The following are paper abstracts and my own brief impression of the research underlying the manual therapy treatment of cervicogenic dizziness.

Aleksander Chaibia, and Peter J. Tuchinb. Chiropractic spinal manipulative treatment of cervicogenic dizziness using Gonstead method: a case study. J Chiropr Med. 2011 Sep; 10(3): 194–198.

Objective

The purpose of this case report is to present the response of a patient with chronic nonresponsive cervicogenic dizziness to chiropractic care.

Case report

A 29-year-old man had a 10-year history of progressive cervicogenic dizziness with symptoms including a sensation of excessive motion, imbalance, and spinning associated with neck pain and stiffness. After treatment, he reported a reduction in pain and dizziness and an improved quality of life following Gonstead method of chiropractic spinal manipulative therapy.

Conclusion

This case study suggests that a patient with nonresponsive cervicogenic dizziness might respond to chiropractic spinal manipulative therapy approach using Gonstead method.

Granted just a case report and solely SMT was provided, but a good read for a chronic, 10-year history of dizziness symptoms.  Quite a few treatments (17) over course of 2 months, and I wonder in this case if a habitual vestibular program would have given any additional benefit.

Hain, Timothy C. Current Opinion in Neurology. February 2015. Vol. 28 – Issue 1: p 69–73

Purpose of review: Herein we discuss the recent literature concerning cervicogenic vertigo including vertigo associated with rotational vertebral artery syndrome, as well as whiplash and degenerative disturbances of the cervical spine. We conclude with a summary of progress regarding diagnostic methods for cervicogenic vertigo.

Recent findings: Several additional single case studies of the exceedingly rare rotational vertebral artery syndrome have been added to the literature over the last year. Concerning whiplash and degenerative disturbances of the cervical spine, four reviews were published concerning using physical therapy as treatment, and two reviews reported successful surgical management. Publications regarding diagnostic methodology remain few and unconvincing, but the cervical torsion test appears the most promising.

Summary: Little progress has been made over the last year concerning cervicogenic vertigo. As neck disturbances combined with dizziness are commonly encountered in the clinic, the lack of a diagnostic test that establishes that a neck disturbance causes vertigo remains the critical problem that must be solved.

Dr. Hain is one of the leading physicians in the study of cervicogenic dizziness.  This review is exactly what it is…a review of cervicogenic causes of vertigo.  He does make a key point in regards to treatment—in that physical therapy is the preferred treatment for most kinds of cervicogenic vertigo

Reid SA1, Rivett DA, Katekar MG, Callister R.Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther. 2014 Apr;94(4):466-76. doi: 10.2522/ptj.20120483. Epub 2013 Dec 12.

OBJECTIVE: The purpose of this study was to compare the effectiveness of SNAGs and Maitland mobilizations for cervicogenic dizziness.

RESULTS: Both manual therapy groups had reduced dizziness intensity and frequency posttreatment and at 12 weeks compared with baseline. There was no change in the placebo group. Both manual therapy groups had less dizziness intensity posttreatment (SNAGs: mean difference=-20.7, 95% confidence interval [95% CI]=-33.6, -7.7; mobilizations: mean difference=-15.2, 95% CI=-27.9, -2.4) and at 12 weeks (SNAGs: mean difference=-18.4, 95% CI=-31.3, -5.4; mobilizations: mean difference=-14.4, 95% CI=-27.4, -1.5) compared with the placebo group. Compared with the placebo group, both the SNAG and Maitland mobilization groups had less frequency of dizziness at 12 weeks. There were no differences between the 2 manual therapy interventions for these dizziness measures. For DHI and pain, all 3 groups improved posttreatment and at 12 weeks. Both manual therapy groups reported a higher GPE compared with the placebo group. There were no treatment-related adverse effects lasting longer than 24 hours.

CONCLUSIONS: Both SNAGs and Maitland mobilizations provide comparable immediate and sustained (12 weeks) reductions in intensity and frequency of chronic cervicogenic dizziness.

This is the 2nd of 3 trials as of early 2016 by Reid and colleagues on the manual treatment for cervicogenic dizziness.  In this study, the researchers divided participants into 3 groups (Mulligan SNAGs & self-SNAGs, Maitland Mobilizations plus ROM, or placebo as laser treatment).  This differs from her 2008 study that consisted of same treatment (SNAGs and detuned laser), but without Maitland mobilizations.  An excellent RCT as the researchers looked at effectiveness of symptoms immediately and 3 months showing no difference in intensity and frequency of dizziness between the two manual therapy interventions.

Reid SA1, Rivett DA, Katekar MG, Callister R.. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Man Ther. 2008 Aug;13(4):357-66. Epub 2007 Oct 22.

Cervicogenic dizziness is dizziness described as imbalance occurring together with cervical pain or headache. This study aimed to determine the efficacy of sustained natural apophyseal glides (SNAGs) in the treatment of this condition. A double-blind randomised controlled clinical trial was undertaken. Thirty-four participants with cervicogenic dizziness were randomised to receive four to six treatments of SNAGs (n=17) or a placebo of detuned laser (n=17). Participants were assessed by a blinded assistant before treatment, after the final treatment and at 6- and 12-week follow-ups. The primary outcome measures were severity of dizziness, disability, frequency of dizziness, severity of cervical pain, and global perceived effect; balance and cervical range of motion were secondary measures. At post-treatment, 6- and 12-week follow-ups compared to pre-treatment, the SNAG group had less (P<0.05) dizziness, lower (P<0.05) scores on the Dizziness Handicap Inventory (DHI), decreased (P<0.05) frequency of dizziness, and less (P<0.05) cervical pain. The placebo group had significant (P<0.05) changes only at the 12-week follow-up in three outcome measures: severity of dizziness, DHI, and severity of cervical pain. Compared to the placebo group at post-treatment and 6-week follow-up, the SNAG group had less (P<0.05) dizziness, lower (P < or =0.05) scores on DHI, and less (P<0.05) cervical pain. Balance with the neck in extension improved (P < or =0.05) and extension range of motion increased (P<0.05) in the SNAG group. No improvements in balance or range of motion were observed in the placebo group. The SNAG treatment had an immediate clinically and statistically significant sustained effect in reducing dizziness, cervical pain and disability caused by cervical dysfunction.

This is one of the first RCTs (albeit detuned laser as a group) comparing manual therapy (SNAG) to a placebo group.   Definitely powerful differences between the two groups in severity of dizziness, disability associated with the condition and frequency of dizziness that was immediate and maintained over a 3 month period.   Of note, the participants only received 4-6 treatments over 4 weeks—definitely a winner in regards to cost effectiveness for a treatment!

Wrisley DM1, Sparto PJ, Whitney SL, Furman JM.. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther. 2000 Dec;30(12):755-66.

The diagnosis of cervicogenic dizziness is characterized by dizziness and dysequilibrium that is associated with neck pain in patients with cervical pathology. The diagnosis and treatment of an individual presenting with cervical spine dysfunction and associated dizziness complaints can be a challenging experience to orthopaedic and vestibular rehabilitation specialists. The purpose of this article is to review the incidence and prevalence, historical background, and proposed pathophysiology underlying cervicogenic dizziness. In addition, we have outlined the diagnostic criteria, evaluation, and treatment of dizziness attributed to disorders of the cervical spine. The diagnosis of cervicogenic dizziness is dependent upon correlating symptoms of imbalance and dizziness with neck pain and excluding other vestibular disorders based on history, examination, and vestibular function tests. When diagnosed correctly, cervicogenic dizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation. We present 2 cases, of patients diagnosed with cervicogenic dizziness, as an illustration of the clinical decision-making process in regard to this diagnosis.

A classic article dating back to 2000 by Diane Wrisley and her colleagues.  Definitely a must read for clinicians who want an overview of cervicogenic dizziness, diagnosis and implications for treatments.  There are nice tables in this paper to help in differential diagnosis and a Figure tree showing an example of clinical decision making to treat or refer for dizziness.

Cervicogenic vertigo is defined as a sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. As a consequence of their association with the vestibular nucleus, patients frequently experience a sensation of rotation or falling when they turn or flex and extend their head. Nystagmus may be present but no other neurological deficits are typically found. Restrictions in joint play are commonly palpated in the upper cervical spine motion segments, in particular C1-C3. Although spinal manipulation to the involved segments has provided relief, consideration of other etiological factors is essential. This paper discusses the etiology, diagnosis, and management of cervicogenic vertigo. Three cases illustrating the typical presentation and management are included.

This is a chiropractic case series on the treatment of cervicogenic dizziness utilizing mainly joint manipulation and soft tissue mobilization to the cervical and thoracic spine.  An ancient reference (1991) in today’s standards of a treatment paper (not concepts / histological studies , etc) but does add to repertoire of manual therapy’s effectiveness for this diagnosis.

Kondratek M et al. Use of Translatoric Mobilization in a Patient with Cervicogenic Dizziness and Motion Restriction: A Case Report. Journal of Manual & Manipulative Therapy Volume 14, Issue 3, 2006

Some physical therapists consider the report of dizziness at end-range cervical extension when coupled with side-bending and rotation to the same side (coupled lower cervical rotation in extension) to be a positive sign of vertebral artery compromise. However, degenerative changes and associated movement abnormalities in cervical motion segments may also produce dizziness. The use of mid-line translatoric joint mobilization in the presence of limited active cervical motion that is accompanied by dizziness during cervical extension, rotation, and coupled rotation in extension has not been addressed in the current literature. This case report describes the examination, evaluation, diagnosis, intervention, and outcomes for a 64-year-old woman who presented with limited cervical mobility and the complaint of dizziness during performance of these movements. Examination included a clinical differentiation process to determine the cause of the movement-related dizziness. Examination findings included increased translatoric joint play, tenderness, and reproduction of dizziness at the C4-C6 segments and decreased translatoric joint play at the C1-C4 and C7-T4 motion segments. Intervention included movement re-education and application of translatoric joint mobilization to the hypomobile segments. After 8 visits, there was complete resolution of dizziness during all active cervical movements and improved cervical mobility, as documented with the CROM. This case report demonstrates that clinical symptoms consistent with cervicogenic dizziness and limited cervical mobility may be treated safely and effectively using translatoric joint mobilization techniques. Confirmatory diagnostic ultrasound analysis of the vertebral artery revealed no compromise in flow velocity during the application of these translatoric mobilization techniques.

A very detailed case report comprising of almost 10 pages total!  I really enjoyed the background information, detailed subjective and objective findings.  I wonder if the treatment protocol needed to be so specific as described in intervention section to gain the outcomes necessary in this case, but nevertheless, shows the effectiveness of a translatoric technique over the course of 8 visits to relieve symptoms.

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