By Nikki Bach SPT and Jessica Ford (Dietz) PT, DPT, NCS
Have you ever experienced dizziness that seems to be related to your neck? If so, you may be suffering from a condition known as “cervicogenic dizziness”. This blog will discuss the definition of cervicogenic dizziness, associated symptoms, how physical therapy can help, and expectations for recovery.
What is Cervicogenic Dizziness?
Dizziness is very complex and cervicogenic dizziness is just one type and/or reason to cause dizziness. Often patients characterize their dizziness as a feeling of imbalance, unsteadiness, or disorientation that occurs with neck symptoms. It is closely related to changes in the position of the neck or movement of the joints in the neck. Cervicogenic dizziness often, but not always, occurs as a result of trauma as one study showed a relation up to 75% of whiplash injuries. Cervicogenic dizziness can also be paired with other symptoms such as neck stiffness (loss of range of motion), neck pain, and/or tension headache.
The scientific reasoning behind cervicogenic dizziness is very interesting so it is worth discussing it a little bit! Currently the exact cause is still debated, but it is hypothesized that neck symptoms like pain or stiffness can cause dizziness due to incorrect sensory information being relayed from the neck to the brain about the head’s position in space. In order for the brain to process your balance and head position, it requires accurate information from different systems: visual (eyes), vestibular (inner ear), somatosensory (touch), and proprioception (mechanoreceptors, such as in the neck). The sensory mismatch theory states that with neck symptoms like pain or stiffness, the signals from the neck contradicts the other systems regarding the head’s position in space. This mismatch of information results in a feeling of imbalance, unsteadiness, and disorientation – i.e. dizziness.
Signs That Tour Dizziness Could be Cervicogenic Dizziness:
If you experience the following, you may be affected by cervicogenic dizziness:
- Dizziness that seems to correlate with neck symptoms
- Dizziness that began after or with neck trauma, such as whiplash injury
- Dizziness that is worse with head movements
- Dizziness after maintaining one head position for an extended time
- Dizziness symptoms lasting minutes to hours
- Dizziness associated with a tension headache
Cervicogenic dizziness is a less likely diagnosis if you experience any of the following symptoms:
- Tinnitus (ringing in the ears)
- Hearing loss
- A feeling of “fullness” in the ear
- Vertigo (true spinning sensation)
- Falling or balance difficulties due to dizziness
*** These types of dizziness are caused by other conditions and require further evaluation and assessment from PT or MD ***
How Can Physical Therapy Help?
Due to the close association between dizziness and neck symptoms with cervicogenic dizziness, many of the symptoms will improve with direct treatment to the neck. Your physical therapist can examine your cervical spine range of motion, joint mobility, and muscle balance to determine the particular cause of your cervicogenic dizziness. It is important to note that cervicogenic dizziness is not just related to neck pain/stiffness as cervical joint proprioception, cervical reflexes, as well as maladaptive balance sensory integration are also common deficits.
In general, your physical therapist will work with you to manage your symptoms and improve your quality of life. Your plan of care will most likely have a mix of standard cervical treatment as well as individualized, specific vestibular rehabilitation. Treating beyond just the neck pain and stiffness will even further reduce your dizziness to help you return to your favorite hobbies, work, and recreational activities so you can get back to doing what you love!
Expectations for recovery
The good news is that most cases of cervicogenic dizziness are significantly reduced with proper conservative treatment. One small-sample study found that 77% of their cervicogenic dizziness patient cases were resolved with physical therapy within 6 months, with 64% of these cases experiencing reduced or no dizziness after two years. You should realize that every patient is unique in their recovery so timelines may vary but usually improvements are seen within the first month!
If you believe you may be experiencing cervicogenic dizziness, you would benefit from making an appointment with a vestibular specialized physical therapist for an evaluation. While physical therapists are generally trained in treating the neck/spine, those who specialize in vestibular dysfunction are specially trained to treat, monitor, and appropriately progress every part of this condition.
References
Reiley, A.S., Vickory, F.M., Funderburg, S.E. et al. How to diagnose cervicogenic dizziness. Arch Physiother 7, 12 (2017).
Treleaven, J., LowChoy, N., Darnell, R., Panizza, B., Brown-Rothwell, D., & Jull, G. (2008). Comparison of sensorimotor disturbance between subjects with persistent whiplash-associated disorder and subjects with vestibular pathology associated with acoustic neuroma. Archives of Physical Medicine and Rehabilitation, 89(3), 522-530.
Brandt, T., & Bronstein, A. M. (2001). NOSOLOGICAL ENTITIES?: Cervical vertigo. Journal of neurology, neurosurgery and psychiatry, 71(1), 8‐12.
Eva-Maj Malmström, Mikael Karlberg, Agneta Melander, Måns Magnusson & Ulrich Moritz (2007) Cervicogenic dizziness – musculoskeletal findings before and after treatment and long-term outcome, Disability and Rehabilitation, 29:15, 1193-1205
