Most of us know that neck pain can be not only a symptom of an issue somewhere along the spine, but for some, neck pain is also associated with some other unpleasant and unhelpful symptoms, one of which is dizziness. Chiropractors call this Cervicogenic dizziness. This week, let’s look at what causes Cervicogenic dizziness and how we can treat it.
So what is Cervicogenic dizziness?
Cervicogenic dizziness is medically defined as a syndrome of neck pain accompanied by an illusory sensation of motion and disequilibrium due to neck pathology.[1] In layman’s terms, it’s currently thought that these are episodes of dizziness caused by disturbed sensory inputs from the neck – this in turn, leads to a sensory mismatch between cervical, visual and vestibular inputs, causing dizziness.[2] Cervicogenic dizziness is diagnosed when these episodes correlate with neck pain.
To understand the problem, it’s worth spending a moment discussing how things should work. Normally, proprioceptive inputs (that is to say, sensory information) from the neck play an important role in head-eye coordination and postural processes. Humans, (as I’m sure you will be aware!) have highly mobile necks which allow us (or should allow us!) to pivot, twist and rotate or heads in many different ways. Because of this, neck proprioception (read, position sensing) is critical to the stability of the body – your brain needs to know both where your trunk and your neck are, in order to balance properly. We won’t go deep into the details here, but its worth knowing that the structures of the neck are enriched with a complex sensory structure – the information from which participates in perceptual functions and reflex responses, thereby interacting with signals of the vestibular (balance) and visual system to stabilize the eyes, the head and posture.
Put simply – its very important that the bones and muscles in the neck are working correctly, in order for the brain to receive the sensory information it needs to maintain good balance. If that isn’t happening, Cervicogenic dizziness can result.
How do we diagnose Cervicogenic dizziness?
Cervicogenic dizziness can be a tricky diagnosis to make, since the underlying structures of the neck are so complicated, there are a wide range of possible specific causes. At the moment, we also don’t have a definite diagnostic test for Cervicogenic dizziness, so its often diagnosed by ruling out other common conditions. Dizziness is frequently also associated with issues such as migraine, concussion (or post-concussion) or vertigo.[3]
Once these conditions have been ruled out, Cervicogenic dizziness is diagnosed by the association of the symptoms with another painful condition of the neck. It has also been postulated that Cervicogenic dizziness may well be associated with the “head down” lifestyles which we live today – Sustained loadings of the neck, e.g. long smartphone use, mobile gaming and desktop work, are common symptom triggers, and a such it is thought that degenerative or traumatic changes of the spine and problems in the neck muscles as a result could induce distorted sensations and cause symptoms of disequilibrium. This may well account for the fact that today, the condition does seem to be becoming more common.
How can we treat Cervicogenic dizziness?
The first (and usually most difficult step) in treating Cervicogenic dizziness is diagnosing it. Since there are a large number of potential conditions which need to be ruled out first, the best option is to consult with a spinal specialist, such as a chiropractor, who will be able to quickly assess and classify your case. In many instances, resolving Cervicogenic dizziness is then as simple as dealing with the underlying spinal problem.
The good news is that results from clinical studies[4] confirm the use of manual approaches, such as chiropractic in the treatment of Cervicogenic dizziness (CGD). It is believed that such treatments find success but both stimulating cervical proprioceptors and normalising the sensory input, based on the restoration of normal motion.[5]
Are you suffering with Cervicogenic dizziness?
If you are experiencing dizziness associated with neck stiffness or pain, Cervicogenic dizziness may be your issue. Since there are other conditions which can be associated with unexplained dizziness, it’s a good idea to see your GP, or a spinal specialist to get to the bottom of the issue. If an underlying spinal issue is the cause, as it frequently is, then Chiropractic stands a good chance of getting you back to normal, sooner rather than later!
[1] Wrisley DM, Sparto PJ, Whitney SL, Furman JM.
Cervicogenic dizziness: a review of diagnosis and treatment.
J Orthop Sports Phys Ther 2000;30:755–66
[2] Moustafa IM, Diab AA, Harrison DE.
The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.
Eur J Phys Rehabil Med 2017;53:57–71
[3] Wrisley DM, Sparto PJ, Whitney SL, Furman JM.
Cervicogenic dizziness: a review of diagnosis and treatment.
J Orthop Sports Phys Ther 2000;30:755–66
[4] Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H.
A Randomized Clinical Trial of Exercise and Spinal Manipulation for Patients with Chronic Neck Pain
Spine (Phila Pa 1976). 2001 (Apr 1); 26 (7): 788–797
Hawk C, Cambron JA, Pfefer MT.
Pilot Study of the Effect of a Limited and Extended Course of Chiropractic Care on Balance,
Chronic Pain, and Dizziness in Older Adults.
J Manipulative Physiol Ther. 2009 (Jul); 32(6): 438–447
Hawk C, Cambron J.
Chiropractic Care for Older Adults: Effects on Balance, Dizziness, and Chronic Pain
J Manipulative Physiol Ther. 2009 (Jul); 32 (6): 431–437
Maiers M, Bronfort G, Evans R, Hartvigsen J, Svendsen K, Bracha Y, et al.
Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain
Spine J. 2014 (Sep 1); 14 (9): 1879–1889
[5] Kristjansson E, Treleaven J.
Sensorimotor Function and Dizziness in Neck Pain: Implications for Assessment and Management
J Orthopaedic Sports Physical Therapy 2009 (May); 39 (5): 364–377
