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Posted on 03-05-2012

Good Morning!  Many of our patients have presented over the years with sudden onset of vertigo or dizziness.  There are several reasons for vertigo but the most common reason is "BPV" or Benign Positional Vertigo. Many people unknowingly expect that it is coming from their inner ear.  This study shows it actually comes from the upper neck!  Here is a great study out of the European Spine Journal.

From the study: To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist.

We examined the cervical spines of 67 patients who presented with symptoms of dizziness.

Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up.

Group A 31 patients [31/50 = 62%], were diagnosed with dysfunctions of the upper cervical spine. These dysfunctions were found at the following levels:

C1 in 14 cases C2 in 6 cases C3 in 4 cases In seven cases

[14/31 = 45%]
[6/31 = 19%]
[4/31 = 13%]
[7/31 = 23%] more than one upper cervical spine motion segment was affected

Dysfunctions of the upper cervical spine "were treated and resolved with mobilizing and manipulative techniques of manual medicine." [Very Important]

Group B 19 patients [19/50 = 38%], did not show signs of cervical dysfunction.

"Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy."

At the final 3-month follow-up, 24 patients of the cervical spine dysfunction group (77.4%) reported an improvement of their vertigo and 5 patients [16%] were completely free of vertigo.

In the group with no cervical spine dysfunction, at the 3-month follow-up, improvement of vertigo was recorded in only 26.3% and none of these patients became free of symptoms.

These authors "concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of

long-lasting dizziness in our population."

THESE AUTHORS ALSO NOTE

"The term 'dysfunction' as used in manual medicine terminology is defined as a reversible, functional restriction of motion of an individual spinal segment or as a peripheral articular malfunction presenting with hypomobility."

Upper cervical spine dysfunctions can be the cause of localized or pseudo- radicular pain as well as the "cause of vertigo and impaired hearing via disturbances of the proprioception from the neck."

"The significance of dysfunctions of the upper cervical spine as one cause of vertigo and impaired hearing has been commonly discussed in ENT and neurology literature [13 references]." [Very Important]

Only dysfunctions of the upper cervical spine segments can cause vertigo.

[Very Important]

Cervical spine dysfunctions below the C2/C3 motion segment are thought unlikely to be a cause of vertigo. [Very Important]

Clinical experience and anatomical studies "identify links between cervical spine receptors and vestibular nuclei." [Very Important]

"A large supply of receptors was found in neck muscles, especially when muscles were short and in close proximity to facet joints." [Very Important]

The reproducible manual medicine examining technique used in this study consisted of three well-defined steps used to diagnose segmental cervical spine dysfunction:
1) "Hypomobility of the individual spinal segment was determined by examining isolated segmental rotation and observing asymmetry in rotation of one side compared to the other."
2) "Limited rotation of individual cervical spine segments was detected by comparative palpation of bony prominences of adjacent vertebrae serving as points of reference, e.g. mastoid process, transverse processes of the atlas, and spinous process of the axis."
3) The spine was then examined for a "zone of segmental irritation" which is detected by palpation. "Its characteristics are tenderness to palpation, increased palpatory resistance and non-uniform consistency."
"The zone of segmental irritation directly relates to the dysfunction of the individual spinal segment in terms of time and quality, as it will disappear once the dysfunction is corrected."

"Segmental dysfunctions are functional restrictions of motion."

In this study, "if dysfunctions of cervical spine segments were diagnosed in the studied patients with vertigo, they were subsequently resolved with manual therapy. Mobilizing techniques without impulse as well as manipulative techniques with high-velocity impulses were applied."

RESULTS

Thirty-one patients (group A), displayed dysfunctions of the upper cervical spine at the initial visit.

Nineteen patients (group B), did not have dysfunctions of the upper cervical spine.

DISCUSSION

It is apparent that improvement of vertigo was seen more frequently in patients with cervical spine dysfunction than in those without cervical spine dysfunction (77.4% vs 26.3%). "A similar pattern was seen with respect to complete relief of vertigo."

"We conclude that physical therapy is more likely to succeed in reducing vertigo symptoms if these patients present with an upper cervical spine dysfunction that is successfully resolved by manual medicine prior to physical therapy."

"We regard the cervical spine dysfunction seen in patients of group A as the principal cause of their vertigo."

The positive influence of physical therapy in some of the patients without cervical spine dysfunction "may be explained by an improvement of muscular imbalances of neck muscles."

"The existence of links between neck muscles and vestibular nuclei is known."

"In the presence of vertigo, our presented data suggests consideration of cervical spine dysfunctions, requiring a manual medicine examination of upper motion segments." [Very Important]

KEY POINTS I WANT YOU TO KNOW:

1) "The term 'dysfunction' as used in manual medicine terminology is defined as a reversible, functional restriction of motion of an individual spinal segment or as a peripheral articular malfunction presenting with hypomobility."

2) "Segmental dysfunctions are functional restrictions of motion."

4 3) Upper cervical spine dysfunctions can be the cause of localized or pseudo-

radicular pain as well as the "cause of vertigo and impaired hearing via disturbances of the proprioception from the neck."

4) "The significance of dysfunctions of the upper cervical spine as one cause of vertigo and impaired hearing has been commonly discussed in ENT and neurology literature [13 references]." [Very Important]

5) Only dysfunctions of the upper cervical spine segments can cause vertigo. [Very Important]

6) Cervical spine dysfunctions below the C2/C3 motion segment are thought unlikely to be a cause of vertigo. [Very Important]

7) Clinical experience and anatomical studies "identify links between cervical spine receptors and vestibular nuclei." [Very Important]

8) "A large supply of receptors was found in neck muscles, especially when muscles were short and in close proximity to facet joints." [Very Important]

9) In this study, dysfunctions of cervical spine segments were resolved with manual therapy, which included "manipulative techniques with high-velocity impulses."

10) "Physical therapy is more likely to succeed in reducing vertigo symptoms if these patients present with an upper cervical spine dysfunction that is successfully resolved by manual medicine prior to physical therapy."

11) In this study, the cervical spine dysfunction was the principal cause of their vertigo.

12) Physical therapy can improve vertigo patients without cervical spine dysfunction "by an improvement of muscular imbalances of neck muscles."

  1. 13)  "The existence of links between neck muscles and vestibular nuclei is known."

  2. 14)  In this study only 38% of patients did not show signs of cervical dysfunction.

  3. 15)  In this study, most patients with vertigo [62%] had dysfunctions of the upper cervical spine. The segmental levels of the cervical spine dysfunctions are:

  1. A))  C1 in 45%

  2. B))  C2 in 19%

  3. C))  C3 in 13%

  4. D))  More than one segment in 23%

16) Dysfunctions of the upper cervical spine "were treated and resolved with mobilizing and manipulative techniques of manual medicine." [Very Important]

17) It is apparent that improvement of vertigo was seen more frequently in patients with cervical spine dysfunction than in those without cervical spine dysfunction (77.4% vs 26.3%). "A similar pattern was seen with respect to complete relief of vertigo." [At the final 3-month follow-up]

18) These authors "concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population."

19) "In the presence of vertigo, our presented data suggests consideration of cervical spine dysfunctions, requiring a manual medicine examination of upper motion segments." [Very Important]

Be sure to share this article with those you love.  Have a blessed day! 

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