Cervicogenic Dizziness, Cervical Vertigo,

Is muscle thickness different in persons with cervical vertigo?

Out of Iran and part of PhD work, Dr. Ronak Zagar, and colleagues in a 2020 study examined this just question.

The study examined muscle thickness of both the anterior and posterior cervical muscles using ultrasound between persons diagnosed with cervical vertigo and compared the results to healthy controls.  Figure 1 from the study is shown below:

Ronak Zargar Talebi et al. Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonographyJ Phys Ther Sci. 2020 Jul; 32(7): 439–443.

The cervical flexors (anterior muscles) studied were:

  1. Sternocleidomastoid
  2. Longus Colli
  3. Longus Capitis

The cervical extensors (posterior muscles) studied were:

  1. Rectus Capitis Posterior Major bil
  2. Obliquees Capitis Inferior bil

The main findings of the study were:

The thickness of extensor muscles was not significantly different between the patients with cervical vertigo and healthy participants.

The Longus Colli thickness was higher in the patients with cervical vertigo than healthy subjects.

How do the authors interpret this research?

The authors hypothesized that the higher thickness of Longus Colli may a compensatory mechanism in the patients with cervical vertigo.  

They go on to write,

Due to the small number of the literature in the field of RUSI, clinical interpretation of the findings is difficult and more studies are required to confirm results of our study, but so far, it can be suggested that the clinicians take into account the findings of this study in the evaluation of patients with cervical vertigo and incorporated the cervical stabilization exercises in the treatment planning for the cervical vertigo.

How do we interpret this research as clinicians?

It is inherently known in the rehabilitation profession that a mis-match exists between the deep and superficial deep cervical flexors and extensors in individuals with vertigo, dizziness, neck pain, whiplash, mTBI and concussion.  The mis-match can vary depending on the plethora of studies performed over the last 20 years, but generally speaking, there is a motor control disturbance placing too much of a demand on the superficial vs deep musculature.

The current study is quite interesting that prior to reading it, I would have hypothesized that the Sternocleidomastoid (SCM) would have higher thickness values.  Instead, the findings are the opposite, with the Longus Colli taking first place.

Overall, I utilize this one study as another puzzle piece for a multi-sensory condition.  This does not change my practice patterns.  I will not stop inhibiting the SCM and aim to activate the Longus Colli more effectively as this works and works well.

This research makes medicine and science interesting and progressive.  I am glad we now have the technology to perform these types of studies in rehabilitation and I look forward to future research by this group or other groups to continue to help others.


You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course.  Pertinent to this blog post, the first day provides the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” to assist in ruling out disorders and ruling in cervical spine, including determining if single or double entity exists.  

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 prices and discounts.

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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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