Cervical Vertigo and Cervicogenic Dizziness – Neck pain and dizziness

Ross Hauser, MD

For many people with neck pain and symptoms of vertigo and dizziness, common sense and their own awareness of their daily quality of life suggest to them that the many symptoms they have must be interconnected. There can be no other explanation. Yet for many of these people, their symptoms are divided up and distributed among specialists to be given individual focus. Digestive problems and nutritional disorders are sent to the gastroenterologist, cardiovascular-like problems are sent to the heart specialist, and balance and dizziness issues are sent to the ENT and then possibly a neurologist. Rarely do these specialists talk to each other, rarely is there a “master plan” or grand unifying attempt to get these patients into a treatment program that addresses them as a whole.

It is for this reason that we will often get an email asking “Can a pinched nerve in the neck cause vertigo?” This email may be coming from someone who has battled many symptoms for many years and it is through their own research or an appointment with an enlightened physical therapist, chiropractor, or doctor that the idea that a pinched nerve in their neck may be their “ground zero” for the cause of many of their symptoms. This may describe you, you may be on this article because you are searching for support material to validate or dismiss this idea of a pinched nerve in the neck causing among other things, cervical vertigo, dizziness, and balance issues.

What are we going to discuss in this article?

Discussion points:

The prevalence of cervical dizziness is still not recognized by the entire medical community

A December 2022 paper writes: (21) “The prevalence of cervical dizziness, still not recognized by the entire medical community, not only does not become less frequent, but even increases today. This phenomenon is facilitated by the widespread computerization of our lives and, in particular, the strain on the neck when working with portable electronic equipment. Despite the fact that criteria that reliably confirming the association of dizziness with cervical pathology have not yet been defined, experimental and clinical evidence of such an association continues to accumulate.”

I start this article with that quote from doctors who see as we have seen, the damage that the poor posture of the technological age has caused and the length of debate surrounding what is causing the symptomatic problems many people suffer from and the controversies of how to treat them and if what they are sufferings from actually exists as a diagnosis. Neck pain and dizzy spells are not problems that typically problems that are isolated. The person who suffers from these disorders will usually, almost always suffer from many problems, and they will all be related to each other.

Here are some examples:

When I turn my head I get dizzy.

After the car accident.

There was no “event,” that triggered this.

No one wants to believe me because an MRI of my head doesn’t show anything.

I am arguing with my doctor that he is recommending me to get surgery that I do not need

Now it is more than just dizziness – new symptoms

Over the next few months and years, I had occasional dizziness, sometimes severe enough to send me for emergency care and an emergency room x-ray of my head and neck.  All the doctors could tell me was that they suspected some type of post-traumatic concussion syndrome or whiplash-related disorders. At the last emergency room visit, it was recommended to me that I get “more aggressive,” with seeking out what was wrong with me.

I now began the more aggressive course of action that started with physical therapy. At PT, my therapist recommended that I go back to the doctor and get a referral for an ENT specialist, a neurologist, and a cardiovascular specialist. Let’s “rule out what is not wrong with you.”

Doctors too are looking for answers, including the relationship between neck pain and dizziness.

Above we read about people and their stories. Their stories contain fear and confusion and sometimes conflicting ideas with their doctors as to what is wrong with them. Doctors too are looking for answers, including the relationship between neck pain and dizziness.

Let’s look at an April 2020 study from the Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, in Norway. The paper was published in the journal Physiotherapy Research International. (1)

In this paper, the researchers wanted to know if dizziness severity and degree differed between patients who only suffered from dizziness and patients who suffered from dizziness and neck pain. In other words, how did neck pain contribute to dizziness as compared to people with dizziness without neck pain?

Here are the summary learning points:


Conclusion: Neck pain is associated with certain dizziness characteristics, increased severity of dizziness, and increased physical impairment when compared with dizzy patients without neck pain.

So what can one do with information like this? Simply explore cervical spine instability as the cause of headache if neck pain is present.

You have likely been asked the key questions numerous times: How often do you get dizzy? Do you get dizzy when you look up? Look down? All around?

If you are reading this article it is likely that you have seen many health care providers with problems of neck pain and dizziness. It is also very likely that you are still looking for an answer, any answer to why your problem persists.

You have likely been asked the key questions numerous times: 

You may also be tired of answering these same questions because no one has seemed to help you.

Your doctor may have offered you a diagnosis of benign paroxysmal positional vertigo or BPPV with a somewhat reassuring tone that your dizziness, loss of balance, sometimes nausea, sometimes vomiting is something that can be managed, and may go away on itself, and this will be more of a nuisance than anything. That is why it is called “Benign.”

For some people, it may end at just that, a nuisance. These are usually not the people that come into our offices. We see the people whose symptoms have progressed to include double vision or sight problems and other challenges. These are related below.

“After all the lab tests, I was still dizzy”

Often a patient will tell us that they had a myriad of lab tests looking for the source of their frequent, occasional, or most of the time dizziness. At the end of these tests, the patient started looking for other doctors to help them. When they are sitting in our clinic they will often tell us, “after all the tests, I was still dizzy and worse, there seemed to be no plan to help me.”

Further, the controversy surrounding a diagnosis of cervical vertigo stems from confusion and comparison with other symptoms related to whiplash-related injuries and inner ear disorders. Below we will review studies, which detail in-depth, screening procedures that exclude possible causes of dizziness.

The controversy surrounding a diagnosis of cervical vertigo and why no one has been able to help you

Sometimes a patient will tell us that they went to a specialist and were told that there is no such thing as cervical vertigo. Pursuing this diagnosis was not helpful. Above we examined one study that tried to make a connection between neck pain and dizziness. Let’s look at another.

A June 2019 study (2) offered these statements:

It should be pointed out that despite the confusion and the controversy, manual therapies, treatments that address the cervical spine, and physical therapy seem to be the best answers.

Cervical Vertigo–Reality or Fiction?” Two studies 23 years apart, ask the same exact question.

The title of this 2019 research study is: “Cervical Vertigo–Reality or Fiction?”

In 1996, 23 years earlier, a research study (3) also had the same exact title: “Cervical Vertigo–Reality or Fiction?” The answer to the question, in 23 years, had still not been sufficiently answered.

In this 1996 study, Professor Thomas Brandt of the Department of Neurology at the University of Munich offered this assessment:

“Neck afferents (nerves) not only assist the coordination of eye, head, and body, but they also affect spatial orientation and control of posture. This implies that stimulation of, or lesions (damage) in, these structures can produce cervical vertigo. . . Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. To date, however, the syndrome remains only a theoretical possibility awaiting a reliable clinical test to demonstrate its independent existence.”

Just like your medical journey, the research journey of doctors trying to understand the cause of your dizziness and the origins of cervical vertigo is also a long one.

Please refer to my companion article:

An introduction to our treatment philosophy with Ross Hauser, MD.

We know that you have probably done extensive research on the internet for the treatment of your dizziness and balance issues and you have read many, many articles. Before we move into the clinical and research observations, many new studies from within the last year, let’s have Dr. Hauser present a short summary.

Summary learning points of this video

At 1:00 of the video, Dr. Hauser refers to this image to describe the impact of compression of the vagus nerve and the glossopharyngeal nerve on heart rate and blood pressure

This image describes the impact of compression of the vagus nerve and the glossopharyngeal nerve on heart rate and blood pressure

At 2:00 of the video – When a person has cervical instability especially upper cervical instability

At 2:20 of the video, the close proximity of the vagus nerve, the glossopharyngeal nerve, and the spinal accessory nerve to the C1-C2 vertebrae is demonstrated in this image

This image displays the close proximity of the vagus nerve, the glossopharyngeal nerve, and the spinal accessory nerve to the C1-C2 vertebrae. This proximity makes compression of these nerves common in cervical spine instability.

Brief introduction of Prolotherapy as a treatment for this problem

At 3:00 of the video: We document the cervical instability by scanning with a Digital Motion X-Ray (explained below) and when instability in the C1-C2 region is found, we then tighten the stretched-out ligaments with Prolotherapy. These injections are typically given once a month. It causes a tightening of the ligaments and once the cervical spine is made stable again the nerve sensors through the vagus nerve and the glossopharyngeal nerve start working correctly and the arrhythmias go away.

Back in 1998, the connection between cervical neck pain and dizziness was not only not understood, but it was rarely studied. Doctors began to study the cervical spine as a cause of dizziness.

When we started our regenerative medicine practice back in 1993, one of the phenomena we studied in neck pain patients was, why did they have dizziness. So for us, treating the neck for problems of dizziness, balance, and healing problems is not a new phenomenon. But at the time was certainly something debated. Does neck instability cause dizziness?

The connection to cervical neck pain and dizziness was not only not understood, but it was also rarely studied.

In 1998, just over 22 years ago, the connection to cervical neck pain and dizziness was not only not understood, but it was also rarely studied.

Listen to what German researchers wrote back then in the European Spine Journal. (4) This research is important today as it is often used as a starting point of the cervical neck/dizziness connection debate: In this research, treating cervical neck instability made vertigo go away.

The research paper begins:

To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist.”

To test their hypothesis that upper cervical disorders caused dizziness, the German doctors examined the cervical spines of 50 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out.

The researchers concluded that “functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population.”

Disabling dizziness from neck instability treated successfully with Prolotherapy

In this video, a patient shares his experience with dizziness and light sensitivity coming from neck instability, and treatment with Prolotherapy here at the Hauser Neck Center. His story is similar to many people who we speak to and see here for care. **DISCLAIMER: As with any medical treatment, no guarantees or claims of cures are made as to the extent of the response to treatment that every person experiences. Every therapy/treatment has patients who experience varying levels of success and failure. Results may not be the same from patient to patient, even with a similar diagnosis, as the body’s internal status is unique to each individual.

A note on the cervical spine or neck muscles.

If you notice, the patient in this video has a muscular physique and what would be considered a “thick neck.” Many people ask, how does someone with such a strong neck have cervical instability problems? Isn’t a goal of physical therapy the strengthening of neck muscles to restore stability?

Before these questions are answered let’s look at some research.

A July 2020 paper in the Journal of Physical Therapy Science (18) suggests that neck muscles do play a role in providing pain relief and stability but the results are not clear. This is what the paper highlighted:

Results of this study showed that the thickness of (the cervical spine) extensor muscles was not significantly different between the patients with cervical vertigo and healthy (control) participants. This finding is consistent with previously published medical review results in a comparison of muscle thickness between people with and without forward head posture. Other research showed cervical muscle thickness in people with and without forward head posture showed only a significant difference in Sternocleidomastoid muscle thickness (the largest muscle at the front of the neck). However, in this study, a significant difference was only observed in the Longus colli muscle. (The Longus colli muscle is a paired muscle on the left and right front side of the neck. The muscles work with the longus capitis, rectus capitis anterior and scalenus anterior muscles to stabilize the front of the neck). Yet it was only Longus colli muscle thickness that was observed to be higher in the patients with cervical vertigo than in healthy subjects. This finding is inconsistent with previous research results. The Longus colli muscle as a deep neck flexor muscle stabilizes the cervical spine together with other deep muscles during the movements. As the cervical instability may cause abnormal afferent signals to the central nervous system and consequently vertigo feeling, the higher thickness of the Longus colli muscle may be a compensatory mechanism in the patients with cervical vertigo.

The learning points are:

People with neck pain and dizziness do not seem to display a loss of muscle strength

The idea that this is not solely a problem of the muscles is indicated in a March 2022 paper in The International Tinnitus Journal. (19) In this paper doctors at the Department of Otolaryngology Head and Neck Surgery, University of São Paulo offered an evaluation of neck pain with proprioceptive (with movement) cervicogenic dizziness.

Learning points:

Why physical therapy may not help neck pain and secondarily, vertigo. Tendonitis

For physical therapy to be effective in building muscle strength, the muscles must have sufficient resistance to challenge the muscle. The muscle attaches to the bone at the tendon interface. A November 2018 paper in the journal Review Medicine (20) suggested that vertigo was caused by longus colli tendonitis.

Here are the learning points and presented case history of this paper:

The patient case:

Outcomes: The symptoms were relieved immediately after the treatment and complete resolution of the symptoms was observed after 1 week.

Lessons: “Longus colli tendinitis with vertigo is an under-reported condition in the literature and physicians should be aware of its existence. A lack of familiarity with the anatomy of the prevertebral space and its variable radiographic appearance makes the diagnosis of longus colli tendinitis clinically difficult. Misdiagnosis of this condition may lead to unnecessary interventions in vertigo.”

People with neck pain have worse dizziness, and people with dizziness have worse neck pain. This should be studied

Let’s look at an April 2020 paper which examined the connection between neck pain and dizziness. This paper was published in the journal Physiotherapy Research International (5) and comes to us from the Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology, and Head and Neck Surgery, Haukeland University Hospital. Here are the learning points. Remember these are doctors educating other doctors on the relationship between dizziness and neck pain.


Conclusion: “Neck pain is associated with certain dizziness characteristics, increased severity of dizziness and increased physical impairment when compared with dizzy patients without neck pain.”

“Functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo.”

Why do we find this one sentence so remarkable?  Because this one line may be the answer for many of you reading this article. Let’s explain.

The researchers suggest that you must examine the motion segments of the upper neck because it is the unresolved (non-treated) vertebral segments that are causing the problems. In our 26+ years of service in treating cervical neck disorders, we have found that many patients who come through our doors do not have an accurate diagnosis or assessment of their situation.

As you can see in the video below, DMX is a motion picture of the bones while a person is moving. It is a dynamic diagnostic tool, versus a static one. The scan is produced in real-time, while the person is moving his/her neck.  Pain typically occurs with motion. By being able to see the bones in motion, DMX picks up abnormal or excessive motion whereas MRI, CT scan, and static x-rays do not.

“Let’s rule out what is not wrong with you.”

Above we told the story of a patient who had many symptoms. The aggressive plan to help her was to rule out what is not wrong with her.

Finding the source of dizziness is a matter of exclusion. It is a process of elimination – The Tests

In September 2017, doctors at Duke University published research in the Archives of Physiotherapy. (6) Here is the introductory paragraph:

“Cervicogenic dizziness is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for Cervicogenic dizziness and therefore Cervicogenic dizziness is a diagnosis of exclusion.

It can be difficult for healthcare professionals to differentiate Cervicogenic dizziness from other vestibular, medical, and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses.

Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose Cervicogenic dizziness. . .  and provide steps to exclude diagnoses that can present with symptoms similar to those seen in Cervicogenic dizziness, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash-associated disorder.”

Here are some of the tests they reviewed for patients’ cervical vertigo and cervicogenic dizziness and brief reasoning behind them:

The Duke researchers were very comprehensive. Here are some of the tests they reviewed for patients with chronic conditions and the brief reasoning behind them:

Let’s point out again that the Duke team suggests that diagnosis is difficult and is sort of like peeling an onion, there are many layers that need to be peeled away, Cervicogenic dizziness is a diagnosis of exclusion.

In research published by Caring Medical:  Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability led by Danielle Steilen-Matias.(7) Our team also suggested that the diagnosis of chronic neck pain due to cervical instability is particularly challenging. In most cases, diagnostic tools for detecting cervical instability have been inconsistent and lack specificity, and are therefore inadequate. A better understanding of the pathogenesis of cervical instability may better enable practitioners to recognize and treat the condition more effectively. For instance, when cervical instability is related to injury of soft tissue (eg, ligaments) alone and not fracture, the treatment modality should be one that stimulates the involved soft tissue to regenerate and repair itself.

As we were ruling out possible causes for my dizziness, more and more symptoms developed

If you are like the people with a similar story to that above, your medical journey may have continued like this:

At some point, my physical therapist confirmed with my doctors, and finally, something began to make sense. Were all these problems with my neck? Did I have cervical neck instability?

Another story: Here is a patient on video. Patricia’s story is one we commonly see. The results she achieved may not be typical for everyone. Complex cases typically require more than one treatment. Not everyone has successful outcomes. Here is the transcript to read:

My problems began after I fell. I tripped over a curb and fell. After the fall  I started having problems with dizziness, being unstable, and my ears were ringing. I started getting a lot of head pain, muscle spasms, and pain between my eyes.

I’ve now had one dose of Prolotherapy, my symptoms are so much better. Prior to the Prolotherapy, I was sort of a prisoner in my own house because of my dizziness and lack of balance, and the pain that I was in.

I was pretty much a couch surfer and in bed and I had to cancel a lot of activities that I had signed up for I wasn’t able to take my dog for a walk. My life really changed. I had Prolotherapy 3 weeks ago and pretty much all of my symptoms have been alleviated I’m very thankful for that because I don’t have to stay home all the time because I’m in pain and the Prolotherapy from Dr. Hauser has been very very helpful.

The Prolotherapy was given in my c-spine about 3 weeks ago and my symptoms, my energy level, everything is really improved since then.

Since posting this video we were asked questions about this type of Prolotherapy treatment for these symptoms

So why is the connection between cervical neck dysfunction and dizziness still controversial?

In this research from 2000, we can demonstrate that coming up two decades later, the problem of Cervical Vertigo and Cervicogenic Dizziness still presents problems for health providers in identifying and treating these problems and as you know FIRST HAND, problems that cannot be identified in patients ARE OFTEN DISMISSED.

Here is the 2000 research (8from the Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, appearing in the Journal of Orthopaedic & Sports Physical Therapy:

Dizziness, headaches, and neck pain come together. Is it a pinched nerve?

Halfway between 2000 and today, a 2009 study appeared in the Annals of Physical and Rehabilitation Medicine. (9) Here medical university researchers in Tunisia wanted to examine balance disorders in chronic neck pain patients suffering from vertigo and balance instability.

Ninety-two patients having suffered from chronic neck pain for at least 3 months were enrolled in the present study. Patients with a history of neck trauma or ear, nose, and throat, ophthalmological or neurological abnormalities were excluded so as to be able to focus on cervical instability as the cause.

The patients were divided into three groups:

Findings in the groups

The doctors also noted that the study evidenced abnormal static and dynamic balance parameters in chronic neck pain patients with vertigo. These disorders can be explained by impaired cervical proprioception (a disruption in nerve signaling in the body’s unconscious or involuntary movements – pressure on the nerves) and neck movement limitations. Headaches were also more frequent in these patients.

The connection between dizziness, cervical instability, and degenerative disc disease in our aging population – is dizziness a problem of degenerative disc disease in the neck?

A second 2009 study by often cited researcher Setsuko Morinaka M.D, of the Department of Otorhinolaryngology, Kobe Japanpost Hospital (10) examined patients over 66 and younger than 65.

In his study, Dr. Morinaka analyzed the frequency of musculoskeletal diseases in patients with cervical vertigo, as well as the relations of neck tenderness, psychiatric symptoms, and autonomic abnormalities (other symptoms beyond dizziness including irregular heartbeat after exercise, blood pressure drop, fainting, et al.) with pain and age.

One hundred and seventy-six patients with cervical vertigo were analyzed.

Degenerative disc disease in the cervical spine, cervical spondylosis: Damaged cervical ligaments as a cause of dizziness – the loss of blood flow to the brain

Is Vertigo associated with advanced degenerative changes in patients with cervical spondylosis? That is the title of a 2011 paper published in the medical journal Clinical Rheumatology (11) by doctors at Mansoura University in Egypt.

Here are the learning points of their research.

In this research, the doctors investigated the effect of cervical spondylosis on the blood flow velocity in vertebral arteries during cervical rotation and to identify the possible association of vertigo with the decreased blood flow velocity during head rotation in these patients.

Dizziness and pain may be a call from your ligaments asking you for help

The cervical ligaments are strong bands of tissues that attach one cervical vertebra to another. In this role, the cervical ligaments become the primary stabilizers of the neck. When the cervical ligaments are healthy, your head movement is healthy, pain-free, and non-damaging. When the ligaments are suffering from degenerative wear and tear or excessive looseness or laxity that prevents the ligaments from holding the vertebrae together, the ligaments lose their ability to control the proper motion of your head. The head begins to move in a destructive, degenerative manner on top of your neck. When this occurs the cervical neck ligaments cry out and you feel pain and you can develop the symptoms of cervical vertigo and dizziness.

In the journal, Medical Hypothesis,(12) researchers and clinicians made a connection that the loss of flexibility of the posterior longitudinal ligament in the neck, was a compounding factor in cervical dizziness.

Here are the learning points of this study and what the doctors were looking for in the treatment of cervical disorders, such as vertigo, headache, and dizziness.

So what does this mean to you? 

But what if fusion is not what you want? Can this ligament be repaired to not send pain signals and cause dizziness? The answer is for many people, yes.

Brain fog, breathing and swallowing difficulty, dizziness, tinnitus

Brad’s story will resonate with many of you. He will describe the same symptoms and combination of symptoms that many of our patients suffer when they first see us.

Brad’s story is unique, it may not be typical of the patients we see. Brad with treated with Prolotherapy injections and neck curve correction techniques. Not everyone will achieve these results as the results of treatment will vary.

We specifically want to highlight his case because he has some unusual strange sensations in his ear and breathing difficulties because of his problem with his contracting diaphragm.

Patient symptom list:

The patient had these symptoms for 3 – 4 months. It started with a fall off a ladder. Symptoms did not develop for months

Because of the nature of his injury and ligament damage in his cervical spine, the patient underwent eight prolotherapy treatment sessions. Here is his description:

Cervical Vertigo Treatment options

There are many treatment options for the management of chronic neck pain and cervical vertigo. That you are reading this article is an indication that you may have tried many of these treatments with limited or no results.

These treatments may have included:

The bottom line is that two-thirds of patients experienced dizziness relief for two months with a nerve block.

The hunt for muscle pain, muscle spasms, and weakened neck muscles as the cause of dizziness

Treatments surrounding blood flow

The bottom line of this research is that these treatments may have good short-term benefits, however, long-term is more typically the patient’s goal. This is achieved by addressing the stabilizing of the cervical spine and healing ligament injuries.

Looking at a muscular cause for this is confusing to researchers because there do not appear to be consistent answers. What did the physical therapists find?

As like yourself, many people with neck problems and systems of dizziness, after extensive testing, are often sent for exercise or physical therapy to strengthen the neck. For some, there must be a muscle component whether it is atrophy or thickening/swelling.

In July 2020 in the Journal of Physical Therapy Science (15), a group of physical therapists looked at the muscles of their patients who suffered from cervical vertigo. They compared these patients’ muscles with the cervical spine muscles of people who did not have cervical issues or cervical vertigo. What were they looking for and what did they find? Let’s let them answer.

“Cervical vertigo as a common complaint is associated with some musculoskeletal disorders. However, to date, ultrasonographical parameters of cervical muscles in patients with cervical vertigo have not been investigated. (Guidelines to help other health care professionals zero in on the muscles as a possible cause of the patient’s dizziness.) (The researcher’s study) was conducted to investigate the size of cervical muscles in patients with cervical vertigo compared to healthy controls.”

Thicknesses of cervical flexor (If you have been going to physical therapy, these names should be familiar to you: the longus colli, longus capitus, rectus capitus, and longus cervicus muscles) and extensor muscles (the deep muscles, the semispinalis cervicis, and multifidus) were evaluated through ultrasonography and results were compared between the patients and healthy controls.

Results showed that the thickness of the longus Colli muscle (the muscle that helps you look down) was significantly different between the patients and healthy controls. According to the findings of the study, the size of longus colli muscle is likely to be associated with the etiology of cervical vertigo.”

What does this mean?

The researchers noted: “As the cervical instability may cause abnormal afferent signals (messages between the brain and spinal cord) to the central nervous system and consequently vertigo feeling, the higher thickness of Longus Colli may be a compensatory mechanism in the patients with cervical vertigo.”

In other words, the muscle is thicker because it is trying to do a job it is not intended to do, the job of the cervical ligaments and keeping the vertebrae in place.

In this image, we see a depiction of a muscle spasm in the back of the neck. Why the muscle spasms, or why it gets thicker is a response to cervical spine ligament injury. The muscle is trying to hold things together to prevent the nerve or cervical arteries from being impinged.

In this image we see a depiction of muscle spasm in the back of the neck. Why the muscle spasms, or why it gets thicker is a response to cervical spine ligament injury. The muscle is trying to hold things together to prevent the nerve or cervical arteries from being impinged.

These researchers did cite another study that you may find of interest because it is something we see in many patients. The inability of the head to return to a normal posture position following certain movements because the vertebrae are not where they should be. They are not lined up correctly. This would lead to muscle thickening. This study comes from the Journal of Rehabilitation Medicine. (16) It deals with whiplash victims and dizziness.

“Dizziness and/or unsteadiness are common symptoms of chronic whiplash-associated disorders. This study aimed to report the characteristics of these symptoms and determine whether there was any relationship to cervical joint position error. Joint position error, the accuracy to return to the natural head posture following extension and rotation, was measured in 102 subjects with persistent whiplash-associated disorder and 44 control subjects. . . The results (of this study) indicated that subjects with whiplash-associated disorders had significantly greater joint position errors than control subjects.”

The researchers noted:

“Within the whiplash group, those with dizziness had greater joint position errors than those without dizziness following (head) rotation (to the right or left) and a higher neck pain index (score). . . Cervical mechanoreceptor dysfunction (simply the sensors in the neck that transmits information based on touch, pressure, stretching, and motion) is a likely cause of dizziness in whiplash-associated disorder.”

So what do we have here and what does it mean to you? Something is pressing on your nerves and arteries causing a dizzy situation.

Possibly that injury such as whiplash or degenerative disease or diseases possibly hEDS (Ehlers-Danlos Syndrome) has caused cervical spine instability. A thicker Longus Colli muscle may offer the clue necessary to help isolate cervical spine instability as opposed to other causes for your dizziness. The thicker muscle may indicate that the cervical spine ligaments are weak, your cervical vertebra is out of place, and something is pressing on your nerves and arteries causing a dizzy situation.

Regenerative Medicine Injections | Caring Cervical Realignment Therapy

Prolotherapy is an injection technique that stimulates the repair of unstable, torn, or damaged ligaments. When the cervical ligaments are unstable, they allow for excessive movement of the vertebrae, which can then restrict blood flow to the brain, pinch on nerves (a pinched nerve causing vertigo), and cause other symptoms associated with joint instability, including cervical instability.

Non-surgical treatment – Cervical Spine Stability and Restoring Lordosis -Making a case for regeneration and repair of the spinal ligaments

Above we spoke about the vertebrae not being in the right place and this is caused by cervical spine ligament laxity or damage. The muscles of the neck may then spasm and thicken as a result of the muscle trying to do a job it was really not intended to do. Hold the cervical vertebrae in place. We also spoke about people who suffer dizziness when they move their heads a certain way.

Look at these images below. When the patient looks down, there is a 6 mm (about 2/10ths of an inch) space between the C1-C2. There is room for some vessels and nerves to get through. When the same patient looks up, 0 mm or NO SPACE. Everything in between gets pinched.

The space between C1 and C2 varies with head movement.

In this section, we are going to talk about the realistic non-surgical options for the treatment of cervical spine instability and compressed cervical arteries and their related symptoms.

Digital motion X-ray showing C1-C2

This is another of our videos, it gives a clearer view of C1-C2 instability in another patient.

Here are some brief explanatory notes. The video is only 1 minute in length.

  • Digital Motion X-ray is a great tool to show instability at the C1-C2 Facet Joints
  • The amount of misalignment or “overhang” between the C1-C2 demonstrates the degree of instability in the upper cervical spine. How much space there is between the C1 and C2 on certain neck movements.
  • This is treated with Prolotherapy injections (explained below) to the posterior ligaments that can cause instability.
  • At 0:40 of this video, a repeat DMX is shown to demonstrate the correction of this problem.

Treating cervical ligaments – published research from Caring Medical

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment for difficult to treat musculoskeletal disorders including problems created by neck instability. Above, we discussed our 2014 research headed by Danielle R. Steilen-Matias, PA-C, (7) we also noted that when the cervical ligaments are injured, they become stretched out and loose. This allows for excessive abnormal movement of the cervical vertebrae.

Treating and stabilizing the cervical ligaments can alleviate the problems of cervical vertigo by preventing excessive abnormal vertebrae movement, the development or advancing of cervical osteoarthritis, and the myriad of problematic symptoms they cause.

Actual Prolotherapy treatment

This video jumps to 1:05 where the actual treatment begins.

This patient is having C1-C2 areas treated. Ross Hauser, MD, is giving the injections.

Caring Cervical Realignment Therapy (CCRT)

As we discussed in reviewing the research above, our goal is to provide long-term solutions to the problems and symptoms of chronic neck pain and instability such as headaches, dizziness, vertigo, lightheadedness, imbalance, and a host of other symptoms attributed to neck injuries.

Caring Cervical Realignment Therapy combines individualized protocols to objectively document spinal instability, strengthen weakened ligament tissue that connects vertebrae, re-establish normal biomechanics and encourage the restoration of lordosis. This is our treatment method of moving towards putting a patient’s cervical spine back into place.

Through extensive research and patient data analysis, it became clear that in order for patients to obtain long-term cures (approximately 90% relief of symptoms) the re-establishment of some lordosis, (the natural cervical spinal curve) in their cervical spine is necessary. Once spinal stabilization was achieved with Prolotherapy and the normalization of cervical forces by restoring some lordosis, lasting relief of symptoms was highly probable.

The Horrific Progression of Neck Degeneration with Unresolved Cervical Instability. Cervical instability is a progressive disorder causing a normal lordotic curve to end up as an “S” or “Snake” curve with crippling degeneration.

The Horrific Progression of Neck Degeneration with Unresolved Cervical Instability. Cervical instability is a progressive disorder causing a normal lordotic curve to end up as an “S” or “Snake” curve with crippling degeneration.

Treatments for cervical spine realignment – restoring the curve without surgery

When we start looking at the most recent research papers surrounding treatments for cervical spine realignment, we often find ourselves reading a lot of new research on cervical spine surgery procedures. Non-surgical treatments for cervical spine realignment are, for the most part, fewer and far between. There is a rush in medicine to surgically correct cervical spine abnormalities including the loss of the natural cervical spine curve. In our office, we rush more to non-surgical applications to help the patient with cervical spine instability and abnormal curvature of the spine. But what if you were told surgery should be strongly considered?

A February 2017 study in the European Journal of Physical and Rehabilitation Medicine (17) investigated the immediate and long-term effects of a 1-year multimodal (multi-treatment) program, with the addition of cervical lordosis restoration and anterior head translation (Forward Head Posture) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility (proper head orientation), and cervical pain in patients with cervicogenic dizziness.

Patients were divided into two groups, both groups received therapy and exercise programs, and one group received a cervical neck traction device.  At 10 weeks, the group analysis showed equal improvements in dizziness outcome measures, pain intensity, head repositioning accuracy, the severity of dizziness, dizziness frequency, and neck pain.

At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation, cervical lordosis, the severity of dizziness, dizziness frequency, and neck pain, indicating greater improvements in the traction group. The results lead the researchers to conclude that “appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation (traction) of the cervical spine (lordosis and head posture correction), as it might lead to greater and longer-lasting improved function.

Treating cervical ligament weakness and starting the journey to restoring proper cervical curve.

In this video, Ross Hauser, MD, and Brian Hutcheson, DC describe a case of restoring the cervical spinal curve and alleviation symptoms.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

Please see related articles:

We hope you found this article informative and it helped answer many of the questions you may have surrounding Cervical Vertigo and Cervicogenic Dizziness. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

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1 Knapstad MK, Nordahl SH, Skouen JS, Ask T, Goplen FK. Neck pain associated with clinical symptoms in dizzy patients—A cross‐sectional study. Physiotherapy Research International. 2020 Apr;25(2):e1815. [Google Scholar]
2 Végh I, Harmat K, Gerlinger I. Cervical vertigo-reality or fiction?. Orvosi hetilap. 2019 Jun;160(25):967-72. [Google Scholar]
3 Brandt T. Cervical vertigo–reality or fiction?. Audiology and Neurotology. 1996;1(4):187-96. [Google Scholar]
4 Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. European Spine Journal. 1998 Feb 1;7(1):55-8. [Google Scholar]
5 Knapstad MK, Nordahl SH, Skouen JS, Ask T, Goplen FK. Neck pain associated with clinical symptoms in dizzy patients—A cross‐sectional study. Physiotherapy Research International. 2020 Apr;25(2):e1815. [Google Scholar]
6 Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Archives of Physiotherapy. 2017 Dec;7(1):12. [Google Scholar]
7 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
8 Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy. 2000 Dec;30(12):755-66. [Google Scholar]
9 Yahia A, Ghroubi S, Jribi S, Mâlla J, Baklouti S, Ghorbel A, Elleuch MH. Chronic neck pain and vertigo: Is a true balance disorder present?. Annals of physical and rehabilitation medicine. 2009 Oct 31;52(7):556-67. [Google Scholar]
10 Morinaka S. Musculoskeletal diseases as a causal factor of cervical vertigo. Auris Nasus Larynx. 2009 Dec 31;36(6):649-54. [Google Scholar]
11 Machaly SA, Senna MK, Sadek AG. Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis. Clinical rheumatology. 2011 Dec 1;30(12):1527-34. [Google Scholar]
12 Li J, Gu T, Yang H, Liang L, Jiang DJ, Wang ZC, Yuan W, Wang XW. Sympathetic nerve innervation in cervical posterior longitudinal ligament as a potential causative factor in cervical spondylosis with sympathetic symptoms and preliminary evidence. Medical hypotheses. 2014 May 1;82(5):631-5. [Google Scholar]
13 Hahn T, Halatsch ME, Wirtz C, Klessinger S. Response to Cervical Medial Branch Blocks In Patients with Cervicogenic Vertigo. Pain Physician. 2018 May;21(3):285-294. PMID: 29871373. [Google Scholar]
14 Wang Y, Ma C, Li L, Zhang T, Gui X, Chen H. Effects on cervical spondylosis of vertebral artery type and the concentrations of plasma NPY and UII in the patients treated with the modified Acupuncture at unilateral/bilateral Renying (ST 9). Zhongguo zhen jiu= Chinese acupuncture & moxibustion. 2018 May 12;38(5):4733. [Google Scholar]
15 Talebi RZ, Rezasoltani A, Khalkhalizavieh M, Manshadi FD, Baghban AA. Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonography. Journal of Physical Therapy Science. 2020;32(7):439-43. [Google Scholar]
16 Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of rehabilitation medicine. 2003 Jan 1;35(1):36-43. [Google Scholar]
17 Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study. European journal of physical and rehabilitation medicine. 2017 Feb;53(1):57-71. [Google Scholar]
18 Talebi RZ, Rezasoltani A, Khalkhalizavieh M, Manshadi FD, Baghban AA. Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonography. Journal of Physical Therapy Science. 2020;32(7):439-43. [Google Scholar]
19 Saraiva R, Nedison GP, Garcia CB. Clinical Evaluation of Neck in Patients with Proprioceptive Cervicogenic Dizziness. International Tinnitus Journal. 2021;25(2):143-8. [Google Scholar]
20 Shen Y, Zhou Q, Zhu X, Qiu Z, Jia Y, Liu Z, Li S. Vertigo caused by longus colli tendonitis: A case report and literature review. Medicine. 2018 Nov;97(45). [Google Scholar]
21 Tardov MV, Boldin AV, Razumov AN. Tservikogennoe golovokruzhenie [Cervicogenic vertigo]. Zh Nevrol Psikhiatr Im S S Korsakova. 2022;122(12):50-56. Russian. doi: 10.17116/jnevro202212212150. PMID: 36537631.

This article was updated April 15, 2022



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Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax
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