Article
Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin☆

https://doi.org/10.1016/S0003-9993(96)90273-7Get rights and content

Abstract

Objective: To assess postural performance in patients with dizziness of suspected cervical origin in whom extracervical causes had been excluded, and to assess the effects of physiotherapy on postural performance and subjective complaints of neck pain and dizziness.

Design: Prospective, randomized, controlled trial.

Setting: Primary care centers and a tertiary referral center.

Patients and Subjects: Of 65 referrals, 43 patients were excluded because extracervical etiology was suspected. Of the remaining 22 patients, 17 completed the study (15 women, 2 men, x̄ age 37yr, range 26–49). The controls were 17 healthy subjects (15 women, 2 men, x̄ age 36yr, range 25–55).

Intervention: Physiotherapy based on analysis of symptoms and findings, and aimed to reduce cervical discomfort. Patients were randomized either to receive immediate physiotherapy (n = 9), or to wait 2 months, undergo repeat measurements, and then receive physiotherapy (n = 8).

Main Outcome Measures: Posturography, measuring velocity and variance of vibration-induced body sway and variance of galvanically induced body sway. Subjective intensity of neck pain (Visual Analog Scale ratings, 0–100), intensity and frequency of dizziness (subjective score 0–4).

Results: The patients manifested significantly poorer postural performance than did healthy subjects (.05 > p >.0001). Physiotherapy significantly reduced neck pain and intensity and the frequency of dizziness (p <.01), and significantly improved postural performance (.05 > p >.0007).

Conclusions: Patients with dizziness of suspected cervical origin are characterized by impaired postural performance. Physiotherapy reduces neck pain and dizziness and improves postural performance. Neck disorders should be considered when assessing patients complaining of dizziness, but alternative diagnoses are common.

References (56)

  • M Ålund et al.

    Dynamic posturography among patients with common neck disorders

    J Vest Res

    (1993)
  • ME Norré et al.

    Cervical vertigo diagnosed by posturography

    Acta Otolaryngol (Belg)

    (1987)
  • H Aalto et al.

    Computerized posturography, a development of the measuring system

    Acta Otolaryngol (Stockh)

    (1988)
  • R Johansson et al.

    Human postural dynamics

    CRC Crit Rev Biomed Eng

    (1991)
  • LM Nashner

    Fixed pattern of rapid postural responses among leg muscles during stance

    Exp Brain Res

    (1977)
  • H Enbom et al.

    Presentation of a posturographic test with loading of the proprioceptive system

    Acta Otolaryngol (Stockh)

    (1988)
  • M Magnusson et al.

    Galvanically induced body sway in the anterior-posterior plane

    Acta Otolaryngol (Stockh)

    (1990)
  • RL Voorhees

    The role of dynamic posturography in neurootologic diagnosis

    laryngoscope

    (1989)
  • LBW Jongkees

    Cervical vertigo

    Laryngoscope

    (1969)
  • JJ Brown

    Cervical contribution to balance: cervical vertigo

  • K Kroenke et al.

    Causes of persistent dizziness

    Ann Intern Med

    (1992)
  • M Feldenkrais

    Awareness through movement

    (1987)
  • E Jacobsen

    Progressive relaxation

    (1938)
  • F Kaltenborn

    The spine

  • K Lewit

    Manipulative therapy in rehabilitation of the locomotor system

    (1991)
  • I Pyykkö et al.

    Hierarchy of different muscles in postural control

    Acta Otolaryngol (Stockh)

    (1989)
  • T Brandt

    Traumatic otolith vertigo

  • AK Ommaya et al.

    Whiplash injury and brain damage

    JAMA

    (1968)

    • Cited by (0)

    ☆

    Supported by grants from the Medical Faculty of the University of Lund, the Swedish Medical Research Council (grant no. 17X-05693), the Swedish Society for Medical Research, and the “Förenade Liv” Mutual Group Life Insurance Company, Stockholm.

    Preliminary results from this study were presented at the XIth International Symposium on Posture and Gait, Portland, OR, May 23–27, 1992.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    View full text
    Copyright © 1996 Published by Elsevier Inc.