, a multi-faceted physiotherapist approach to the assessment of Cervicogenic Dizziness, which includes the appropriate ruling-out process and cervical examination of the articular and non-articular systems. Also pertinent to this blog post, the 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for more information.

Authors

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

Danielle N. Vaughan, PT, DPT, Vestibular Specialist  

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

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