The Problem
Barbara, a 49-year-old female presented to our office with complaints of dizziness, nausea, and disequilibrium of 8 months duration. She had no history of similar condition. The only previous trauma she noted was a neck injury due to whiplash 5 years prior. She described fluctuating symptoms that occurred daily. The symptoms were made worse by head movements or with lying down and would last for hours. She related that she also experienced neck pain and headache in association with the dizziness. She denied any tinnitus or hearing loss.
She demonstrated an inability to maintain focus on an object while turning her head and complained of increased nausea during activities that required head and eye movement. An otolaryngologist who found no pathology and prescribed medication to help with symptoms had evaluated her.
On initial evaluation, Barbara stated that she was suffering from milt to moderate neck pain, which she rated at 4/10. Neck range of motion was mildly impaired in flexion and extension and moderately impaired in lateral bending bilaterally. Spinal joint dysfunction was noted in the neck and upper back region. She also presented with tenderness to palpation and palpable trigger points in her upper trapezius, scalene, and sternocleidomastoid muscles bilaterally. Standing with her feet close together was not a problem with her eyes open, but she was unable to do it when asked to close her eyes. Static head/body rotation test recreated her dizziness and nausea. This is a specific test performed where the patient sits on a chair that rotates. One clinician holds the patients head stable, while another rotates the individual’s body back and forth. This allows for a stimulation of the joints and tissues of the neck without moving any of the vestibular apparatus in the patient’s head. X-rays revealed a slight reversal of the neck’s normal curve and mild disc degeneration at the C5 and C6 levels.
The Solution
Based on all of the clinical findings, the patient was given a diagnosis of Cervicogenic Dizziness/Vertigo. Barbara was initially treated with muscle release techniques, trigger point injections, and spinal adjustments. Symptoms quickly improved and the focus of care shifted to active spinal rehabilitation and the restoration of the normal spinal curves. Active in office care was completed within 2 months and the patient was symptom free. At that point she continued at home exercises and returned for maintenance/supportive care to assist with stabilization and prevent future recurrence.