Cervicogenic dizziness: When your neck affects your balance
What is cervicogenic dizziness?
Cervicogenic dizziness refers to a sensation of instability or disorientation in space, caused by a dysfunction in the neck.
More specifically, the problem often stems from cervical proprioception—that is, the ability of the neck’s muscles and joints to inform the brain about the position of the head.
Normally, the brain combines information from:
- The eyes
- The inner ear (vestibular system)
- The neck
When the information from the neck becomes inaccurate or inconsistent with the other sources, it creates a sensory conflict. As a result, the brain may interpret this as a signal of instability and trigger dizziness.
Where does your dizziness really come from?
Do you feel dizzy, unsteady, or even as if you’re “in a fog”? What if the problem isn’t coming from your inner ear, but rather from your neck? Cervicogenic dizziness is a condition that is still little known, but quite common, especially among people suffering from neck pain or who have experienced whiplash.
A More Common Occurrence Than You Might Think
Dizziness is very common in cases of neck pain. In fact, between 40% and 85% of people who have experienced a neck injury report these types of symptoms.
These sensations can be unsettling and even alarming. They are also sometimes associated with anxiety, a loss of confidence in movement, or a tendency to avoid certain activities. Understanding what is happening is therefore essential to taking the right steps.
What are the symptoms?
Symptoms can vary, but the most common ones are:
- Dizziness or lightheadedness
- A feeling of instability or imbalance
- Blurred vision or difficulty focusing
- Neck stiffness or pain
- Nausea (sometimes)
A key point: these symptoms are often triggered or worsened by neck movements.
Vertigo or dizziness: an important distinction
These two terms are often confused, but they do not refer to the same thing:
- Vertigo: a sensation that you or your surroundings are spinning (often related to the inner ear)
- Lightheadedness: a sensation of instability or floating, without rotational movement
- Instability: difficulty maintaining balance, especially while standing or walking
Cervicogenic lightheadedness generally corresponds to instability, not vertigo.
How is the diagnosis made?
There is no single test to diagnose this condition.
Cervicogenic dizziness is what is known as a diagnosis of exclusion: this means that other possible causes must first be ruled out (particularly vestibular or neurological ones). The physical therapist therefore uses clinical reasoning based on several factors.
A Multi-Step Evaluation
-
The Interview
The professional seeks to understand:
- When the symptoms began
- Whether they are related to neck movements
- Whether there was any trauma
- Any other associated symptoms
-
Screening for Warning Signs
Certain more serious conditions must be ruled out.
If the physical therapist determines that certain signs are sufficiently concerning, a medical referral will be necessary.
-
The neck assessment
- Mobility
- Pain
- Muscle strength
- Motor control
- Posture
-
Sensory-motor tests
These tests assess:
- Cervical proprioception
- Balance
- Eye-head coordination
- Certain vestibular functions
The goal is to determine whether there is an imbalance in the integration of sensory information.
How do you know if the neck is the cause?
The physical therapist considers several factors:
- Are the symptoms triggered by the neck?
- Have other causes been ruled out?
- Are there any deficits in the cervical region?
It is the combination of these clues that points to a cervicogenic origin. Good news: it responds very well to treatment. Cervicogenic dizziness generally responds very well to physical therapy.
With appropriate care, including:
- Vestibular rehabilitation
- Manual therapy
- Therapeutic exercises
The condition often resolves fairly quickly and without lasting effects in most cases.
What does treatment involve?
Treatment is personalized and may include:
- Exercises to improve neck mobility
- Muscle strengthening
- Coordination and stability exercises
- Sensory integration exercises
The goal is simple: to restore clear communication between the neck, eyes, and inner ear.
When should you seek help?
If you experience dizziness:
- Related to neck movements
- Accompanied by neck pain
- Persistent or concerning
Key points
- Cervicogenic dizziness is common but often misunderstood
- It stems from a dysfunction in the neck
- Diagnosis relies on a comprehensive evaluation
- Treatment is usually effective from the very first sessions