Cervicogenic Dizziness

Vestibular Nucleus: The Eye of the Hurricane

Regular practice of exercises that connect the mind and body, such as Tai Chi and Yoga, aid in teaching you how to focus.  In our modern world, this means mindfulness.

A key phrase that is often taught for focus is,

Move from the eye of the hurricane and not be swept away in the surrounding confusion

So, how does this relate to Cervicogenic Dizziness?!

This reminds me of an ever-so-important "eye" of the surrounding storm in the complicated and perplexing area of dizziness, lightheadiness and vertigo ==>>the vestibular nuclei.

The vestibular nuclei are important centers of integration, receiving input from the vestibular nuclei of the opposite side, as well as from the cerebellum and the visual and somatic sensory systems (Purves et al 2001).

Cervicogenic Dizziness, Cervical Vertigo, Dizziness, Neck Pain, Concussion, Whiplash, Proprioception

Neurons in the vestibular nucleus, which receive direct inputs from the vestibular afferents, ocular afferents, cervical afferents and several other locations as shown in diagram above are responsive to head velocity during passive whole-body rotations or passive head-on-body movements.

Therefore, if a mismatch of signals in the "storm" of the hurricane (i.e. several afferent sources); then the ultimate symptom can be vague description of dizziness and vertigo.

Vestibular nuclei neurons are responsive to passive neck proprioceptor activation.  Considering a high percentage of proprioception is in the muscles spindles and joint capsules of the upper cervical spine, this can be a cause of the patient's symptoms.

The sensorimotor control disturbances may result from either a decrease or an increase in cervical afferent activity. The crucial factor appears to be that afferent input is altered and abnormal.  For these individuals, the ultimate symptom can be vague description of lightheadiness, unsteadiness and dizziness.

The Perpetual Cycle of Incorrect Afferent Information Input is known as Sensory or Neural Mismatch Concept. 

Therefore, think of the Vestibular Nucleus being in the "Eye of the Storm" needing to focus even with the turmoil sweeping around it.

Our job is to figure out where this turmoil is coming from and if it is solely cervical dysfunction or cervical dysfunction in combination with other wacky information, then to figure out how to most effectively help the patient in regards to manual therapy, sensorimotor exercise, and vestibular rehabilitation. 

Cervicogenic Dizziness, Cervical Vertigo, Dizziness, Neck Pain, Concussion, Whiplash, Proprioception

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 1st day includes the “Optimal Sequence Algorithm”, a multi-faceted physiotherapist approach to the assessment of Cervicogenic Dizziness, which includes the appropriate ruling-out process and cervical examination of the articular and non-articular systems. Also pertinent to this blog post, the 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

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 more information.

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

Cervical ROM Asymmetry in Cervicogenic Dizziness

Flexion Rotation Test, C1-2, Cervicogenic Dizziness, Cervical Vertigo

Cervicogenic Dizziness / Cervical Vertigo

As much as I do not like the word asymmetrical in regards to musculoskeletal care for many reasons, we cannot neglect its role in the history of our profession.  Historically, clinicians would eye-ball range of motion and even use palpation to determine deficits side to side with resultant definitions and/or descriptions to the patient that could be the reason for his/her symptoms.  We all know the reliability and validity of these measures have their own downfalls and with advanced scientific scrutiny of our own tests, these methods are dying out.  However, there is one test that has been shown to be valid, reliable and useful in the differential diagnosis of certain conditions.  This test is the Flexion Rotation Test.

Flexion Rotation Test, C1-2, Cervical Vertigo, Cervicogenic Dizziness

Back in 2004, Hall & Robinson were the first (to my knowledge) to study and cite the Flexion Rotation test in a comparative measurement study for Cervicogenic Headache.  This test has stood the test of time and continues to be highly valuable in studies examining the upper cervical spine.  I wrote a 3 part series on it over 8 years ago (Part 1, Part 2, Part 3) and still use it consistently to this day!  Even though the Flexion Rotation Test has been validated in Cervicogenic Headache and continues to be a major player in a battery of examination tools for Musculosketal dysfunction in Migraines, its role in diagnosing Cervicogenic Dizziness as a valid measure is lacking.

The purpose of the Flexion Rotation Test is to measure the mobility at the atlanto-axial (AA) joint, which of course is in the upper cervical spine complex.  It encompasses 50% of the rotation of the cervical spine and a major musculotendinous attachment point. Even though the neurophysiology of nocioception from the upper cervical spine to produce Cervicogenic Headaches is more common, there is a plethora of information on the proprioceptive neurophysiology from the upper cervical spine to produce Cervicogenic Dizziness.

Most recently, Quek et al 2013 sought out whether the upper cervical spine rotation ROM asymmetry is associated with postural stability.  The authors found Cervical Flexion-rotation ROM asymmetry group had greater postural sway and from a statistical analysis viewpoint, the study emphasizes the need to consider Cervical Flexion-rotation-ROM asymmetry as an independent predictor of standing balance, over and above the influence of neck pain intensity.  This is a powerful statement and considering in we are dealing with altered orientation, dysequilibrum, and unsteadiness in Cervicogenic Dizziness; we can't ignore this striking finding on correlating postural stability with AA mobility.

However, for MORE diagnostic power in evidence-based practice, we need MORE than just conjecture from basic science and relating range of motion to postural stability.

The clinical reasoning process to diagnose Cervicogenic Dizziness takes the basic science, add a screening process via the Optimal Sequence Algorithm , obtain the appropriate subjective and other objective testing measures---including the Flexion Rotation Test---and BAM...make the clinical diagnosis...doesn't this count as validation?

Honestly this is what we currently have in regards to using the Flexion Rotation Test for Cervicogenic Dizziness.  We don't have a true validation study as we do with Cervicogenic Headaches, but we do have some more oomph from the ivory towers to help make our decision.  To assist with our argument, we have case reports (Gargano et al 2012), case series (Escaloni et al 2018Jung et al 2017) Delphi Study (Reneker et al 2015), case control study (Morgan CD et al 2015), reviews (Cheever K et al 2016) and position statement (Harmon et al 2013).  These literary works all discuss and/or use the Flexion Rotation Test for Cervicogenic Dizziness.

One thing I want to point across is the lack of validation of a test does not mean you can't make inferences.  With basic science input from C0-3 and several studies demonstrating the abnormal findings of C1-2 via the Flexion Rotation Test relating to patients with dizziness, we can't ignore this excellent test.  Use it but use it with strong clinical reasoning for your patients with dizziness to determine how much could be musculoskeletal in nature.


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 1st day includes the “Optimal Sequence Algorithm”, a multi-faceted physiotherapist approach to the assessment of Cervicogenic Dizziness, which includes the appropriate ruling-out process and cervical examination of the articular and non-articular systems. 

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 more information.

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

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Sensorimotor Impairment Treatment in Concussion and Whiplash Patients

Cervicogenic Dizziness, Cervical Vertigo, Dizziness Cervical Spine, Physiotherapy, Physical Therapy, Concussion, mTBI, Whiplash, Harrison Vaughan, Danielle Vaughan

Cervicogenic Dizziness / Cervical Vertigo

It is now well know the correlation between symptoms and physiological effects that are sustained following patients who suffered from concussion and whiplash.  Even though there are still apparent differences clinically, we can now feel comfortable to lump these two conditions together.  It may surprise some readers --- but in this article -- and most likely in the medical literature in the future -- we will collectively call the injury a mild traumatic brain injury (mTBI).  

Galea and colleagues just came out with a Meta-Analysis in 2018 to determine whether persistence of sensorimotor or physiological impairment exists between 4 weeks to 6 months post injury.  More than likely the clinicians reading this article will see a patient suffering from symptoms > 10 days following the injury for definition  of post-mTBI symptoms, but could be between 4-12 weeks so your patient fits in nicely in the objective.  More than likely we are seeing them for dizziness, headaches, neck pain, difficulty concentrating, etc.  

For those interested in reading the entire analysis, feel free to reach out to me for article, but for blog purposes; here is the conclusion:

Findings demonstrate that persistence of sensorimotor and physiological changes beyond expected recovery times following subacute mTBI in an adult population is possible. These findings have implications for post-injury assessment and management.

Big points I want to you to get out of this conclusion. 

Firstly, the "is possible" statement from first glance isn't conclusive at all---but for a meta-analysis---I will take it! 

Secondly, and reason we aim for to read and perform research, is this statement, "these findings have implications for post-injury assessment and management".

The assessment and management of this very complicated and the challenging condition of mTBI is beyond what can be written in words.  In fact, my wife and I teach 16 HOURS worth of updated and modern content to make you more confident in treating someone suffering from mTBI who has Cervicogenic Dizziness / Cervical Vertigo.  This doesn't even include the science and application of treating the other symptoms!

We do know that the presentation of a patient who could have Cervicogenic Dizziness / Cervical Vertigo is much more than someone who has suffered a recent mTBI; but this Meta-Analysis has huge implications for our instructional content and approach.  In fact, a large percentage of our course is dedicated to the assessment and management of Sensorimotor changes.  

Doesn't this last bolded statement correlate nicely with the latest highest-level evidence from Galea et al that was quoted above?

If you're looking to maximize your patient's outcomes---check out a course near you!


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 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

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 more information.

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

Is it Cervical Vertigo or Cervicogenic Dizziness? A Clarification

Cervicogenic Dizziness, Cervical Vertigo, Dizziness Cervical Spine, Physiotherapy, Physical Therapy, Harrison Vaughan, Danielle Vaughan

Cervicogenic Dizziness / Cervical Vertigo

Any clinician working in the neuromusculoskeletal field knows we have a big problem in describing conditions that we diagnosis and treat.  You get 10 PTs to examine a patient and you may get 10 different explanations.  A colleague's work has even just eliminated all abbreviations across all of their clinics as we can't get that right either!

Additionally, there has always been the multi-term description of a "joint problem"---somatic lesion, derangement, dysfunction, hypo mobile joint, hyper mobile joint, etc etc.  The trend is even getting less specific with conditions that have historically carried a diagnostic term.  Subacromial impingement is now being called anterior shoulder pain and patellofemoral pain syndrome is now being called anterior knee pain.

One of the main reasons for this discrepancy is that we have a challenging time correlating the actual source of nocioception from a clinical exam, and can be even less accurate with imaging exam for the above two conditions.  Even more, the purpose of a diagnosis is to lead to a sound treatment plan, but this depends on multiple variables.  Providing a clarification for our findings is challenging.

In the dizziness world, the subjective and variable explanation of symptoms makes the clarification of terminology even more challenging.  

The current medical definitions of vertigo, dizziness, and imbalance are based on the recommendations made by the classification committee of the International Bárány Society for Neuro-Otology.

Vertigo is the sensation of self-motion when no self-motion is occurring; dizziness is the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion; and imbalance or unsteadiness is the feeling of being unstable while sitting, standing, or walking without a particular directional preference.

Additionally, dizziness may be described as feeling dizzy, lightheaded, giddy, faint, spacey, off-balance, rocky, spinning, or swaying (Newman-Toker DE & Edlow JA 2015).  Aren't these descriptions all over the board?!

The definition of Cervicogenic Dizziness / Cervical Vertigo is even more muddy.  Here is a sample of dizziness descriptions from leading authors, alongside correlating them with neck positions/movements.  This is a small collection from my 300 page book (provided with course registration):

Non-rotary dizziness, imbalance, unsteadiness (Reid 2008/2012/2014/2015)

Vague sense of impaired orientation or disequilibrium (Al Saif 2011)

Non-specific sensation of altered orientation in space and disequilibrium (Furman/Cass 1996, Wrisley 2000)

For the most part, dizziness means different things to different people.

One thing I want to point out above is that the description and definition of Cervicogenic Dizziness does not involve vertigo---which is definied as a "sense of spinning, surroundings seem to whirl such as feeling that you are dizzily turning about you".  This is typically associated with BPPV (hence the "V").

In the literature on this topic, you may find  the phrases, "Cervical Vertigo (CV) , Cervicogenic Dizziness,  or Cervicogenic Vertigo" as you search across multiple discipline journals.  Considering vertigo is not a typical description or definition associated with dizziness associated with the cervical spine, I suggest abandoning the phrases, "Cervical Vertigo (CV) and Cervicogenic Vertigo".

You will still find these other terms in overseas texts and articles, so do not abandon it completely in chasing down research, but we do need to continue a trend towards being consistent across our professions.  Therefore...

Let's just stick with good ol' Cervicogenic Dizziness.


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 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

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 more information.

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

Finally. After 17 years, it's here.

CervDizziICC.jpg

Cervicogenic Dizziness

Through my professional life, I have always heard it takes 17 years for evidence to be implemented into clinical practice.  With technological advancements in social media and search capabilities to gain knowledge from literary papers, I feel this number has to be much less nowadays.

While teaching this past weekend, I brought this up.  One of the participants has been treating for 41 years, yes, 41 years!  She quickly reminisced of how different things were back then to share with the class.  Of course obtaining more knowledge and reading papers isn't a quite Google search and follow someone popular on social media platforms.  During those years you actually had to go and search for what you're looking for professionally.  Makes us feel lazy now doesn't it...

The timing of 17 years is coincidental in the context of Diagnosing Cervicogenic Dizziness.  Anyone who has had any interest in this topic has read Diane Wrisley's work: Cervicogenic Dizziness - a Review of Diagnosis and Treatment in our own JOSPT from the year 2000.  It is well cited throughout other profession's works and continues to be almost a "gold standard" go-to when talking about this topic.  You can find it easily online here.

17 years later, in 2017, Alexander Reiley and colleagues right down the road from me at Duke University came out with an updated paper entitled, "How to diagnose Cervicogenic Dizziness".  Within the journal Archives of Physiotherapy, this is an excellent article and has some updated information on the topic.  As an open access article, you can also access it easily online here.

Some of you may think, Harrison---why are you sharing these articles as this is what you and your wife teach during the entire first day on your course circuit!  The purpose of our course is to get this information OUT THERE---to propel our profession forward as the go-to providers to treat Cervicogenic Dizziness / Cervical Vertigo.  We have the background training, the openness in our diagnostic and treatment approaches, the integration of vestibular and manual therapies specialities to change lives.

Also---as I said this past weekend to class participants---we have known about Mark Laslett's SIJ cluster for 10 yrs to diagnose SIJ dysfunction---but we continue to search how to best to TREAT it.

Well---you can always read in papers how to diagnose something, but we do offer our solutions to TREAT it on our second day.  :)

Coincidence of 17 years with update in this diagnostic process system in our professional journals...maybe so.


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 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

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 more information.

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

 

 

Should you recommend surgery for Cervicogenic Dizziness?

CervDizziICC.jpg

Cervicogenic Dizziness

It is well established that conservative treatment should be the primary choice of intervention for non-specific neck pain as the benefit of surgery over conservative care is not clearly demonstrated.  For rehabilitation professionals, the use of exercise therapy and/or manual therapy is obviously the most appropriate decision and should always be utilized prior to most invasive, risky procedures.

This is echoed in the Cervicogenic Dizziness / Cervical Vertigo literature as well.  We have three systematic reviews demonstrating the benefit of non-surgical and non-pharmacological interventions, specifically manual therapy, for these patients.  The high level of evidence all originated in 2005, then again in 2011 and even though just showing effectiveness of acupuncture, endorsed recently in 2017.  Although only three SRs, I think this is very positive considering a condition not well studied and continues to carry the burden of controversy.

Even with substantial evidence showing the effectiveness of conservative care, specifically manual therapies, for Cervicogenic Dizziness / Cervical Vertigo, there are still several citations illustrating success following surgery.

Here is a glimpse of the literature with accompanying conclusion:

Yang Y et al 2007

“Percutaneous laser disc decompression can decrease intradiscal pressure, increase local temperature and remove the spasm of the vertebral artery while providing a remarkable therapeutic effect for the treatment of cervical vertigo.”

 Ren L et al 2014

“Excellent outcome in 18 out of 35 patients who underwent percutaneous laser disk        decompression”

Li J et al 2014

“Good results following more extensive cervical surgery”

Park J et al 2014

“Patient vertigo disappeared after surgical decompression of transverse foramen of C1”

Liu XM et al 2017

“ACDF provided a good resolution of cervical vertigo in a retrospective study of 116 patients”

Yin HD et al 2017

“Radiofrequency ablation nucleoplasty improves the blood flow in the narrow-side vertebral artery in 27 patients diagnosed with cervical vertigo and illustrates the therapeutic effect on cervical vertigo. Radiofrequency intradiscal nucleoplasty can be used as a minimally invasive procedure for treating cervical vertigo”

You can see a trend in the just the last few years indicating success of vertigo/dizziness after surgical procedures.  As an evidence-informed practitioner or even a vestibular specialist who isn’t trained in treating the neck, and recognizes lack of consistent relief in your patient, you may seek out this research and consider referring on to a surgeon.  Before you do so, let’s dive into the most recent article with surgical success to jack into a clinical reasoning discussion.


 

Patients/Methods: Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain

Results: There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group.

Conclusion: This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis.

Out of China, Dr. B Peng and his colleagues recently had this article published in the Bone & Joint Journal (not the best journal but higher impact factor than JOSPT). This is a level 2 multi center prospective cohort study—not bad when considering level of evidence as we have very few studies higher up on the chain and most involve the same name of Susan Reid & her colleagues from the land of Australia.

From initial glimpse of methodology, results and conclusion (you know we all typically look at the abstract…), my thoughts are that if my patient has arthritis and dizziness, then if they have surgery, they will have less intensity and frequency of dizziness compared to conservative route.

The first thing I did was to look at what type of conservative treatment was performed.  Here is the description:

Conservative treatment included physiotherapy, intermittent cervical immobilization with a collar, nonsteroidal anti-inflammatory drugs and rest.

This doesn’t tell us much what kind of physiotherapy was performed (stabilization exercises, heat/ice, e-stim, massage, squeezes for the shoulder blade squeezes with theraband, neck ROM—hell we don’t know!).  We don’t know what was meant by rest, or what was meant by intermittent immobilization of the spine (does anyone do this nowadays anyway?).  For all purposes, it could be the Physio Blend buffet style…but doubtful.

The second thing I did was look at the type of patients that were recruited.

Between March 2014 and March 2015, 157 patients with cervical spondylotic radiculopathy and/or myelopathy from three spinal centres (General Hospital of Armed Police Force, Beijing; 304th Hospital, Beijing; Changzheng Hospital, Shanghai) were enrolled in the study.

Additionally, the patients had failed conservative treatment (3 months of treatment!) prior to potentially having surgery—-34 of the 157 patients declined surgery—but continued with conservative treatment—and this was the group that surgery was compared to!  I’m sure the patients who continued with PT after 3 months were stoked to continue more of the same cervical immobilization, rest, NSAIDs and general physiotherapy….

The third thing I did—write this blog.


Big key points:

This is not a bash against the article—I thought it was well written and authors were open to the limitations in the conclusions.  They even stated the patients selected for study were for myelopathy/radiculopathy and not dizziness!  But, knowing the time and effort that goes into reading research in the profession—the title and abstract could be misleading to the consumer and I felt this blog would be beneficial to my rehabilitation colleagues.

Just like any condition we treat, this paper exemplifies a double entity.  Yes, the patients had improvement in dizziness following the procedure, but I would really say these patients had success of cervical pain due to cervical spondylotic radiculopathy and/or myelopathy, NOT cervicogenic dizziness.

This paper also exemplifies the notion that dizziness can arise from the neck, and can improve with intervention!  So yes, still can be controversial in the medical eyes, but this group sought out improvement in dizziness following the procedure indicating a cause/effect relationship.

Further, if you’re a vestibular therapist seeing patients you think that symptoms could be arising from the cervical spine, don’t just pass on to your orthopedic mate in the clinic.  Get some training, some real training.  We can help you with that.


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 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

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 more information.

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

Everyone loves a buffet – Cervicogenic Dizziness Style

CervDizziICC.jpg

Cervicogenic Dizziness

Happy 2018 everyone!  This year, I am completing my first decade of work as a Physical Therapist—wow, can’t believe it.  I believe I am now considered an oldie…the dinosaur…in our field!

I hope all of my colleagues and readers are continuing to enjoy the profession. Like you all, I continue to have the challenges, failures, and tribulations with clinical practice.  Hopefully these get fewer and fewer between but still very normal even with experience—its the beauty of physiotherapy…of healthcare.   I continue to aim high and hopefully the defeat gets buried away, hidden underneath the hours you spend beating on your craft.  Continue to pursue greatness to propel yourself and our field.  Always remember, have fun as we are very fortunate to change lives everyday.

Over the years, the pursuit of additional training and knowledge has led me down many paths.  As you all are aware if reading this blog over the past year, professionally, I have taken the challenge of being part of a continuing education company,; specifically, teaching the Differential diagnosis & the Manual and Therapeutic Exercise Management of Cervicogenic Dizziness.

The beauty of this condition is that it is a very specific diagnosis—one of which is still controversial, yet, responds very well to multiple treatment approaches throughout the literature.  Unlike treatment approaches in other fields of medicine, you would think that a specific diagnosis would lead to a specifictreatment.  But, just as gray as PT can be, this just isn’t true.  Cervicogenic Dizziness can improve with a taste of ALL we have to offer.  Hell, we can just talk to them and give some general exercises and they improve…but can we do more?  Can we achieve better results?!

This is what the Physio Blend is all about.  It is my specific approach incorporating a taste of ALL we can offer that is achievable no matter your skill level and previous training; including signature soft tissue spots, upper cervical spine joint work, vestibular, pain-relieving and sensorimotor exercises—all packaged together smoothly to maximize results.

It is really our whole package of what we do as a profession.  Its the whole buffet.

buffetline.jpg

If you want to treat concussion, treat whiplash, treat BPPV or even the elderly with balance disturbances, AND be evidence-based in 2018, this is where it’s at.  Feel more confident in your differential diagnosis and be more confident in attacking the upper neck as your resolution this year. You may push and prod on the upper neck and make change, but always know, the desserts are at the end of the buffet.  You may be missing other applicable manual therapies, other applicable exercises, and other applicable confidence to give the entire experience that your patients deserve.


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 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.

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