Cervicogenic Dizziness
Our balance is controlled by three primary body systems: vision, vestibular (inner ear), and somatosensory. Somatosensation is the ability to perceive our environment and bodily awareness through touch, taste, pain, pressure, temperature, sound, stretch, vibration, and joint and muscle position sense. The information that our muscles and joints perceive regarding where we are in space and what position we are in is called proprioception. The most obvious way that proprioception contributes to our balance is through our feet. If we feel a bump on the ground with our feet, we know to make a correction with our balance. However, every joint in our body provides information to help us balance, including the spine. Problems arise when there is conflicting information between the different systems. This conflict can result in dizziness, disequilibrium, and sometimes nausea. For example, if we are on a boat below deck level in which we feel movement but don’t see movement, our visual system seems stable, but our vestibular and proprioceptive systems sense the movement of the boat. This mismatch can result in motion sickness. When the conflicting system is the proprioceptive system of the neck, we call this cervicogenic dizziness (CGD). This may be caused by whiplash, neck pain, postural changes, concussion, degenerative changes to the cervical spine or any other neck disorder. According to research performed by Chester et al (1991), 88% of subjects with persistent neck pain following a whiplash injury also had abnormal balance when sensory organization testing, such as computerized dynamic posturography (CDP) was performed.
Symptoms of CGD may vary. Often, patients describe a sense of dizziness and/or lightheadedness, headaches localized at the base of the skull, neck pain or stiffness, and postural imbalance. Dizziness may persist seconds, minutes, hours or days. This dizziness is often associated with an abnormal position of the neck or head. For example, a woodworker may spend significant time with his head flexed forward to do detailed work and subsequently noticing associated symptoms.
There is no specific, single diagnostic test for CGD, rather it is diagnosed based on a cluster of tests to rule out other possibilities and to understand more about each patient’s symptoms. A hands-on assessment of the neck is imperative, assessing for musculoskeletal impairments, pain, and posture to name a few. Specialized equipment and diagnostic testing, such as Videonystagmography (VNG) inclusive of traditional and non-traditional tests, such as neck torsion testing, Computerized Dynamic Posturography (CDP) and Video Head Impulse Testing (vHIT, also known as vHIMP), may be necessary to diagnose CGD. Often CGD occurs concurrently with other vestibular or balance disorders.
Treatment for cervicogenic dizziness may include increasing range of motion, flexibility or strength of the neck, retraining posture, and improving head-neck awareness, also called cervical proprioception. According to research performed by Beinert and Taube (2013), balance training can effectively improve neck muscle function and decrease neck pain intensity. Additionally, research by Karlberg (1995) revealed that physical therapy aimed at reducing neck discomfort improved postural control, even when there was no posture or balance training included in the rehabilitation plan. These findings suggest that those with neck pain should have their balance assessed and treated, and those with balance problems would benefit from having their neck assessed!
It is important to find a provider with the correct diagnostic and treatment skills to receive proper help for cervicogenic dizziness. Many physical therapists are comfortable treating the neck, and some may even be able to treat the vestibular system. Cervicogenic dizziness is both orthopedic and neurological, and an understanding of both systems is necessary. Working with a skilled physical therapist as well as performing a consist home exercise program, dizziness due to neck problems can be completely resolved.
Beinert K, et al. The effect of balance training on cervical sensorimotor function and neck pain. J Mot Behav. 2013;45(3):271-278.
Chester J. Whiplash, postural control and the inner ear. Spine. 1991;6(7):716-720.
Karlberg M, et al. Impaired postural control in patients with cervico-brachial pain. Acta Oto Laryngologica. Supplement. 1998;2(440):440-442.
Symptoms of CGD may vary. Often, patients describe a sense of dizziness and/or lightheadedness, headaches localized at the base of the skull, neck pain or stiffness, and postural imbalance. Dizziness may persist seconds, minutes, hours or days. This dizziness is often associated with an abnormal position of the neck or head. For example, a woodworker may spend significant time with his head flexed forward to do detailed work and subsequently noticing associated symptoms.
There is no specific, single diagnostic test for CGD, rather it is diagnosed based on a cluster of tests to rule out other possibilities and to understand more about each patient’s symptoms. A hands-on assessment of the neck is imperative, assessing for musculoskeletal impairments, pain, and posture to name a few. Specialized equipment and diagnostic testing, such as Videonystagmography (VNG) inclusive of traditional and non-traditional tests, such as neck torsion testing, Computerized Dynamic Posturography (CDP) and Video Head Impulse Testing (vHIT, also known as vHIMP), may be necessary to diagnose CGD. Often CGD occurs concurrently with other vestibular or balance disorders.
Treatment for cervicogenic dizziness may include increasing range of motion, flexibility or strength of the neck, retraining posture, and improving head-neck awareness, also called cervical proprioception. According to research performed by Beinert and Taube (2013), balance training can effectively improve neck muscle function and decrease neck pain intensity. Additionally, research by Karlberg (1995) revealed that physical therapy aimed at reducing neck discomfort improved postural control, even when there was no posture or balance training included in the rehabilitation plan. These findings suggest that those with neck pain should have their balance assessed and treated, and those with balance problems would benefit from having their neck assessed!
It is important to find a provider with the correct diagnostic and treatment skills to receive proper help for cervicogenic dizziness. Many physical therapists are comfortable treating the neck, and some may even be able to treat the vestibular system. Cervicogenic dizziness is both orthopedic and neurological, and an understanding of both systems is necessary. Working with a skilled physical therapist as well as performing a consist home exercise program, dizziness due to neck problems can be completely resolved.
Beinert K, et al. The effect of balance training on cervical sensorimotor function and neck pain. J Mot Behav. 2013;45(3):271-278.
Chester J. Whiplash, postural control and the inner ear. Spine. 1991;6(7):716-720.
Karlberg M, et al. Impaired postural control in patients with cervico-brachial pain. Acta Oto Laryngologica. Supplement. 1998;2(440):440-442.