Cervical ROM Asymmetry in Cervicogenic Dizziness

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 2018, Jung 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 [email protected] 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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