Vertigo, Benign Positional Paroxysmal Vertigo(BPPV), Cervicogenic Dizziness
Dizziness that accompanies cervical movement impairments my originate from Vertebrobasilar Insufficiency (VBI), the vestibular system, the visual system, or from structures that constitute the cervical spine, ie. cervicogenic dizziness. Cervicogenic dizziness has been described as a false sense of motion or a nonspecific sensation of altered orientation; spinning, whirling, and lightheadedness, or a sense of disequilibrium. It has been proposed that degenerative changes of joint and periarticular soft tissue structures may lead to an altered/ false sense of motion. Differentiation tests can be performed by Physioterapists to differentiate the cause of dizziness: vestibular, visual, cervical articular, or vertebrobasilar systems Based upon the outcome of these tests the Physiotherapist would treat the client accordingly.
Physiotherapists can effectively treat cervicogenic dizziness. Treatment my include:
- Manual joint mobilizations (including gliding mobilizations, specific joint traction mobilization, translatoric mobilization) for cervical joint hypomobilities.
- Cervical stabilization and joint protection techniques for cervical joint hypermobilities.
- Movement re-education techniques including the use of thoracic extension to decrease the necessity of end-range cervical extension, and the use of thoracic rotation in extension for the purpose of minimizing full cervical rotation.
Physiotherapists do not use rotational mobilization/ manipulations that potentially can compromise vertebral artery blood flow. Vertebral artery compromise in response to spondylotic changes has the potential to produce dizziness. In the lower cervical region, the vertebral artery may be distorted or displaced secondary to enlargements of facet joints. In the upper cervical spine, blood flow changes secondary to changes in lumen diameter may occur due to excessive rotation occuring between the C1 and C2 vertebrae.
Trained Physiotherapists in the treatment of BPPV perform the modified Canalynth Repositioning Procedure with an estimated success rate of 95.6% after the first maneuver.