Tua Tagovailoa, an American football quarterback in the NFL, sustained two concussions in the same week. The second concussion resulted in abnormal posturing of his hands. As we wait for a Tua injury update, it is unclear how he will recover.
When someone sustains a concussion, additional symptoms may be secondary to the trauma. Secondary complications could delay the ability to return to sport or activity. Today, we are speaking on one of these: Cervicogenic Dizziness.
What is Cervicogenic Dizziness?
Cervicogenic dizziness refers to conditions in which dizziness is due to a neck problem. Cervical vertigo, another term used for this condition, is less popular. Vertigo, a spinning sensation, is not common in most cases of CGD or cervicogenic dizziness.
Cervicogenic dizziness remains a controversial diagnosis. Many doctors, researchers, and rehabilitation specialists still have doubts about whether the neck is the cause of dizziness. Anecdotally, however, the number of patients who fit this description and respond to neck-directed therapy is high. In addition, research over the past ten years supports the diagnosis of Cervicogenic Dizziness.
Your head can sense where it is in space and in which direction it is moving from three systems within your body.
1) Your vestibular (inner ear) system
2) Receptors in the neck (proprioceptors).
3. Your vision
One or more of these systems can malfunction and cause dizziness, imbalance, or instability. Cervicogenic dizziness is coming from your cervical spine (neck). Typically a mechanical dysfunction.
Sensors in the joints of your neck help detect motion and position. When there is a mismatch between your neck’s motion sensor and your head’s motion sensor (vestibular systems), your brain can get confused, leading to dizziness. If the main cause of dizziness stems from the cervical spine, this is known as cervicogenic.
Cervicogenic Dizziness Symptoms:
Cervicogenic dizziness, like many other conditions, can cause patients to have different symptoms, patterns, or progressions. The following is generally used to describe these symptoms.
Usually
- Motion sensitivity, dizziness, light-headedness
- Difficulty in describing symptoms (or vague)
- Neck stiffness or pain. Neck symptoms can lead to dizziness.
- Tense muscles or trigger points in the neck
- Dizziness when your head moves (especially if you extend your neck back) or when your head is in poor positions for prolonged periods
- The symptoms can last from minutes to hours.
- The symptoms are not always present but occur in episodes.
- If there is no neck trauma, the symptoms will develop gradually and not in one sudden bout.
Occasionally
- Headaches radiating towards the front, especially at the back and/or one side of your head.
- Nausea
- Vertigo symptoms: spinning and/or floating
Not Likely to Be Cervicogenic Vertigo
- Tinnitus and hearing loss
- Migraines
- Significant visual problems (double vision, unsteady, or shaky vision).
What Causes are You Looking For?
1) Degenerative Disc Disease of the Neck
Osteoarthritis, and other neck-related issues, are the primary causes of proprioception errors (joint position sensing) that can lead to cervicogenic dizziness.
2) Sympathetic nervous systems impairments
The sympathetic nervous system controls our body’s “fight/flight” response, including pupil dilation, heart rate/palpitations, poor digestion, and sweating. In addition, these nerves can become compressed in the neck or nearby spinal cords due to disc problems and neck joint issues. All of which can lead to dizziness.
3. Compression of the neck arteries
Compression of the neck arteries due to diseases like atherosclerosis or blood clots (thromboemboli), and sometimes it can also be due to arthritis in your neck joints. Reduced blood flow to the following can cause dizziness symptoms: vestibular organs, the brain where motion information is processed.
4) Migraine Associated Vertigo (neck variant)
Recent evidence suggests that cervicogenic dizziness caused by a migraine may be related to the neck, jaw/facial nerves.
5) Chronic neck pain
Chronic neck pain can cause dizziness. Even if the chronic neck pain has subsided, cervical vertigo may persist.
Cervicogenic Dizziness: Risk Factors
- Poor posture
- Whiplash Associated Disorders or Other Traumatic Injuries to the Neck
- Head injuries and concussions
- Nail weakness
- Osteoarthritis in the neck joints
- Inflammatory diseases of the neck, such as ankylosing and rheumatoid arthritis
What does a Physical Therapist look at for Cervicogenic Dizziness?
A single test does not diagnose cervicogenic dizziness. It is rather a diagnosis of exclusion. This means that all possible causes of dizziness are excluded. Then rule in cervical vertigo as the most probable diagnosis. There are many causes of dizziness.
Cervicogenic dizziness can be confused with other vestibular disorders. However, many other symptoms of dizziness, such as neck pain, can be present without cervicogenic dizziness including:
- Vestibular Migraine
- Meniere’s Disease
- Persistent Postural Perceptual Dizziness (PPPD)
- Mal de Debarquement (MdDS)
A vestibular/orthopaedic physiotherapy assessment will:
- Take a detailed history of your neck problems and dizziness.
- Screen for risk factors that could lead to cervicogenic dizziness
- Perform neurological testing of your central nervous systems
- Perform a manual exam of your neck to check range, strength, joint stability, and stability.
- Perform tests on your peripheral vestibular systems
Experts suggest that a series of neck treatments is the best way to diagnose cervicogenic dizziness. If your dizziness improves, then you may have CGD.
Treatment for Cervicogenic Dizziness
A proper diagnosis is essential for the effective treatment of neck-related dizziness. Different causes can lead to other treatments. These are some of the most common ways to treat cervicogenic dizziness.
An experienced physiotherapist who has experience with treating neck impairments can use many tools. These tools can include:
- Manual therapy to mobilize neck joints
- Retraining neck proprioception (specific exercises that help the neck joints sense motion and position more accurately).
- Strengthening the neck muscles and core stability of shoulder, neck, and head complexes.
- Global Strengthening
- Increased activity tolerance.
Dry needling and acupuncture- This may help reduce chronic pain and muscle spasm.
Rehabilitation of the vestibular system- This area of treatment usually involves supervision by a vestibular physiotherapist. The exercises test your body’s ability to understand where your head is in space.
Anxiety Management- Anxiety can be a side effect of many chronic conditions or symptoms. Anxiety can slow down your recovery from cervical vertigo. It causes neck muscles to tighten even more and over-stimulates and confuses your vestibular system, resulting in more dizziness.
Does Cervicogenic Dizziness Go Away?
Cervicogenic dizziness is considered milder than other dizziness disorders and therefore has a lower incidence of disability overall. In addition, most cases can be treated with great success, and often, recovery is long-lasting.
Depending on the root cause, some cases can lead to chronic conditions that can lead to repeated relapses. These factors include:
- High cholesterol untreated
- Migraines can be difficult to manage.
- You may also be recovering from another vestibular disorder (e.g., PPPD, Vestibular Neuritis, Meniere’s and Vestibular Migraine
- Unmanaged anxiety
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Author
Dr. Tyler is a physical therapist and founder Scottsdale Physical Therapy & Performance in North Scottsdale, Arizona. He see golfers, athletes and active adults. His focus is offering one-on-one sessions for 1 hour focused on developing individualized programs to get you back to your goals.
If you have any questions about online programing or want to stop in for a visit, please reach out by hitting “request appointment” in the top of the page.
– Dr. Tyler PT, DPT, FAAOMPT, TPI-2
