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Cervicogenic Dizziness: Could my Neck be behind my Dizziness?
Dizziness is a common symptom with a variety of underlying causes, including the neck. Often we look towards vestibular and central issues for dizziness, but what happens when everything is clear and we are still dizzy? This often results in people seeing multiple healthcare professionals, specialists, and taking many trips to the Emergency Department, never getting answers. Could cervicogenic dizziness be the key?
Cervicogenic dizziness is a type of dizziness that originates from a problem in the cervical spine (neck) and is often overlooked. It's believed to be caused by abnormalities or disturbances in the neck joints, muscles, or nerves, which then affect the sensory input (proprioception) to the brain responsible for balance and spatial orientation. In this article, we will explore the causes of cervicogenic dizziness and discuss treatment options, including two home exercises you can begin with today!
Symptoms of Cervicogenic Dizziness
The symptoms of cervicogenic dizziness can vary from person to person but commonly include:
Dizziness, vertigo, motion sensitivity or light-headedness, which may worsen with certain head or neck movements or after maintaining certain neck positions for a long time.
Discomfort or tightness in the neck, often localized to one side. Often dizziness will increase when neck symptoms increase.
Trigger points, tenderness or tense neck muscles.
Headaches, often described as a dull, aching pain that radiates from the neck to the back of the head or behind the eyes.
Temporomandibular joint (TMJ or jaw) pain
Ear fullness and/or tinnitus (ringing in the ears)
Visual disturbances including blurred vision, difficulty focusing, or sensitivity to light.
Difficulty concentrating, feeling foggy or disoriented, especially during dizziness episodes.
What Causes Cervicogenic Dizziness?
We have three systems that make up our overall sense of balance and orientation:
Vision (or eyes)
Vestibular (inner ear)
Proprioception (receptors in your neck, feet and throughout your body)
Dizziness can arise when these three systems aren’t in agreement or there is dysfunction in one system. Where vestibular disorders arise from problems from our inner ear, cervicogenic dizziness primarily arises from issues in the proprioceptors in the cervical spine.
Throughout our body we have receptors in our joints that tell our brain about where our body is in space.
Give this exercise a try to see what I mean:
Hold up your pointer finger in front of you and bend and straighten it. With your eyes open you can see that you are doing that motion, so your vision can tell your brain what is happening. Now close your eyes and bend and straighten your finger. Can you still sense when it is bent or straight even without vision? This is our proprioception system at work, telling us all the time what our body is doing.
These sensory receptors exist in our neck and provide input to our brain letting us know where our head is in space. For example, are we looking forward, to the side, tilting or head, etc.? What cervicogenic dizziness, these sensory receptors lose sensitivity and our brain no longer receives adequate input as to where our head is orientated. Since we still receive input from our vision and our vestibular system, there is now a mismatch between our 3 balance systems, and dizziness results.
What Causes a Loss of Proprioception in our Neck?
There are various reasons why we may lose our sense of proprioception in the neck, these include:
Joint dysfunction: Dysfunction in the cervical facet joints, which are small joints located between the vertebrae in the neck. These joints are commonly affected in osteoarthritis and degenerative disease.
Muscle tightness or weakness: Imbalances or tension in the muscles of the neck, often secondary to poor posture, high stress, or whiplash can disrupt normal neck movements and sensory input, leading to dizziness.
Nerve irritation: Irritation or compression of nerves in the neck, such as the cervical nerves or the vestibular nerve, can disrupt signals to the brain involved in balance and spatial orientation.
Sympathetic nervous system (SNS) impairments: Our SNS regulates our body’s “fight or flight” response which includes heart rate, sweating, pupil response, and digestion. When we irritate these nerves in the neck, it can lead to dizziness along with various SNS symptoms.
Artery compression: This results in reduced blood flow to the vestibular organ or various parts of your brain responsible for processing information and can result in dizziness. Common causes of arterial compression include atherosclerosis, blood clots and arthritis in the neck.
Can Vestibular Disorders Cause Neck Pain?
Sometimes we may see a slow involvement of the neck secondary to vestibular or vision issues. Our balance system (vision, vestibular and proprioception) are always in communication with each other, so malfunction in one can potentially result in adaptations in our other two systems. When it comes to the neck, we see this often we one loses their sense of verticality. This can occur from our vestibular system and changes in our gravitational receptors, or from our vision system and an altered perception of horizontal or vertical. In both cases, altered signals can result in one feeling like their world is tilted or they feel like they are falling to one side.
To accommodate, people often end up tilting or turning their heads in a manner that makes them feel oriented to vertical. This, however, can result in the neck getting tight on one side, leading to altered proprioception from the neck, and the dizziness cycle continues.
How is Cervicogenic Dizziness Diagnosed?
Unlike vestibular disorders such as BPPV, cervicogenic dizziness does not have a single test, and is often considered a diagnosis of exclusion. This means that other causes of dizziness are ruled out, which then rules in cervicogenic dizziness.
As discussed, cervicogenic dizziness can exist on its own, or it can also be in combination with other vestibular and central disorders. Common conditions that often have a cervical component include:
Diagnosis thus involves a through examination of central, vestibular and cervical areas and requires an experienced clinician. A vestibular/orthopaedic assessment includes:
Detailed history of your dizziness and neck complaints including onset, presentation, and past medical history
Neurological screening including vision, cranial nerves and cerebellum testing
A full vestibular examination
Physical examination of the cervical spine including range of motion, joint mobility, joint stability, muscle length and overall strength
Posture, resting position and proprioception of the cervical spine
Treatment for Cervicogenic Dizziness
Treatment for cervicogenic dizziness typically involves a combination of different modalities to address underlying impairments as well as any secondary issues.
Correct Posture
Poor posture is a common cause for non-traumatic cervicogenic dizziness. Poor posture leads to muscle imbalances, specifically tightness in the chest and suboccipitals and weakness in the deep neck flexors and shoulder blades.
Correcting resting posture and working on lengthening and strengthening specific muscles can improve overall mobility in the neck and reduce dizziness.
Manual Therapy
Hands on therapy can include joint mobilizations, soft tissue release of muscles, trigger point release and manual stretching.
Proprioception Training
These are specific exercises that help your neck joints sense positions as well as motion and accuracy.
Acupuncture
This helps to reduce pain and discomfort while also calming the nervous system, improving circulation, and reducing stress.
Modalities
Utilizing tools such as ice and heat, TENS and ultrasound can help reduce pain and inflammation, allowing better tolerance for exercise and manual therapy.
Vestibular Rehabilitation
As discussed, often cervicogenic dizziness can be in combination with vestibular disorders, or even stem from vestibular dysfunction.
Addressing any vestibular dysfunction and often correcting our sense of verticality will help improve dizziness.
Lifestyle modifications
Ergonomic adjustments at workstations, stress and anxiety management techniques, and avoiding aggravating activities can help manage symptoms and prevent flare-ups.
Medications
If inflammation is present, NSAIDs (non-steroidal anti-inflammatory drugs) can be helpful to reduce acute inflammation and allow you to begin active rehabilitation.
In a similar rationale, muscle relaxants can do the same if muscle spasms or tightness are limiting factors in your participation in rehabilitation.
Overall, recovery is shown to be quite good for those with cervicogenic dizziness, especially when in combination with other vestibular or central treatment if there are multiple causes. Dosing is very important with cervicogenic dizziness, as with all types of vestibular disorders, as large rapid changes to our system, even in the right direction, can overwhelm it and result in increased dizziness. So small, frequent adjustments are vital in success with any dizziness therapy.
Home Exercises for Cervicogenic Dizziness
Continuing to work on muscle imbalances and joint mobility away from the clinic is important for long term success. Below are two of my favourite home exercises for cervicogenic dizziness and headaches!
Cervical SNAGs
SNAG stands for self-sustained natural apophyseal glide and can be very effective for improving range of motion and reducing symptoms. You wan to focus on the cervical spine at C1-C2, which houses a large portion of our proprioception sensors and has been shown to improve neck rotation range of motion, headaches, and reduce dizziness frequency and intensity. SNAGs are performed by using a belt and applying pressure on the upper neck while moving your head into the restricted or painful/dizzy movement. You know a SNAG is useful for you if your pain or dizziness is reduced or your range of motion increases. And if looking up triggers too much dizziness for you, focus on a point in front of you and lean forwards instead - your neck moves into extension without triggering your vestibular system in your inner ear.
Chin Tucks
Chin tucks focus on two specific areas of our neck - our deep neck flexors (DNF) and our suboccipitals. Many people with cervicogenic dizziness have weak DNF and tight suboccipitals, often resulting from poor posture and increased stress. Tight suboccipitals are especially important in dizziness management, as this area of our neck contains over half of our proprioceptors! Dysfunction here leads to a loss of proprioception, mismatch between our neck and other systems (vestibular and vision) and can cause dizziness. By doing chin tucks, we can help both strengthen our DNF and lengthen our suboccipitals, improving overall mobility in the neck and starting the process of improving our proprioception. You can progress this exercise by doing it at an angle and then in four point kneeling, having to do the chin tuck against gravity which is much more challenging!
Cervicogenic Dizziness Treatment Near Me
Healing Vertigo physiotherapists are trained in vestibular, concussion, TMJ and the neck, providing a thorough evaluation and balance treatment approach to dizziness, from any cause.
Some aspects of cervicogenic dizziness can be provided virtually (Ontario-wide), however it is highly recommended that in-person treatment be considered. Healing Vertigo is located in Ancaster, ON, so give us a call today to begin your recovery.
Disclaimer: This advice is not meant to be a substitute for advice from a medical professional regarding diagnosis, prognosis, or treatment. Always seek advice from your physician, physiotherapist, or other qualified healthcare provider with questions you may have regarding a healthcare condition. The information of this website and email, including but not limiting to text, graphics, videos, images, and other materials are for informational purposes only. Reliance on the information on this website and email is soley at your own risk.