Treating cervicogenic dizziness with exercise and education
Cervicogenic dizziness is defined as: “a nonspecific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activity from the neck”, which is thought to be caused by disorders in the upper cervical spine.
It has been discussed in the literature as being the disruption of the input from the upper cervical spine to the sensory systems, and secondary afferent input from the somatosensory system, vestibular system, or visual system can also contribute to cervicogenic symptoms. Cervicogenic dizziness can result in patient’s being limited or hesitate with cervical movements, and pain and dizziness can further impair functional movements.
The condition has commonly been treated with manual therapy and exercise therapy, but the authors of this article hypothesized that exercise and education would have a greater impact on overall functional improvements.
This article examined the outcomes of 8 patients with cervicogenic dizziness. Trained physiotherapists completed the inclusion testing and patients with additional sources of vestibular involvement were ruled out. Patients were excluded if they had additional sources of dizziness, or had sustained a trauma. 2 outcome measures were used: The Dizziness Handicap Inventory (self-reported assessment on how dizziness impacts the patient’s quality of life) and the Neck Disability Index (25 questions that classify the effects of dizziness in 3 categories: physical, functional and emotional).
Patients were treated over 4 weeks, with 2 sessions each week. Sessions 1-4 focused on pain education therapy, range of motion exercises and engaging the deep neck flexor muscles of the neck for improved motor control. During the last 4 sessions, strength exercises were given to improve the strength of flexors, rotators and inclinators muscles. The treatment was broken into phases of mobilisation exercises for cervical range of motion, motor control exercises, oculomotor exercises, and strength exercises.
The authors found the majority of participants showed a clinically significant improvement in catastrophism, neck disability and dizziness disability as noted on the outcome measures after the 8 sessions. Range of motion was also improved. The authors concluded that therapeutic patient education in combination with therapeutic exercise was an effective treatment, and especially beneficial with patients who have high levels of fear avoidance around neck movements.
This article highlights the uses of a multi-modal approach with education and basic stability exercises providing a large portion of the treatment. While this does highlight the need for a more robust treatment approach than just manual therapy alone, the exclusion criteria of trauma may limit the clinical application to some patient populations. Motor vehicle accident injuries as well as concussion injuries may not fit this inclusion criteria based on this article. Thus, additional research is needed to note impacts that this treatment may have on those who have sustained a level of traumatic injury. But it could be concluded that more conservative treatments, especially education, can be used across a wider patient population for help with cervicogenic management.
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> From: Minguez-Zuazo et al., J Exerc Rehabil 12 (2017) 216-225. All rights reserved to Korean Society of Exercise Rehabilitation. Click here for the online summary.