Banner: Dizziness & Balance
Title: Could it be Your Neck?
By Poonam McAllister, PT, Central Illinois Institute of Balance
Dizziness and balance issues are a common complaint that can be difficult to diagnose
because there are many different causes. People often suffer unnecessarily because and it
can take some time to go through the process of exploring the various possibilities in
order to determine the correct diagnosis. However, once the diagnosis is made, the
condition is highly treatable. One cause of dizziness may be cervical vertigo.
What is cervical vertigo?
Cervical vertigo is dizziness that is provoked by a particular neck posture no matter what
the orientation of head with gravity. Cervical vertigo is caused by inflammation, trauma
or degenerative changes in the cervical spine or neck musculature. Symptoms may
include dizziness and neck pain with head movements. It may be accompanied by tense
and tight neck muscles, stiffness of the neck as well as referred pain to the head, neck or
arms.
What causes Cervical vertigo?
Cervical vertigo tends to be a controversial topic because there are no tests to confirm the
diagnosis. This diagnosis is determined after ruling out other causes of vertigo like inner
ear disorders, problems with the central nervous system and the spine. This condition can
happen after head injuries and whiplash injuries. It can occur along with brain injury or
injuries to the inner ear. There are two possible explanations:
1. Obstruction or pressure on the vertebral artery. The vertebral arteries travel
through the neck vertebrae to enter the brain and provide the circulation to the
brain structures.
2. Reduced sensory information from the neck muscles to the brain. The
information from the neck muscles is combined with information from the inner
ear and eyes to tell the brain about our orientation in space. This altered or
reduced information can cause symptoms of dizziness with certain neck postures.
Types of testing for diagnosis:
Evaluation for cervical vertigo involves a medical evaluation first. After the medical
evaluation, testing of the inner ear function and brain function is usually requested to
ensure that the inner ear structures and the central structures are working properly.
Following is a list of possible tests that the medical provider might order.
1. Medical assessment: physical examination
2. MRI of the brain and neck
3. Videonystagmography( rule out vestibular neuritis and Benign Paroxysmal
Positional Vertigo
4. Hearing Test
5. CT- Angiography to study the blood vessels
6. Neck X-Rays
7. Physical Therapy Evaluation: Assessment of inner ear function( rule out Benign
Paroxysmal Positional Vertigo)
8. Computerized Dynamic Posturgraphy- performed by a trained Physical Therapist.
This is a test of balance which determines the use of sensory inputs
Treatment Options:
75% of the people who suffer from true cervical vertigo with neck pain recover with
Physical Therapy treatments. Gentler physical therapy treatments like gentle trigger point
therapy and myofascial release can help reduce the vicious cycle of neck pain and muscle
tightness. Treatment techniques that use more pressure or are more vigorous can make
this dizziness worse.
Treatments include:
1. Medication prescribed by the physician
2. Physical Therapy treatments include gentle stretching, myofascial release, and
soft tissue mobilization. Modalities like electrical stimulation and ultrasound
help reduce muscle tightness and enable the muscles to tolerate stretching during
range of motion exercises.
3. Education in proper sitting and sleeping posture, and proper use of neck during
activities of daily living.
4. Some patients need addition of vestibular rehabilitation therapy which targets the
inner ear function.
For more information about treatment options for neck pain and dizziness you may
contact Poonam McAllister, Physical Therapist, Central Illinois Institute of Balance at
309-663-4900 or e-mail poonam@dizzyil.com