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Cervical Vertigo: Combined Treatment
Cervical vertigo is one of the most commonly diagnosed forms of vertigo. Symptoms include: dizziness; episodic or persistent balance instability; tinnitus; neck pain; and, less frequently, hearing loss. It is commonly associated with whiplash injuries, but this study worked with a population of 15 subjects suffering from cervical vertigo mainly associated with non-traumatic, chronic musculoskeletal conditions.
A group of Brazilian researchers set out to assess the therapeutic results of several conservative treatments for patients suffering from cervical vertigo. The following modalities were used in treatment:
- Spinal manipulation (1 patient had contraindications for spinal manipulation and did not receive this treatment.)
- Manual techniques including: postisometric relaxation, ischemic compression, and proprioceptive neuromuscular facilitation. These treatments were to improve coordination of motion patterns for muscle groups in the shoulder girdle and cervical region and to lessen abnormal muscle tonus.
- Electrotherapy – analgesic interferential therapy.
- Medication Labyrinth-sedation drugs were used on a limited basis.
- Biofeedback Cervical and upper trapezium region were subject to surface electromyography biofeedback.
- Exercise program aimed at increasing balance, increasing range of motion for thoracic, shoulder-girdle region, and cervical spine and stretching of affected muscles.
The researchers found a strong correlation between cervical vertigo and musculoskeltal pain. They state:
"There is a marked difference between average duration of vertigo at the first consultation (36 days) and musculoskeletal symptoms (7.5 Years). These data suggest that in the patients studied dizziness arises as an aggravating factor of chronic musculoskeletal dysfunction of the cervical spine and shoulder girdle. It is also interesting to notice that the treatment was more efficient for remission of vertigo (9 patients), an acute symptom, than for remission of pain (4 patients), a chronic problem. Two patients observed a clear relationship between the aggravation of pain and occurrence of vertigo and that the treatment was effective both for the reduction of pain and interruption of vertigo, suggesting a clear parallel between the intensity of cervical and shoulder dysfunction and the onset of vertigo."
This graph displays study results:
The authors conclude:
"Complete remission or consistent improvement of vertiginous symptoms was reported by 80% of the patients studied, and there was no case of worsening of symptoms. The result suggests that the treatment protocol presented is indicated and effective for the treatment of cervical vertigo."
"Chronic, non traumatic, cervical and shoulder-girdle dysfunction appears to be an important causal and perpetuating factor of cervical vertigo in the population studied."
Bracher E, Almeida C, Almeida R, Duprat A, Bracher C. A combined approach to the treatment of cervical vertigo. Journal of Manipulative and Physiological Therapeutics 2000;23(2):96-100.
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