Cervical Dizziness Diagnosis & Management with Physical Therapy

Subclinical neck pain --- don't forget about this category!

This could be a missing link in giving someone assistance who could have a neck dysfunction leading to alteratings in head on neck orientation that may cause them lightheadiness, dizziness and unsteadiness.

What do you think?!

Citation:
Daligadu J., Haavik H., Yielder P.C., Baarbé J., Murphy B. Alterations in Cortical and Cerebellar Motor Processing in Subclinical Neck Pain Patients Following Spinal Manipulation. J. Manip. Physiol. Ther. 2013;36:527–537.

Lee H.-Y., Wang J.-D., Yao G., Wang S.-F., Yao K.-P.G. Association between cervicocephalic kinesthetic sensibility and frequency of subclinical neck pain. Man. Ther. 2008;13:419–425.

Lee H., Nicholson L.L., Adams R.D. Cervical Range of Motion Associations With Subclinical Neck Pain. Spine. 2004;29:33–40.

Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population.
Pain co-exists with dizziness and is associated with dizziness severity.
The findings of both of these symptoms correlating indicate that pain should be systematically assessed and treated in patients with persisting dizziness.
We do this entire approach in our Cervicogenic Dizziness method!

Citation:
Moen U, Knapstad MK, Wilhelmsen KT, Goplen FK, Nordahl SHG, Berge JE, Natvig B, Meldrum D, Magnussen LH. Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study. BMC Musculoskelet Disord. 2023 Mar 8;24(1):173. doi: 10.1186/s12891-023-06279-z. PMID: 36882720; PMCID: PMC9992911.

Information on forward head posture!

Ask a Physical Therapist about Cervicogenic Dizziness and I guarantee two phrases come out: Joint Position Error (JPE) and SNAGs.

Wow, there is so much more.

Come on guys --- those are things patients are searching on YouTube now. We can do better. We teach you how to actually get results.

In the clinic, I use "noise" as a descriptor for pain to help patients understand the impact of constant signals' influence on the nervous system.

Here is a simple way of looking at it in regards to Cervicogenic Dizziness!

If you're a vestibular therapist, you need to learn how to treat the neck!

Trust us, your patients are already doing upper trap, levator scapulae and anterior scalene stretches before they get to you. If you're prescribing these, you're not doing the best service to help them recover.

Learn more with our neck approach specifically for dizziness and vertigo patients!

https://fithip.podia.com/cervicogenic-dizziness-solution

Cool study on figuring out what the re**us capitis posterior muscles do! Yes, they are active in extension but also flexion!

Therefore, found to be more of a stabilizer of the OA joint!

Great place to treat for your neck pain and dizzy patients!

Citation:
Hallgren, Richard C. and Rowan, Jacob J.. "Implied Evidence of the Functional Role of the Re**us Capitis Posterior Muscles" Journal of Osteopathic Medicine, vol. 120, no. 6, 2020, pp. 395-403. https://doi.org/10.7556/jaoa.2020.061

2 points that will change how you forever view Cervicogenic Dizziness

2 points that will change how you forever view Cervicogenic Dizziness -

2 points that will change how you forever view Cervicogenic Dizziness Remember the 1996 flick Jerry Maguire and the famous saying, "show me the money!"? Well, back when I had tons of doctoral interns, we would have a saying, "show me the evidence!". I thought it was the cooler way of being an evidence-based police officer.  Not sure if they saw it the same way :) Nev...

We have lots of articles and papers showing pathways and approaches to differentiate cervicogenic dizziness from other causes.

This is a 2023 model by Alvarez et al. He is actually a PT and a DO --- cool combo!

If you want the whole package, we have put it together for you with our diagnostic and treatment process. All in one place...books and course :)

Learn more here:
https://fithip.podia.com/cervicogenic-dizziness-solution

Citation:
Alvarez, Gerard, Lucas, Sergi and Roura, Sònia. "Osteopathic manipulative techniques in the treatment of vestibular dizziness not related to the cervical spine" Journal of Osteopathic Medicine, 2023. https://doi.org/10.1515/jom-2022-0224

What is the magic number of trials to accurately assess joint position error testing?

Read the post for research conclusions and our conclusions!

Go on and help those with cervicogenic dizziness!

Great information for clinicians to know here...

We have an entire section in our book too showing in several different resources what levels are involved in cervical vertigo and dizziness. Hint: it is NOT just the C1-2!

Citation:
Zheng HL, Li B, Song SK, Chen PB, Jiang LS, Jiang SD. Anterior cervical discectomy and fusion to treat cervical instability with vertigo and dizziness: A single center, retrospective, observational study. Front Surg. 2023 Jan 6;9:1047504. doi: 10.3389/fsurg.2022.1047504. PMID: 36684132; PMCID: PMC9852603.

The OCI typically does not have significant change in length of the tissue with forward head posture.

But, this doesn't mean rotation isn't affected!

Ask a Physical Therapist about Cervicogenic Dizziness and I guarantee two phrases come out: Joint Position Error (JPE) and SNAGs.

Wow, there is so much more.

Come on guys --- those are things patients are searching on YouTube now. We can do better. We teach you how to actually get results.

Wow, incredible!

AI is here and crazy powerful.

For you vestibular therapists, the simple saccades and smooth pursuits and even canalith repositioning procedures will be delegated to AI, apps, and online programs in the future.

So will exercise, especially if you're just doing stretches and SNAGs.

But what will never be replaced -- your knowledge, skills and competency to work on someone's neck, especially if they are having dizziness.

I hope if you want to learn the best out there, we can be that answer for you. Check out more of our information:

https://fithip.podia.com/cervicogenic-dizziness-solution

A simple screen to do in your clinic!
- The 10-step tandem gait test.

The authors conclude from this study that 10-step tandem gait test is an objective and useful screening test for evaluating gait disturbance in patients with degenerative cervical myelopathy.

Screening for cervical myelopathy is a must prior to performing manual and exercise therapy to the cervical spine -- with patients with or without dizziness!

Call me old school, but I still like the reflex testing for this population but adding this screen can be helpful!

What do you think?

Citation:
Yoo D, Kang KC, Lee JH, Lee KY, Hwang IU. Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy. Sci Rep. 2021 Aug 26;11(1):17212. doi: 10.1038/s41598-021-96725-6. PMID: 34446786; PMCID: PMC8390502.

Fear of movement is real and can delay or hinder progress with your recovery of neck pain and dizziness.

Here is a scale to help you figure this out or show your clinician to create strategies for you!

Link for scale:
http://www.tac.vic.gov.au/__data/assets/pdf_file/0004/27454/tampa_scale_kinesiophobia.pdf

Will we see more of these as more and more people are using self strategies to help headaches, dizziness and neck pain?

Citation:
Shariff E, Al Ghannam ZT, AlDamigh FA, AlGhamdi AG, AlEisawi YM, Aloqalaa KF, Sallout BZ. Home Self-Massage Device Necessitates Public Awareness: Vertebral Artery Dissection Associated With a Home Massage Device. Cureus. 2023 Jan 5;15(1):e33394. doi: 10.7759/cureus.33394. PMID: 36618494; PMCID: PMC9815484.

Training the neck in rehab setting the way you use it day to day can be key to progress!

It can not only be more functional, but you can "teach" the neck that it can be okay to have an additional load on the neck with movements, such as looking up.

Kudos to our military and rescue personnel!

Citation:
Rafique D, Heggli U, Bron D, Colameo D, Schweinhardt P, Swanenburg J. Effects of increasing axial load on cervical motor control. Sci Rep. 2021 Sep 20;11(1):18627. doi: 10.1038/s41598-021-97786-3. PMID: 34545145; PMCID: PMC8452641.

Consume content to produce content

Consume content to produce content -

Consume content to produce content Consume content to produce content.   I got caught up in YouTube shorts the other night.  Who knew that was a thing --- YouTube has short videos that are vertical and up to 60 seconds -- same as Tik Tok and IG Reels. I normally do not do this but I always find cool stuff and the videos are endle...

This deep brain and neurology stuff is best told by raccoons!

Ask a Physical Therapist about Cervicogenic Dizziness and I guarantee two phrases come out: Joint Position Error (JPE) and SNAGs.

Wow, there is so much more.

Come on guys --- those are things patients are searching on YouTube now. We can do better. We teach you how to actually get results.

Can exercise help cervical radiculopathy?

Sure it can!

And two types of exercise has been shown to be better than 1.

More is always better, right?!

If exercise can help radiculopathy from the neck, it can certainly help dizziness from the neck! The neural irritation is just a different segment and instead of going into the arm, you get it into the head!

Citation:
Rafiq S, Zafar H, Gillani SA, Waqas MS, Liaqat S, Zia A, Rafiq Y. Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial. Biomed Res Int. 2022 Oct 5;2022:9385459. doi: 10.1155/2022/9385459. PMID: 36246968; PMCID: PMC9556173.

Less than 100 patients in an 8 yr span had ACDF for dizziness but still shows a link between the neck and dizzy/vertigo symptoms.

Here is the study on how it helped these patients.

Citation:
Zheng HL, Li B, Song SK, Chen PB, Jiang LS, Jiang SD. Anterior cervical discectomy and fusion to treat cervical instability with vertigo and dizziness: A single center, retrospective, observational study. Front Surg. 2023 Jan 6;9:1047504. doi: 10.3389/fsurg.2022.1047504. PMID: 36684132; PMCID: PMC9852603.

Smooth flights = happy nervous system!

Another way to think of how abnormal signals from the neck influence the neuronal activity throughout the central nervous system.

Even though we may know more and more about the nervous system, we can't just talk about decreasing pain --- we need to do something about it!

The best way is for direct treatment of the cervical spine.

Don't be lazy! Actually test --- true for BPPV and neck disorders!

Citation:
Harrell R, Manetta C, Guthrie M, Enam N. The Prevalence of Symptom Reporting for Benign Paroxysmal Positional Vertigo in a Traumatic Brain Injury Population. Otol Neurotol. 2023 Feb 1;44(2):172-176. doi: 10.1097/MAO.0000000000003770. Epub 2022 Nov 29. PMID: 36624599.

Bow hunter syndrome in rheumatoid arthritis.

RA-associated cervical spine disease may rarely present as symptoms of vascular insufficiency. Clinicians should consider the possibility, though rare, of cervical spine involvement in patients with RA experiencing symptoms consistent with vertebral basilar insufficiency.

Citation:
Curry BP, Ravindra VM, Boulter JH, Neal CJ, Ikeda DS. Bow hunter syndrome in rheumatoid arthritis: illustrative case. J Neurosurg Case Lessons. 2021 Jul 19;2(3):CASE21298. doi: 10.3171/CASE21298. PMID: 35854915; PMCID: PMC9265219.

You should have access to our hard work over the years.

It is for you to enjoy.

Use this link and code to access for FREE download:
https://www.physiofitnc.com/ebook/cervicogenic-dizziness-literature-review/

If you want to know how to use this knowledge, check out our books and online course.
https://fithip.podia.com/cervicogenic-dizziness-solution

Muscles, muscles, muscles!

Don't forget them in the rehabilitation of neck pain and dizziness.

BUT, we want to make sure your patients feel the exercises where they should as this could mean the difference between failure and success!

If you treat dizzy patients and want to know how to treat the neck for this population --- we got you!

Our approach is specifically designed for the dizzy/vertigo subpopulation!

We like to think there should not be a border between getting quality fascial/manual and vestibular care for our patients :)

Learn more:
https://fithip.podia.com/cervicogenic-dizziness-solution

Ask a Physical Therapist about Cervicogenic Dizziness and I guarantee two phrases come out: Joint Position Error (JPE) and SNAGs.

Wow, there is so much more.

Come on guys --- those are things patients are searching on YouTube now. We can do better. We teach you how to actually get results.

3 factors that contribute to more non serious adverse events following manual therapy to the neck:
1. Smoking
2. Comorbidities
3. Female gender

And this study found more adverse events following MOBILIZATIONS vs MANIPULATIONS.

I tend to agree with the above -- depends on the patient and skill set of the clinician.

Rock on!

Citation:
Peters R R, Schmitt M, Mutsaers B, Buyl R, Verhagen A, Pool-Goudzwaard A, Koes B. Identifying patient characteristics associated with the occurrence of post treatment non-serious adverse events after cervical spine manual therapy treatment in patients with neck pain. Arch Phys Med Rehabil. 2022 Aug 26:S0003-9993(22)00597-4. doi: 10.1016/j.apmr.2022.08.007. Epub ahead of print. PMID: 36037878.

The future of getting rid of in-person insurance covered canalith repositioning is going to be gone one day.

I am not making this up --- it is happening with orthopedics (rehab after total knees and total hips are happening in trials with tablets).

Learn a great skill to help others that is tough to help themself --- the neck. And doing it well will really help you.

Citation:
Kim HJ, Kim JS, Choi KD, Choi SY, Lee SH, Jung I, Park JH. Effect of Self-treatment of Recurrent Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial. JAMA Neurol. 2023 Jan 17. doi: 10.1001/jamaneurol.2022.4944. Epub ahead of print. PMID: 36648931.

Eyes closed for JPE! No peeking :)

Do you ever refer your patients out for acupuncture?

Or, do you get help with acupuncture for your vertigo and dizziness?

Here is a post on a paper out (in Chinese though) of one professor's approach to helping vertigo.

Interesting and shows you more gut to brain connection!

Make some local contacts for referring out and working alongside acupuncturists!

Remember, this treatment was highly sought out prior to the advent of physio work not even 70 years ago!

Citation:
Wang SL, Fu LX, Wang HY, Wu JS, Wang Y, Jiao ZP. [FU Li-xin's experience in treatment of vertigo with "regulating the middle jiao, opening gate and relaxing tendon" method of acupuncture]. Zhongguo Zhen Jiu. 2022 Sep 12;42(9):1049-52. Chinese. doi: 10.13703/j.0255-2930.20211008-k0004. PMID: 36075604.

Is joint position error greater in persons with neck pain?

The answer has been and always will be ....YES!

See post for our thoughts on this :)

Ask a Physical Therapist about Cervicogenic Dizziness and I guarantee two phrases come out: Joint Position Error (JPE) and SNAGs.

Wow, there is so much more.

Come on guys --- those are things patients are searching on YouTube now. We can do better. We teach you how to actually get results.

Here is a 6 week program for neck pain utilizing the NeckX device (R).

If exercise can help medical students, then it can help you!

Of note, these students had pain but not known pathology.

A 10 min a day program could certainly help with neck pain. You just need to find your cocktail to maximize benefit and minimize time --- talk to your physio about coming up with a daily program for you!

Citation:
Anderson BG, Benzinger B, Chickness J, Hietanen C, Hill K, Lucas JP, Tuck J, Ghassibi M. Effects of Cervical Spine Exercise Protocol on Neck Pain, Pericervical Muscle Endurance, and Range of Motion in Medical Students: A Prospective Study. Cureus. 2022 Jul 22;14(7):e27160. doi: 10.7759/cureus.27160. PMID: 36017270; PMCID: PMC9393318.

What a treat for you if you want to learn about Cervicogenic Dizziness!

We have our 2 published books and our online course available to help you help others.

Copy and paste the URL below to get started!
https://fithip.podia.com/cervicogenic-dizziness-solution

Harrison & Danielle Vaughan

Do you treat the skull?

Do you treat the skull? -

Do you treat the skull? Treating the skull / cranium can be nonsense --- it can be "out there" --- it can be eastern medicine -- its just massage.  This thought process inundates the evidence-informed mindset of a clinician nowadays.  Palpation stinks, manual therapy is short term and we are all fitness forward. I can't ...

New Systematic Review on Cervicogenic Dizziness

New Systematic Review on Cervicogenic Dizziness -

New Systematic Review on Cervicogenic Dizziness