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
- 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.
- 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.
- Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017 Sep 12;7:12.
- 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.