Can improving cervical lordosis help with Cervicogenic Dizziness?

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Cervicogenic dizziness has been described in the medical literature to be caused by functional problem of the cervical spine associated with postural alignment, proprioception and range of motion. Although cervical dizziness is controversial, we have large randomized controlled trials and systematic reviews saying that manual therapy and exercise can help with dizziness frequency, intensity and duration.

However, until two chiropractic pieces have arisen in the last few years, we didn’t know if an improvement in cervical lordosis can be linked to improvement in neck dizziness. I find these article interesting on several accounts, but mostly due to a measure of actual cervical lordosis that physical therapists do not have the capability nor training to examine. Let’s explore more.

The first trial comes from Moustafa et al in 2017 entitled, “The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study”. The authors found a statistically significant differences for all of the measured variables of dizziness impairments between groups, including an improvement in cervical lordosis.

The authors hypothesized that

it was the loss of cervical lordosis that was causative for the dizziness symptoms since the comparison group had only temporary symptomatic relief that was lost at the 1 year follow-up

The second study comes from 2020 case report. Dr. Gerstin and colleagues presented a case entitled, “The treatment of dizziness by improving cervical lordosis: a Chiropractic BioPhysics case report”. This case demonstrates the relief of dizziness by the improvement in cervical lordosis in a mid-aged female. There was an approximate 20° lordosis increase achieved over the duration of one year after 115 in-office treatments.

The authors concluded, “

Cervical hypolordosis may be an under-diagnosed cause of idiopathic dizziness in some patients.

Just two studies linking dizziness improvement alongside lordotic posture is not groundbreaking science, but does show a correlation between dizziness and the cervical spine. Also, it answers our blog question that yes, I would say cervical lordosis improvement can help with Cervicogenic Dizziness.

The one thing I want to send out to the readers is that the symptomology of dizziness, lightheadiness and unsteadiness can improve much quicker than 1 year (the final duration in these articles) but it does take time for reversal of the lordotic curve. Therefore, I would still suggest you can get quick relief with appropriate manual therapy and exercise techniques if the diagnosis is correct of cervical reason for the dizziness symptoms.

Without getting into too much details for the readers, the pathophysiology of loss of lordosis is described by the following statement that I use in my teachings: The hypolordosis in mid-cervcial spine will eventually lead to concomitant upper cervical spine extension posture to compensate and assist in horizontal gaze. Therefore, the treatment to the upper cervical spine to improve mobility and flexion will help symptoms in the short term, but ultimately for long term control, addressing the mid-cervical spine to aid in improving cervical lordosis is absolutely necessary.

I applaud these authors for putting this information out there and continue to advance the diagnosis and treatment for these disorders!

You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course.  Pertinent to this blog post, the second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.

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 prices and discounts.

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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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