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 for orthopaedic and vestibular rehabilitation specialists[1]Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy. 2000 Dec;30(12):755-66.
When diagnosed correctly, cervicogenic dizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation.
Cervicogenic dizziness may result from whiplash injury, other forms of cervical spine dysfunction, or spasms in the cervical muscles. It is defined as “a nonspecific sensation of altered orientation in space and dysequilibrium originating from abnormal afferent activity from the neck.”
Cervicogenic dizziness does not result from vestibular dysfunction and rarely results in true vertigo.
Diagnosis of Cervicogenic Dizziness
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[2]Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Archives of physiotherapy. 2017 Dec;7:1-2..
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.
Treatment possibilities
When diagnosed correctly, cervicogenic dizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation[3]Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropractic & manual therapies. 2011 … Continue reading.
Manual therapy techniques such as sustained natural apophyseal glides (SNAGs) and self-SNAG exercises have been shown to be effective in reducing symptoms of cervicogenic dizziness.
Vestibular rehabilitation is an exercise-based program designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and fall risk.
Do you have cervicogenic dizziness and feel overwhelmed by the amount of information available online? Go no further as we dissect a 2014 research study examining two manual therapy procedures for treating cervicogenic dizziness[4]Reid SA, Callister R, Katekar MG, Rivett DA. Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized … Continue reading.
This article will supply you with essential information on the strategies that have proven to be highly successful in both the short and long term for minimizing cervicogenic dizziness.
The Study: Manual Therapy for Cervicogenic Dizziness
Susan Reed, an expert researcher in cervicogenic dizziness, conducted a study in 2014 that looked at the long-term outcomes of two popular manual therapy approaches for cervicogenic dizziness. The study involved 86 participants who were divided into three groups.
One group received Mulligan SNAG (sustained natural apophyseal glide) techniques, the other received Maitland Jeff Maitland style manual therapy techniques, and the third group received a placebo technique. Each participant received between two and six physiotherapy sessions with a therapist who had postgraduate training in either Mulligan style manual therapy or Maitland style manual therapy.
SNAG – sustained natural apophyseal glide
It is a type of manual therapy intervention used in the treatment of cervicogenic dizziness. In this study, participants assigned to the SNAG group received SNAGs with self-SNAG exercises.
The Results: Effective Treatments for Cervicogenic Dizziness
The study measured the intensity and frequency of dizziness, the intensity of cervical spine pain, and balance. The Mulligan and Maitland groups showed significant improvements in all measures, even in the short run, whereas the placebo group only showed improvement at the 12-month follow-up.
The intensity of dizziness decreased by 43% for the Mulligan group and 53% for the Maitland group at the 12-month follow-up. The frequency of dizziness also improved significantly for both manual therapy groups, but not for the placebo group.
The magnitude of reductions in dizziness handicap inventory scores were 38% for the Mulligan group and 46% for the Maitland group. Both manual therapy groups showed significant improvements in the intensity of cervical spine pain and balance.
Effective Interventions for Cervicogenic Dizziness
The Mulligan group received Mulligan SNAG techniques, which involve the physiotherapist guiding the participant as they rotate to ensure their rotation is dizzy-free. Participants were also given home self-SNAGs to perform once a day for 12 months.
The Maitland group received manual therapy interventions from a therapist and were given range of motion exercises to perform at home once a day for 12 months. Both interventions were shown to be highly effective in decreasing cervicogenic dizziness.
Relevance
This study is important because it provides evidence for the effectiveness of manual therapy, specifically SNAG treatment, in improving cervical ROM in patients with chronic cervicogenic dizziness.
This information can be useful for medical practitioners when considering treatment options for their patients with this condition.
Other studies
Another study evaluated SNAgs for cervicogenic dizziness in 2008[5]Reid SA, Rivett DA, Katekar MG, Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual therapy. 2008 Aug 1;13(4):357-66..
Participants assigned to the SNAG group received SNAGs with self-SNAG exercises. The results showed that compared to pre-treatment, the SNAG group had less dizziness, lower scores on the Dizziness Handicap Inventory (DHI), decreased frequency of dizziness, and less cervical pain at post-treatment, 6- and 12-week follow-ups.
Balance with the neck in extension improved and extension range of motion increased in the SNAG group. No improvements in balance or range of motion were observed in the placebo group.
Conclusion
If you are suffering from cervicogenic dizziness, this study provides valuable information on effective manual therapy interventions. Look for a physiotherapist in your community who has postgraduate training in either Mulligan or Maitland style manual therapy.
You can also perform Mulligan SNAG techniques or range of motion exercises at home, as shown to be efficacious in the study. Don’t let cervicogenic dizziness hold you back any longer, seek effective treatments backed by research today.
Physiatrist, M.D. Pain Center of University of São Paulo
References
| ↑1 | Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy. 2000 Dec;30(12):755-66 |
|---|---|
| ↑2 | Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Archives of physiotherapy. 2017 Dec;7:1-2. |
| ↑3 | Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropractic & manual therapies. 2011 Dec;19(1):1-1. |
| ↑4 | Reid SA, Callister R, Katekar MG, Rivett DA. Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial. Archives of physical medicine and rehabilitation. 2014 Sep 1;95(9):1603-12. |
| ↑5 | Reid SA, Rivett DA, Katekar MG, Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual therapy. 2008 Aug 1;13(4):357-66. |