Do you have neck pain or stiffness accompanying with dizziness (including lightheadedness, unsteadiness)? If you answer "YES" to this question, you might have a working hypothesis of cervicogenic dizziness (CGD). CGD is defined as "a non-specific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activity from the neck."
Dr. Jung and colleagues recently published manuscript about "Clinical Decision Making in the Management of Patients with Cervicogenic Dizziness: A Case Series" in the Journal of Orthopedic & Sports Physical Therapy (JOSPT), November 2017. He is one of clinical experts in this area to manage patients with dizziness and headache. Dr. Jung and colleagues suggested four-step clinical diagnostic decision making processes to determine the recognition of clinical presentations of CGD and recommended clinically useful test items. They also provided case examples of conservative physical therapy management to guide clinicians. The temporal relationship of neck pain (stiffness) and dizziness is considered as an important clue to guide clinicians or patients to recognize the possibility of CGD.
Dizziness is a prevalent complaint leading individuals to seek medical care. It is the primary reason for 7% of physician visits in individuals over the age of 45 and the leading reason to visit a physician for individuals over the age of 65. Additionally, the incidence of dizziness precipitating emergency department visits in the U.S.A. has increased 37% during a recent 10 year period. Despite advances in medical technology, achieving a relevant medical diagnosis for dizziness in emergency or primary care setting remains problematic, with only 49.2% of patients complaining of dizziness being given a confirmatory diagnosis. Because dizziness may result from dysfunction in the musculoskeletal, vestibular, cardiovascular, neurologic, and/or metabolic systems. After screening out systems of review (other causes of dizziness), dizziness may result from dysfunction within the neuromusculoskeletal structures of the cervical spine.
Clinical presentations associated with CGD may include neck stiffness, muscle tenderness in the cervical region, altered cervical joint positional sensation, poor neck stability, dizziness provoked by neck or head movements, and postural imbalance. The common clinical cases suggesting CGD include a patient group who present with whiplash associated disorders (auto collision related injuries to head and neck) or have a history of cervical dysfunctions including recurrent muscle spasms, spondylosis, or degenerative disc disease.
If you experience with dizziness and notice temporal relationship of neck pain/stiffness and dizziness behaviors, have past or present predisposing/contributing factors described above, you may want to consult us whether your familiar signs and symptoms of dizziness is consistent with CGD. Once we establish the recognition of CGD after review of systems and examination, we can help patients with conservative management consisting of manual therapy, sensorimotor training, adaptation/substitution, breathing/relaxation, and cognitive behavioral treatment for successful management of CGD. If you have any clinical inquiries, please give us a call at 443-979-7123 or email us at francisj@columbiaptinmotion.com.