Understanding Cervicogenic Dizziness: Causes, Symptoms, and Treatment.
Dizziness is a common complaint of those who have suffered a Concussion injury but it can stem from various underlying causes, one of which is cervicogenic dizziness. Cervicogenic dizziness is often overlooked but can significantly impact an individual's quality of life and drastically slow the concussion recovery time if it is not identified early in the recovery process. In this blog post, we'll delve into what cervicogenic dizziness is, its causes, symptoms, diagnosis, and available treatment options.
What is Cervicogenic Dizziness?
Cervicogenic dizziness is a type of dizziness that originates from the upper cervical spine. It occurs when dysfunction or injury in the neck joints, muscles, or nerves leads to disturbances in the vestibular system, which controls balance and spatial orientation. Unlike other types of dizziness, cervicogenic dizziness is not typically associated with inner ear problems or neurological conditions.
According to the theory proposed in the article "How to Diagnose Cervicogenic Dizziness" by Reiley et al. (2017), cervicogenic dizziness stems from dysfunction or irritation within the cervical spine, particularly involving the upper cervical joints and muscles. This dysfunction can disrupt the normal functioning of the vestibular system, responsible for maintaining balance and spatial orientation. Additionally, irritation of cervical proprioceptors, which provide sensory feedback about neck position and movement to the brain, may contribute to the sensation of dizziness. This multifactorial approach underscores the complex interplay between cervical spine pathology, disturbances in the vestibular system, and altered sensory input from cervical proprioceptors in the development of cervicogenic dizziness.
Causes of Cervicogenic Dizziness:
Several factors can contribute to cervicogenic dizziness, including:
Poor Posture: Prolonged periods of poor posture, such as slouching or forward head posture, can strain the neck muscles and joints, leading to cervicogenic dizziness.
Neck Injuries: Trauma or injury to the neck, such as whiplash from a car accident or a sports-related injury, can damage the cervical spine and trigger cervicogenic dizziness.
Degenerative Changes: Conditions like cervical spondylosis or degenerative disc disease can cause structural changes in the cervical spine, contributing to cervicogenic dizziness.
Symptoms of Cervicogenic Dizziness:
The symptoms of cervicogenic dizziness can vary from person to person but may include:
Dizziness or lightheadedness, often worsened by neck movements or certain head positions.
Neck pain or stiffness, particularly on one side of the neck.
Headaches, especially at the base of the skull or behind the eyes.
Imbalance or a sensation of unsteadiness, especially when turning the head or changing positions.
Diagnosis and Treatment:
Diagnosing cervicogenic dizziness can be challenging, as it often overlaps with other vestibular disorders. Healthcare providers may perform a thorough medical history, physical examination, and specialized tests, such as the cervical flexion-rotation test, to identify cervicogenic dizziness. Some other tests that show high test reliability to rule in or out cervicogenic dizziness are The Smooth Pursuit Neck Torsion Test, Cervical Torsion Test, and Head Neck Differentiation Test, which you will read about below.
“Before any cervical testing, all appropriate cervical and vascular screening should be completed. ”
The examiner is approximately 3 feet from the patient.
Complete 2 repetitions, moving 1.5 ft past midline for first the horizontal & then the vertical plane.
Neutral
45 degrees R & L trunk rotation but keep eyes forward-facing examiner.
What is a Positive Test?
Decreased quality or quantity of eye movement including the following:
Decreased amplitude
Catch up Saccades
Increased difficulty
Increased symptoms
Statistics: With Whiplash associated Disorder (WAD) Patients WITH Dizziness the Smooth Pursuit neck Torsion Test has a Specificity of 91% Sensitivity of 90%, and a P-Value of < 0.001. Now with WAD Patients WITHOUT Dizziness, it has a Sensitivity of only 56%. See references below.
Four stages are performed as part of the Cervical Torsion Test, Right, center, and Left, center with each stage maintained for 30 seconds.
Trunk Torsion
Head still & turn trunk 45-90 deg & hold for 30 sec with eyes closed.
Neck Rotation
The trunk still & turn the neck 45-90 deg & hold for 30 sec with eyes closed.
En Bloc Rotation
Turn head & trunk together 45-90 deg & hold for 30 sec with eyes closed.
What is a Positive Test?
o Reproduction of any of the following signs or symptoms indicates a positive test: Dizziness, visual disturbance, unusual eye movements when eyes opened, Speech disturbance, motion sickness, nausea, slurred speech, dysphagia, light-headedness, tinnitus, headache, or paresthesia.
o Statistics: The specificity of the Cervical Torsion Test was 98.64% specifically for the Trunk Torsion discipline. References are below.
There are three test disciplines performed which are listed below. Each discipline is completed for 30 seconds at the speed described below. Signs of a positive test are observed during the test.
Trunk Torsion
Head still & turn trunk 45 deg R & L to the metronome of 60 bpm for 30 sec. Eyes Closed
Neck Rotation
The trunk still & turn neck 45 deg R & L to a metronome of 90 bpm for 30 sec. Eyes Closed
En Bloc Rotation
Turn head & trunk together 45 deg to R & L to a metronome of 60 bpm for 30 sec. Eyes closed
What is a Positive Test?
Dizziness, visual disturbance, unusual eye movements when eyes opened, Speech disturbance, motion sickness, nausea, slurred speech, dysphagia, light-headedness, tinnitus, headache, or paresthesia.
Statistics: The specificity of the Head Neck Differentiation Test was 89.80% specifically for the Trunk Torsion discipline. References are below.
“The Combined specificity of performing both the Cervical Torsion and Head Neck Differentiation Tests is 100%.”
Treatment:
Treatment for cervicogenic dizziness typically focuses on addressing the underlying cervical spine dysfunction and relieving symptoms. Typically, upper cervical dysfunction specifically C0-C3 is commonly associated with cervicogenic dizziness. This may include:
Manual Therapy: Joint manipulation or mobilization as well as soft tissue mobilization/massage can be very helpful in alleviating mechanical dysfunction that is typically associated with cervicogenic dizziness. Typically, upper cervical dysfunction specifically C0-C3 is associated with cervicogenic dizziness. Manual Therapy is regularly performed by a Physical Therapist, as well as Athletic Trainers, Chiropractors, and Massage Therapists.
Therapeutic Exercise / Neuromuscular Re-education: Cervical and Thoracic self-mobilization, stretching, stability/strengthening exercises, and cervical proprioception exercises can help relieve symptoms associated with cervicogenic dizziness.
Modalities: Dry needling, acupuncture, heat therapy, cold therapy, or electrical stimulation techniques may alleviate pain and muscular dysfunction to promote healing.
Lifestyle Modifications: Practicing good posture, avoiding prolonged neck positions, and incorporating stress-reduction techniques can help manage cervicogenic dizziness symptoms.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be prescribed to alleviate neck pain and inflammation associated with cervicogenic dizziness.
Conclusion:
Cervicogenic dizziness is a complex condition that requires careful evaluation and management. By understanding its causes, symptoms, and available treatment options, individuals experiencing dizziness related to neck dysfunction can take proactive steps toward speeding their recovery and improving their quality of life. If you or someone you know is struggling with dizziness and neck pain, consulting a healthcare professional for proper assessment and guidance is essential.
References:
· Treleaven, J., Joloud, V., Nevo, Y., Radcliffe, C., & Ryder, M. (2020). Normative Responses to Clinical Tests for Cervicogenic Dizziness: Clinical Cervical Torsion Test and Head-Neck Differentiation Test. Physical Therapy, 100(1), 192–200. https://doi.org/10.1093/PTJ/PZZ143
· Reiley, A. S., Vickory, F. M., Funderburg, S. E., Cesario, R. A., & Clendaniel, R. A. (2017). How to diagnose cervicogenic dizziness. Archives of Physiotherapy, 7(1), 12. https://doi.org/10.1186/s40945-017-0040-x
· Treleaven, J., Jull, G., & LowChoy, N. (2005). Smooth pursuit neck torsion test in whiplash-associated disorders: Relationship to self-reports of neck pain and disability, dizziness, and anxiety. Journal of Rehabilitation Medicine, 37(4), 219–223. https://doi.org/10.1080/16501970410024299