Cervicogenic Dizziness

Cervicogenic Dizziness

Article by John Miller

What is Cervicogenic Dizziness?

Dizziness may be caused by neck (cervical spine) dysfunction, which is known as cerviocogenic dizziness.

Dizziness is often associated with neck pain. However, it may be difficult to tell whether your dizziness and your neck pain are related or just coincidental. This is where an experienced physiotherapist with the skills to assess and treat both your neck pain and dysfunction plus any vestibular-origin dizziness is important.

The influence of your head position on equilibrium has been known since the mid-1800s. (1) However, a clinical syndrome relating neck pain and/or injury to dizziness and disequilibrium was not discussed until the 1950s.

Ryan and Cope (2) described a syndrome of disequilibrium and disorientation in patients with many different diagnoses of neck pathology including cervical spondylosis, cervical trauma, and cervical arthritis. They introduced the syndrome as cervical vertigo. However, since true “spinning vertigo” is rarely associated with this syndrome, cervicogenic dizziness is a more correct name for this syndrome.

What are the Symptoms of Cervicogenic Dizziness?

People with cervicogenic dizziness tend to complain of:

  • dizziness (a sensation of movement of the self or the environment) that is worse during head movements or after maintaining one head position for a long time.
  • dizziness usually occurs after the neck pain and may be accompanied by a headache.
  • dizziness symptoms usually last minutes to hours.
  • a general imbalance that may increase with head movements and with movement in the environment.

Although no formal studies have been completed, true cervicogenic dizziness is thought to be rare.

How is Cervicogenic Dizziness Diagnosed?

Cervicogenic dizziness can be a controversial diagnosis because there are no specific diagnostic tests to confirm that it is the cause of the dizziness. It is a diagnosis of exclusion. Once other causes of dizziness have been ruled out, cervicogenic dizziness is the diagnosis is assigned to people who have neck injury or pain as well as dizziness or an illusory sense of motion and disequilibrium. (3,4)

An evaluation for cervicogenic dizziness involves a thorough medical evaluation because the symptoms are similar to other causes of dizziness.

Vestibular Testing

Testing of the vestibular system in your inner ear is usually requested to ensure that the peripheral or central vestibular system is intact. Your vestibular physiotherapist or an ENT (Ear Nose & Throat specialist) can perform different clinical tests and manoeuvres to see if it causes nystagmus (eye movements) or dizziness. The results of the clinical tests need to be correlated with subjective symptoms and the clinical findings because the test can also be positive in healthy individuals. (5,6)

Dizziness Post-Whiplash or Head Injury

Cervicogenic dizziness often occurs as a result of whiplash or head injury and is often seen in conjunction with brain injury or injury to the inner ear. (4,7) It is often difficult to distinguish between cervicogenic dizziness and other medical problems.

Cervicogenic dizziness that occurs in conjunction with brain injury or another form of dizziness will be more difficult to diagnose and treat. It is important to be patient while health care professionals sort through the problems and treat them in the most logical order.

Cervicogenic Dizziness Treatment

The good news is that your cervicogenic dizziness will usually decrease when your neck pain decreases. The solution is therefore to alleviate your neck pain.

Neck Treatment

The majority of patients with cervicogenic dizziness improve with only treatment of the neck problem. Several studies have reported that approximately 75 per cent of patients improve with conservative treatment of the neck such as medication, gentle mobilisation, exercise, and instruction in proper posture and use of the neck. (8-10)

Your physiotherapist may assist you in the treatment of cervicogenic dizziness. Please seek their advice and care.

Vestibular Treatment

For other patients, improvement involves treatment of the neck problem in addition to vestibular therapy. Vestibular rehabilitation is directed at what problems are found on evaluation and may include eye exercises, balance exercises, walking, and graded exposure to environments that make you dizzy. (4) A vestibular physiotherapist is the best clinician for you to see if you require vestibular treatment for your dizziness.

Treatment Prognosis

Cervicogenic dizziness will usually resolve with treatment of the neck problem but may require vestibular rehabilitation for complete resolution of symptoms. In general, the prognosis for patients with cervicogenic dizziness is good, with 75 percent of patients having improvement of symptoms.

Your physiotherapist will be able to provide a guide following your assessment and how you respond to initial treatment. Please ask your physiotherapist for specific advice.

Article by I.Kelly, N.Stewart

BPPV Symptoms

The symptoms of BPPV can include:
  • Sudden episodes of violent vertigo.
  • Dizziness and/or nausea.
  • Movements of your head trigger vertigo.
  • Your vertigo may last half a minute or more.
  • Your eyes may drift and flick uncontrollably (nystagmus).

What Causes BPPV?

Inside your inner ear, there is a series of canals filled with fluid. These vestibular canals are at different angles. When your head is moved, the rolling of the fluid inside these vestibular canals tells the brain exactly how far, how fast and in what direction your head is moving. BPPV is caused by little ‘ear rocks’ or otoconia (calcium carbonate crystals) within the vestibular canals. Usually, these crystals are held in special reservoirs within other structures of the inner ear (saccule and utricle). It is thought that injury or degeneration of the utricle may allow the ‘ear rocks’ to dislodge and escape into the balance organ and interfere with your vestibular system.

What Causes Your ‘Ear Rocks’ to Dislodge?

Factors that may cause or allow ‘ear rocks’ to migrate into your vestibular canals include:
  • Head or ear injury.
  • Ear surgery or ear infection, such as otitis media.
  • Degeneration of the inner ear structures.
  • Vestibular neuritis (viral infection of the inner ear).
  • Meniere’s disease (a disorder of the inner ear).
  • Some types of minor strokes.
In around half of BPPV cases, the cause of your BPPV can’t be found. This is known as idiopathic BPPV.

How is BPPV Diagnosed?

Dizziness and vertigo are common to a wide range of medical conditions, so careful differential diagnosis is important. Your physiotherapist or doctor may use several tests to diagnose BPPV.

What is the Treatment for BPPV?

‘Ear Rock’ Relocation Techniques

After assessing, you and confirming BPPV, your BPPV trained physiotherapist will apply specific techniques to relocate the "ear rocks" to an area in the inner ear that doesn't stimulate your feelings of dizziness or vertigo.

How Successful is BPPV Treatment?

When BPPV techniques are performed correctly, reduction of your vertigo, dizziness and other symptoms of BPPV is immediate in 80% or more of cases. Quality BPPV practitioners have a 90%+ success rate within three applications of the techniques.

Other BPPV Treatment Options?

Due to BPPV being caused by the physical presence of ear rocks within your vestibular canal, only the relocation of these ear rocks will clear your symptoms. You may find some drugs can help you mask your BPPV symptoms by diminishing your sensitivity your vestibular symptoms. They work in a similar fashion to sea sickness medications. Please discuss this medicated option with your doctor.

BPPV Surgery

Occasionally conservative BPPV treatments fails. If the symptoms continue for more than 12 months, an operation may be needed. Generally, the nerve that services part of the balance organ (posterior semicircular canal) is cut. The risks of this type of operation include hearing loss. Your ENT (Ear Nose Throat) surgeon is the best person to discuss this option.

Who Performs BPPV Treatment?

Some vestibular physiotherapists and doctors are trained in the assessment and treatment of BPPV.  BPPV-trained physiotherapists undertake specific training to diagnose and successfully treat BPPV. PhysioWorks has several BPPV trained physiotherapists. Please call them to book your appointment with a BPPV physiotherapist.
Article by I.Kelly, N.Stewart

What is the PhysioWorks Difference?

Friendly & Caring Service

One thing that you'll notice about the PhysioWorks team is that they are very friendly and caring health professionals. We know that sometimes pain or injury can make you a little less tolerant, so we've trained our healthcare team always to greet and treat you like they would a family member or best friend.

Thorough & Unrushed

Everyone should be entitled to individualised professional care. That's why we book longer initial appointments to ensure that your unhurried first visit will include a thorough and individualised assessment of your injury or problem. This extra time, then allows us to discuss your short, medium and long-term goals and treatment options before commencing your rehabilitation.

You'll find that your PhysioWorks healthcare practitioner is not only a great listener, but also an excellent treatment planner to focus on your efficient and effective treatment outcome. After all, that's why you have chosen to see us in the first place.

What is the Aim of Your Initial Consultation?

Because we do spend more time than most physiotherapists thoroughly assessing, by the completion of your initial consultation, we should be able to determine and inform you:

  • What exactly is your problem
  • Why you are experiencing pain or dysfunction etc
  • What you can be doing to correct it
  • How long it will most likely take to recover
  • How to prevent a future recurrence

Your Tailored Treatment Plan

Your physiotherapist will design a specific treatment program specifically for you based upon your examination. Your treatment may include hands-on treatment, such as joint manipulation, mobilisation or massage. It will probably also include lots of helpful advice and home exercises. We'll also use other technology or treatment tools depending upon your needs.

Your treatment will vary depending upon your age, sex, sport, work requirements or lifestyle, so generic therapies tend to be effective than specifically targeted treatment plans.

As highly-trained exercise prescribers, your physiotherapist will usually instruct you on specific exercises and stretches for you to undertake at home to assist in your rapid recovery. We'll also offer you some helpful advice to help ease your pain, such as the appropriate resting positions or whether to use heat or ice and precisely for how long.

The result is prompt pain reduction, quicker natural healing and your successful return to full activity, whether it be work or sport, as soon as possible.

How Long is Your Physiotherapy Appointment?

Allow at least one hour for your initial physiotherapy session. Subsequent treatments are usually 30 to 60 minutes in duration. Your physiotherapist will inform you if additional or less time is required. Complex or multiple regions may require a longer consultation. Our receptionist will happily book an appropriate appointment for your clinical needs.

Do You Need a Referral to Consult a Physiotherapist?

A doctor's referral is not required to see a physiotherapist in private practice unless you are claiming a work injury (e.g. Workcover), or some other insurance claims. Department of Veterans Affairs patients will require a doctor referral. If you have been involved in a motor vehicle accident or you are planning for your treatment to be funded by an insurance company, it is good practice to consult your GP for a referral.

What About Private Health Insurance?

A proportion of treatment costs is rebatable under all higher table private health insurance schemes. The private health insurance rebates do vary considerably depending upon your specific coverage.

What is HICAPS?

PhysioWorks is linked to the HICAPS electronic health fund system so you can instantly claim your rebate at the time of treatment. You'll need to present your health insurance card to our receptionist.

Who is a Physiotherapist?

Your physiotherapist is a university-trained medical professional who uses a natural and physical approach to restore, maintain or optimise your physical and psychological well-being. This will enable  you to perform and enjoy your chosen sport, work or everyday activities. In simple terms, your physiotherapist is a health mechanic for the human body.

During a physiotherapist's university training, the study of the human body anatomy, physiology and movement biomechanics, particularly the muscle and joint system. This deep education understanding, helps your physiotherapist to not only diagnose health conditions but also to utilise hands-on techniques, educational advice and exercise prescription to resolve your problem.

Physiotherapy is a science-based methodology that is continually evolving as new research discovers better ways to treat your body. Your physiotherapist will use their extensive knowledge of the human body and highly-trained skills to help restore your aching, stiff and dysfunctional muscles and joints to health.

Physiotherapists at PhysioWorks are highly skilled in numerous niche areas of physiotherapy. These include sports and exercise physiotherapy, musculoskeletal physiotherapy, ergonomics  (workplace wellness), vestibular, jaw and headache dysfunction. Plus, women's health, to name a few.

Vertigo & Dizziness

Common Causes

Due to the complex diagnostic skills required to accurately diagnose the cause of your vertigo or dizziness, we highly recommend seeking the professional opinion of a healthcare practitioner with a special interest in, or expertise in the assessment and management of vestibular disorders.

Vertigo or Dizziness?

Vertigo or dizziness, are symptoms rather than a disease. Vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in your balance (vestibular) system. Vertigo may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo, and the perception of motion in surrounding objects is called objective vertigo. Vertigo usually occurs as a result of a disorder in the vestibular system (structures of the inner ear, the vestibular nerve, brainstem, and cerebellum). Your vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves. When your head moves, signals transmit to the labyrinth, which is an apparatus in the inner ear made up of three semi-circular canals surrounded by fluid. The labyrinth then transmits movement information to the vestibular nerve and the vestibular nerve carries the information to the brainstem and cerebellum (areas of the brain that control balance, posture, and motor coordination). The most common cause of dizziness is BPPV. Others include Inflammation in the inner ear, Meniere's disease, neck joint dysfunction, vestibular migraine and acoustic neuroma. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke or brain haemorrhage.

Private Health Insurance Rebates

PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for the majority of your treatment fees, leaving you with only a small gap payment.

However, Private Health Funds do vary their rebates payable depending upon the level of cover that you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly others haven't, with rebates similar to what they were a decade ago.

HICAPS - Instant Health Fund Claims


Most health funds are members of the HICAPS instant claims system.  Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. For more information, please visit Hicaps for the latest funds which can use their instant claiming system.

Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.

Third-Party Insurers

PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:

  • Workcover
  • InjuryNet
  • Australia Post; Coles Myer; Woolworths
  • Medicare
  • Department of Veterans' Affairs
  • CTP & Sports Insurers
Article by I.Kelly, N.Stewart

References

  1. Brown JJ. Cervical contributions to balance: cervical vertigo. In: Berthoz A, Vidal PP, Graf W, editors. The Head Neck Sensory Motor System. Oxford University Press. 1992:644–647.
  2. Ryan MS, Cope S. Cervical vertigo. Lancet 1955; 2:1355–1358.
  3. Furman JM, Cass SP. Balance Disorders: A Case-Study Approach. Philadelphia: F.A. Davis, 1996.
  4. Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther 2000; 30:755–766.
  5. Norre ME. Cervical vertigo. Diagnostic and semiological problem with special emphasis upon “cervical nystagmus”. Acta Otorhinolaryngol Belg 1987;41:436–452.
  6. van de Calseyde P, Ampe W, Depondt M. ENG and the cervical syndrome. Adv Otorhinolaryngol 1977;22:119–124.
  7. Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain 1994;58:283–307.
  8. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–58.
  9. Karlberg M, Magnusson M, Malmstrom EM, Melander A, Moritz U. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Arch Phys Med Rehabil 1996;77:874–882.
  10. Wing LW, Hargrave-Wilson W. Cervical vertigo. Aust N Z J Surg 1974;44:275–277.
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