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

Quadruped Rocking with Cervical Stabilization Exercise

Seated Mobilization with Movement for Atlanto Axial Rotation Technique

Seated Rotational SNAG Exercise

Sensorimotor and Positional Control Exercise with laser

Sidelying Atlanto Occipital Distraction HVLA Manipulation

Standing Deep Neck Flexion with Cervical Rotation Exercise

Supine Atlanto Occipital Mobilization Technique

Supine Cervicothoracic Junction HVLA Manipulation

  1. Cook, C. and Rogelio Coronado.  Manual Therapy of the Cervical Spine.  IN: Cohen, M., Goucher, J., Kerian, M., Ragonese, N., ed: Orthopedic Manual Therapy: An Evidence-Based Approach.  Second edition.  Upper Saddle, NJ: Pearson Education, Inc; 2012: 67-114.
  2. Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther. 2014 Apr;94(4):466-76.
  3. Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017 Sep 12;7:12.
  4. Jung FC, Mathew S, Littmann AE, MacDonald CW. Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series. J Orthop Sports Phys Ther. 2017 Nov;47(11):874-884.