Cervicogenic (because of neck pain/stiffness) Dizziness

History: B.B. is a 56 year old female who came to The Center for Balance with complaints of dizziness and balance problems. Patient states present symptoms initially began after slipping on ice and falling backwards striking her head. Patient sustained a neck sprain/strain injury.  Patient complains of dizziness, vertigo, imbalance, and neck pain and stiffness, “It is like a whiplash injury to my neck, but I also hit my head and had a concussion”. Patient complains of dizziness with head movements, walking and turning her head, and reading her computer. Patient is presently employed in the medical field and is on her feet all day with a lot of turning, bending, and ambulating. Daily activities include; work, family outings, general activities of daily living, and working out.  Patient complains of dizziness 8/10 (10 being severe dizziness, 0 being no dizziness), fear of falling 5/10 (10 being a high fear of falling, 0 no fear of falling). Patient stated her dizziness feels like, “wooziness, light headedness”, during activities moving her head and trunk.

Examination: Patient demonstrated positive oculomotor testing indicating vestibular (inner ear) deficits with eyes and head movements. Patient experiences dizziness while moving eyes to read and moving her head while focusing on an object. Patient static balance/BERG test score was 42/56 moderate deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 17/24 for moderate deficit (13/24 severe deficit); timed up go test 12 seconds moderate deficit (10 seconds or less is normal). Patient demonstrated a significant decrease in range of motion side bending and rotating her head. Patient demonstrated a positive trunk torsion smooth pursuit test for cervicogenic dizziness secondary to neck pain and stiffness.

Assessment: Patient demonstrating dizziness and imbalance secondary to post concussion and neck injury sustained in a fall (cervicogenic dizziness). Patient demonstrating decreased cervical range of motion, neck stiffness and pain, and abnormal neck biomechanics during activities of daily living. Patient demonstrating increased risk of falling during dynamic activities.

Treatment: Patient underwent an individualized functional vestibular rehab and balance training program concentrating on vestibular adaptation exercises and manual physical therapy techniques to increase cervical (neck) range of motion and to decrease muscle spasms. Treatment included neck manual traction, soft tissue mobilization and massage of the neck muscles, and range of motion and neck strengthening exercises. Patient also performed functional static and dynamic balance exercises.

Results: At the time of discharge from physical therapy, patient was demonstrating no dizziness or fear of falling during daily activities. Patient balance testing scores goals have been met; static balance final score 56/56 (goal 56/56), dynamic balance final score 24/24 (goal 22/24), timed up and go score 7 seconds (goal 10 seconds or less). Patient cervical range of motion was within normal limits, negative trunk torsion smooth pursuit testing. Patient was able to return to her prior level of activities of daily living without dizziness, imbalance, and neck pain or stiffness.