How many times do physiotherapists see patients with cervical pain due to contractures, torticollis, and even a herniated disc, who also have added symptoms such as a feeling of dizziness and instability, sometimes defined by the patient as “dazedness and drunkenness” that can even be accompanied by headache and, on fewer occasions, vertigo crises.
What are vertigo?
Vertigo is known as that sensation of movement, imbalance and turning of the environment that surrounds us in an unexpected way, all this without really existing, frequently accompanied by a feeling of fainting, altered vision and even nausea and vomiting. Vertigo can have a very short duration of a few seconds, however, in more severe cases it can last for hours.
But why can dizziness be related to the cervical area?
Certain vertebral misalignments at the level of the cervical area can affect or impair the blood flow or irrigation of this area and even the correct functioning of the central nervous system due to alterations that affect the vestibular system, which can trigger certain symptoms such as dizziness or dizziness.
Existing types of vertigo
There are actually 2 types of vertigo: one of peripheral origin, where the ear is the main culprit, and another of central origin, where the brain is responsible.
Vertigo of peripheral origin
The ear is one of our organs responsible for balance: in the inner ear there are structures called the cochlea and semicircular canals. The semicircular canals contain hair cells, which are highly specialized and their function is to transmit an impulse to the brain (through the auditory nerve) that allows the latter to generate movement status in the body.
The hair cells only transmit this impulse if they are stimulated, and their stimulation is caused by a liquid called endolymph, which bathes the semicircular canals. If we move our heads, the endolymph moves, and with it the hair cells are stimulated, giving the brain an idea of how the head is in relation to the body and what is needed to maintain balance.
When vertigo of peripheral origin occurs, the following happens: the liquid found in the semicircular canals, behaving like any other liquid, can continue to move within the semicircular canals even though our head and body do not move. The brain interprets the information that is produced from the stimulus of the hair cells that move through the liquid that does not stop, that is: the body is still, but the ear says no.
Vertigo of central origin
Vertigo of cervical origin is a bit different: all the stimuli and responses are integrated in the brain to produce balance. Like any other organ, the brain requires the nutrients contained in the blood (oxygen, glucose, proteins, etc.) in order to function. If the blood supply to the brain is somehow blocked and the cells cannot be nourished, the integration processes begin to fail.
This is the case of the area of the brain responsible for balance and the vertebral artery: when the vertebral artery is blocked, the balance area loses the potential to perform its functions and vertigo occurs.
In these cases, what is indicated would be for the doctor to rule out an ear problem (plugs, infection, otoliths, acoustic nerve neuroma), heart problems, very advanced cervical osteoarthritis (in the elderly) or even brain tumors. The truth is that none of these problems causes neck pain, heaviness and muscle contracture in the trapezius, pain and tension in the neck, stiffness and torticollis.
Therefore, when all this cervical clinical picture is accompanied by dizziness, we may be (very likely) facing a cervical problem, which, among other things, causes dizziness and instability (that is, they are two symptoms that are apparently unrelated but are actually different expressions of the same problem).
What are dizziness due to vertigo? What are its causes and symptoms?
In this complete video I briefly explain what dizziness or vertigo is and what its main causes and symptoms are:
What causes this clinical picture of cervical pain and dizziness or cervical vertigo?
Obviously, there are always postures and gestures of the cervical spine that make it more tense and facilitate the problem, but we must think that often these postures have been held for years and the patient never had this clinical picture so intense, then ¿ because right now?
My experience with many cases is that the patient has gone through or is going through a peculiar situation in his life:
- The patient is very stressed with his nervous system on edge. This is expressed very well when the patient goes to a shopping center and the excess of noise, lights, people moving, supposes an extra stimuli that his nervous system does not support, it is already saturated, triggering the sensation of dizziness, tension in the neck nausea.
- The patient has had a specific disappointment, a difficult situation to digest. Recent deaths, divorces, professional failures.
- In many cases, both options are given at the same time.
According to traditional Chinese medicine, this type of emotion caused by disappointment, stress and bitterness especially affects the gallbladder and when it is in dysfunction it causes a series of symptoms such as nausea and reflexes in the form of muscle tension in various areas of the musculoskeletal system, among them in the neck and nape of the neck, which in turn unsettles the cervical vertebrae, especially the first and second cervical, which irritates the vertebral artery that carries blood supply to the inner ear and the cerebellum.
Other data confirming that the dizziness is of cervical origin:
- The patient usually notices tension in the trapezius and in the neck, but the physiotherapist can look for a very painful area on palpation, which is the left area of the neck (joint between the 1st and 2nd cervical vertebrae).
- This spinal block will cause a decrease in the amplitude of the rotation of the head and neck to the left side, which can sometimes be subtle and others very pronounced and even painful.
- Painful palpation of the fourth and fifth vertebrae dorsally.
- When the patient is standing and looking at the ceiling (Michel’s test) we will see how the left side of the head is higher, we can easily see this by comparing the height of each ear.
How to differentiate if a dizziness is of cervical or ear origin
As many of you already know, the symptoms and signs of dizziness can have several origins, within which, broadly speaking, it can be said that it has two causes that are present in most dizziness. On the one hand, alteration of the posture of the cervical spine and, on the other hand, alterations in the inner ear that can cause these symptoms.
Treatment of this cervical pain accompanied by cervical vertigo or dizziness
Manual therapy is always convenient in cases of cervical dizziness or vertigo, especially osteopathic manipulations in the dorsal area, especially in the fourth vertebra and the relaxation of the cervical and suboccipital muscles that will collaborate in the adjustment of the first two cervical vertebrae and its relation to the head.
On the other hand, the involvement of the patient is very valuable and essential, that he knows the relationship between his stress and his discomfort with his cervical problem and dizziness will greatly facilitate the effectiveness of manual therapy and the treatment of medicinal plants.
Summary about dizziness or cervical vertigo
A clinical picture of cervical pain, heaviness and muscle contraction in the trapezius, pain and tension in the neck, stiffness and torticollis, which is also accompanied by dizziness, indicates that it is not an ear problem but rather a neck problem.
Situations of great emotional tension can trigger the appearance of dizziness or cervical vertigo.
Manual therapy is an ideal way to treat problems of cervical origin that generate or trigger cervical vertigo or dizziness.