Treatment

Meynard Enriquez DPT, Ross Fargnoli DPT OCS, Ray Lunasin DPT OCS,
Mark Lundblad DPT OCS, Shane O’Malley DPT OCS

Goals of physical therapy treatment:

  • Decrease frequency and intensity of symptoms/dizziness
  • Improve pain, mobility, balance, and overall function

Individuals with CGD commonly present with both painful and stiff musculature/joints of the head and neck

  • There is a growing body of evidence that manual therapy (hands-on treatment) is beneficial in the management of cervicogenic dizziness 
  • Examples: Soft tissue mobilization, joint mobilization and manipulation, stretching

A reduction of dizziness symptoms in response to cervical traction may indicate involvement of the cervical spine and is more consistent with CGD than with vestibular dysfunction

  • Cervical traction: The use of light traction force to the head and neck of approximately 5-10 lbs, held for about 1 minute: Force and time is based off patient’s response and determined by the physical therapist
  • Cervical traction can be completed manually by a physical therapist.  Mechanical units in the clinic and for home use are available, as well as other self-traction methods
  • Patients should be properly trained in the safety and functions of each device prior to utilization

Increasing head and neck range of motion (ROM) has demonstrated improvement/normalization of cervical sensory input and thus may improve dizziness that has a cervical origin

  • Exercises may be prescribed specific to areas of limitation and in respect to provocation/relief.  
  • Newly gained range of motion is coordinated by active use and strengthening of the neck and shoulder musculature
  • Fatigue of cervical muscles is linked to adverse integration and feedback of the cervical kinesthetic and sensory system
    • Examples: Stretching, Active ROM, Isometric Holds

Adverse changes in proprioception (awareness of position and movement) of the head/neck may affect the sensory and motor control of gaze stability, eye-head movement, and postural control

  • A thorough examination can identify individual sensory and motor deficits in the head and neck linked to dizziness.  
  • This enables the physical therapist to design a specific/personalized program to improve performance, posture, balance, and function