Prevalence of cervical dysfunction in those referred for treatment of vertigo or dizziness

Abstract

BACKGROUND: Cervical spine dysfunction has been shown to cause symptoms of dizziness and vertigo in patients, due to its connection to the vestibular system. There is a sparsity of prospective studies describing the prevalence of cervical involvement in these patients. OBJECTIVE: To identify the prevalence of cervical mobility restrictions in patients with symptoms of dizziness and vertigo prospectively. METHODS: Eighty-two subjects referred to physical therapy were assessed for mobility restrictions from the Atlanto-occipital joint to the level of C5 using evidenced-based manual techniques. These techniques included the seated and supine cervical flexion rotation tests and posterior to anterior joint mobility assessments. RESULTS: The prevalence of cervical mobility restrictions was 72% overall. Restrictions were found in 70% of those referred for dizziness/vertigo, 64% with benign paroxysmal positional vertigo (BPPV) and 90% of those referred for concussion. None of the referring providers had considered cervical involvement prior to making the referral. CONCLUSIONS: Afferent input from the muscles, joint and connective tissues in the cervical spine can cause the symptoms associated with dizziness, vertigo and concussion. This prospective study demonstrates the high prevalence of cervical mobility restrictions in these patients. This study provides much needed evidence for the need for early manual assessment of the cervical spine and surrounding structures if an appropriate rehabilitation program is to be designed. Physical therapists, athletic trainers and those who care for patients with complaints of dizziness, vertigo, BPPV or concussion should assess their patient for mobility restrictions early on in the evaluation process and treat accordingly.