In this video, I briefly describe the difference in symptoms and description of symptoms between vertigo and cervicogenic dizziness.
Showing posts with label #cervicogenicdizziness. Show all posts
Showing posts with label #cervicogenicdizziness. Show all posts
This is our red light or green light system to treat or refer. This is by far the most important decision that comes out of a clinical evaluation and is especially important with neurological symptoms.
The most common benign cause of vertigo is benign paroxysmal positional vertigo (BPPV). There are specific subjective and objective findings that are crucial to ruling in BPPV in the dizzy patient.
A physical therapist trained in vestibular rehabilitation is well aware of these findings and do a splendid job at helping people! We are actually very good at differential diagnosis and use the latest research to help refine our clinical exam!
In some instances, patients who are having dizzy/vertigo symptoms seek out help from physical therapists with thought they are having BPPV but instead it is an early sign for a stroke. Early diagnosis and intervention are crucial for successful treatment in patients with acute ischemic stroke because prompt thrombolytic treatment improves outcomes. We also do not want to propel a spontaneous dissection through a mechanical input, such as with manual therapy, Dix-Hallpike testing or even range of motion.
In fact, ischemic changes affecting the vestibular artery in patients with BPPV could precede a full-blown ischemic stroke. These ischemic changes affecting the vertebrobasilar system could initially produce vestibular symptoms, such as BPPV.
Here are a three factors for the vestibular therapist to know about BPPV and stroke:
- The vestibular organs are vulnerable to ischemic obstruction. This is due to the “small creek” that finally lead to the organs from the anterior vestibular artery, which as we know, originate initially from the vertebral-basilar artery. Therefore, a disturbance of adequate hemodynamics to this region could indicate a disruption more proximal, such as in the vertebral-basilar artery.
- There are common risk factors associated with both BPPV and ischemic stroke. These can include osteoporosis, smoking, alcohol consumption, anxiety, cardiovascular disease and diabetes. Conditions such as obesity, cardiovascular disease, and diabetes are chronic diseases and related to stroke onset. Therefore, a correlation can be made that BPPV increases the risk of ischemic stroke.
- BPPV is recurrent and can lead to lifestyle changes. One lifestyle change can be physical inactivity. Physical inactivity following BPPV might increase the risk of an ischemic stroke. A sedentary lifestyle due to avoidance of activities from fear or provocation of vertigo/dizzy symptoms can occur in these patients over time. Our goal is to educate our patients to stay active with proper recommendations based off of the patient’s presentation. Our goal too is to get them better so they do not have impairments!
CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES
You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course. Pertinent to this blog post, the entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” and treat through the “Physio Blend.”If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for prices and discounts.
Authors
Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Learn more online - new online discussion group included!
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There are a range of symptoms and variety of potential descriptions of cervicogenic dizziness. Cervicogenic Dizziness symptoms can vary from one person to another and still carries the weight of controversy.
The description of dizziness, including a sensation of spinning and/or dysequilibrium is common (Krabak et al 2000, Kalberg 1996). It has even been described generally as dizziness that may be associated with headache, cervical pain, nausea, cold sweats and/or nonspecific complaints (Morinaka 2006).
With that said, the following are the top 5 symptoms of Cervicogenic Dizziness.
- Lightheadiness
- Drunkenness
- Unsteadiness
- Feeling of imbalance
- Room spinning
It is highly recommended to exclude other sources of dizziness prior to making a diagnosis of cervical origin. We recommend using the Optimal Sequence Algorithm, a detailed subjective and objective screening process.
There are some fine details in symptom and presentation characteristics between several types of dizziness. The differential diagnosis can mean a difference between referring out or greenlight to treat in an outpatient setting.
If benign disorders of the dizziness are found, then the patient could have a double entity, which is both a vestibular disorder and cervical disorder. That is why the patient’s symptoms may vary or change between several of the descriptors above.
CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES
You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course. Pertinent to this blog post, the entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” and treat through the “Physio Blend”.
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for prices and discounts.
Authors
Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.
Keeping it Eclectic...- NEW - Online Discussion Group
- Live cases
- webinars
- lecture
- Live Q&A
- over 600 videos - hundreds of techniques and more!
- Check out MMT Insiders
Cervicogenic dizziness has been described in the medical literature to be caused by functional problem of the cervical spine associated with postural alignment, proprioception and range of motion. Although cervical dizziness is controversial, we have large randomized controlled trials and systematic reviews saying that manual therapy and exercise can help with dizziness frequency, intensity and duration.
However, until two chiropractic pieces have arisen in the last few years, we didn’t know if an improvement in cervical lordosis can be linked to improvement in neck dizziness. I find these article interesting on several accounts, but mostly due to a measure of actual cervical lordosis that physical therapists do not have the capability nor training to examine. Let’s explore more.
The first trial comes from Moustafa et al in 2017 entitled, “The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study”. The authors found a statistically significant differences for all of the measured variables of dizziness impairments between groups, including an improvement in cervical lordosis.
The authors hypothesized that
it was the loss of cervical lordosis that was causative for the dizziness symptoms since the comparison group had only temporary symptomatic relief that was lost at the 1 year follow-up
The second study comes from 2020 case report. Dr. Gerstin and colleagues presented a case entitled, “The treatment of dizziness by improving cervical lordosis: a Chiropractic BioPhysics case report”. This case demonstrates the relief of dizziness by the improvement in cervical lordosis in a mid-aged female. There was an approximate 20° lordosis increase achieved over the duration of one year after 115 in-office treatments.
The authors concluded, “
Cervical hypolordosis may be an under-diagnosed cause of idiopathic dizziness in some patients.
Just two studies linking dizziness improvement alongside lordotic posture is not groundbreaking science, but does show a correlation between dizziness and the cervical spine. Also, it answers our blog question that yes, I would say cervical lordosis improvement can help with Cervicogenic Dizziness.
The one thing I want to send out to the readers is that the symptomology of dizziness, lightheadiness and unsteadiness can improve much quicker than 1 year (the final duration in these articles) but it does take time for reversal of the lordotic curve. Therefore, I would still suggest you can get quick relief with appropriate manual therapy and exercise techniques if the diagnosis is correct of cervical reason for the dizziness symptoms.
Without getting into too much details for the readers, the pathophysiology of loss of lordosis is described by the following statement that I use in my teachings: The hypolordosis in mid-cervcial spine will eventually lead to concomitant upper cervical spine extension posture to compensate and assist in horizontal gaze. Therefore, the treatment to the upper cervical spine to improve mobility and flexion will help symptoms in the short term, but ultimately for long term control, addressing the mid-cervical spine to aid in improving cervical lordosis is absolutely necessary.
I applaud these authors for putting this information out there and continue to advance the diagnosis and treatment for these disorders!
You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course. Pertinent to this blog post, the second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for prices and discounts.
Sign up for more emails on this topic by clicking here
Authors
Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.
Keeping it Eclectic...- NEW - Online Discussion Group
- Live cases
- webinars
- lecture
- Live Q&A
- over 600 videos - hundreds of techniques and more!
- Check out MMT Insiders
Cupping therapy can be described as a technique that uses cups placed over the skin to create negative pressure through suction. It has been in use all over the world for centuries for many musculoskeletal and some non-musculoskeletal conditions. The treatment approach has created more buzz in the Physio world for the past few years for musculoskeletal conditions, mostly pain.
I believe the pictures of Olympic swimmer, Michael Phelps, in 2016 games was the reason the modality was brought to the attention of the most of the western world. Therefore, it struck a chord with the sport and active crowd!
There are two types of cupping methods, dry and wet. Dry cupping is noninvasive with no bloodletting. Wet cupping is invasive and includes bloodletting. The current western approach by physios / chiropractors and massage therapists use the dry cupping method.
Our profession has then created many variations of cupping approaches. Some clinicians leave them in place for a period of time with the patient still. Some clinicians move the cups over the skin themselves through different planes. Some clinicians even leave them in place for a period of time on patients but have the patient move in a therapeutic manner.
The question that I have never encountered before is the title of this blog: “Can Cupping help Dizziness?”
To answer that question from the medical research, I take the reader to a case report by Almusleh and Ansari in 2020 entitled “Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: a Case Report” in the journal, Cureus. You can access it free here.
I find it interesting to read literature outside our profession as it broadens the mindset of what others can do. It is the same reason I get any PT student to observe local chiropractors, acupuncturists, podiatrists, running shoe store owners, etc as we tend to get stuck in our own ways that exercise fixes everything!
If you read the title, you will realize that the authors were mainly writing about the effects of wet cupping for sudden sensorineural hearing loss that failed conventional medical treatment, but within the report, you will see this statement on dizziness changes:
DHI {Dizziness Handicap Inventory} score was improved from an initial 52 score to 0 (no handicap at all)
And this conclusion:
In our case, WCT {wet cupping therapy} improved the feeling of fullness after the first session and improved hearing loss, tinnitus, and dizziness after the completion of the WCT treatment regime (12 weeks).
We don’t recommend every patient with dizziness to get wet cupping from the report by any means! However, I think it does show a link between many symptoms: dizziness, hearing loss, tinnitus and pain. It also shows a manual therapy approach can be helpful for these conditions, including dizziness.
You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course. Pertinent to this blog post, the second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for prices and discounts.
Sign up for more emails on this topic by clicking here
Authors
Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.
Keeping it Eclectic...- NEW - Online Discussion Group
- Live cases
- webinars
- lecture
- Live Q&A
- over 600 videos - hundreds of techniques and more!
- Check out MMT Insiders
