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Cervicogenic dizziness is a condition where dizziness or a sensation of imbalance originates from the neck (cervical spine). The cervical spine is home to highly advanced proprioceptors which are responsible for the body’s sense of self movement and knowing where we are in space. Li et al., (2022) has suggested that dysfunction in the musculoskeletal structures of the neck and the resulting mismatch of proprioceptive input can lead to cervicogenic dizziness. This is due to the fact the body’s ability to process balance and spatial awareness is affected.

Musculature of the neck

Signs and Symptoms

Dizziness is complex and it can often be difficult to determine if the cervical spine is the true underlying cause of dizziness, due to various systems working simultaneously. That being said, the list below outlines clinical signs and symptoms that are commonly associated with cervicogenic dizziness:

  • Sensation of dizziness or disorientation, often described as a feeling of “floating” or being “off balance”.
  • Dizziness that becomes worse with head movement
  • Dizziness that becomes worse with prolonged neck positions
  • Dizziness that occurs secondary to neck pain or stiffness
  • Symptoms that subside as neck pain eases
  • Headaches; which are often localised to the back of the head
  • Symptoms that can last for minutes to hours

Contributing Factors

Cervicogenic dizziness is directly related to issues which arise in the neck and each of the following can be classed as contributing factors:

  • Neck trauma or injury – Whiplash and/or concussion from a car accident or sports injury can damage soft tissues and joints, leading to dysfunction.
  • Poor posture – Prolonged forward head posture (e.g., from desk work or frequent phone use) can strain the neck muscles and joints.
  • Impaired proprioception – 50% of all cervical proprioceptors are present in the joint capsules of C1–C3 hence dysfunction of these joints is a key factor in this condition.
  • Degenerative changes – Age-related conditions such as osteoarthritis or cervical spondylosis can affect joint function.
  • Muscle imbalances – Weakness or tightness in the neck and shoulder muscles can alter normal movement patterns.
  • Temporomandibular joint (TMJ) dysfunction – Problems with the jaw can create tension in the neck, affecting balance perception.
  • Stress and anxiety – Increased muscle tension in the neck due to psychological stress can contribute to symptoms.

Diagnosis

There is no one clinical test that leads to a diagnosis of cervicogenic dizziness and is often classed as a diagnosis of exclusion. A thorough history is required to rule out the following:

  • Medical concerns: Heart conditions or neurological conditions that may present with dizziness as a symptom
  • Vestibular concerns: Can often be concurrent to a diagnosis of cervicogenic dizziness or neck pain and hence this can make the distinction difficult at times.

In conjunction with the above a series of physical examinations will be conducted to assess neck mobility, muscle tightness, joint function and posture.

Depending on the history of the presenting concern and onset of symptoms, imaging may be needed to help determine the anatomical cause of this condition; particularly in cases where an injury or trauma has occurred in the neck/head region.

Prognosis

The outlook for cervicogenic dizziness depends on the underlying cause and how well it responds to treatment. With appropriate management, many people experience significant improvement or complete resolution of symptoms. However, recovery time can vary, with some individuals improving within weeks, while others may require ongoing management if symptoms are linked to chronic conditions such as osteoarthritis.

Early intervention, including physiotherapy, can lead to better outcomes and reduce the risk of persistent dizziness.

Physiotherapy

Physiotherapy can be largely beneficial for people living with cervicogenic dizziness from the point of view of both treating symptoms and addressing underlying causes. Physiotherapy intervention may include but is not limited to:

  • Manual Therapy – Hands-on techniques such as joint mobilisation, soft tissue massage, and muscle release to improve neck mobility and reduce muscle tension.
  • Postural Retraining – Education on postural adaptations, particularly for desk workers and those with forward head posture.
  • Strengthening Exercises – Targeted exercises for the deep neck flexor muscles improve neck stability and reduce strain on the upper cervical spine.
  • Vestibular Rehabilitation – While cervicogenic dizziness is not a vestibular disorder, balance retraining exercises can help improve spatial awareness and reduce dizziness.
  • Proprioceptive Training – Exercises focusing on head and neck awareness can help the nervous system better integrate sensory information.

Cervicogenic dizziness is an evolving field in the profession of physiotherapy with continued improvements being made to treatment techniques and protocols. De Vestel et al., (2022) suggesting that the best improvement of symptoms for cervicogenic dizziness comes from a combination of manual therapy techniques and exercise therapy.

Additional Treatment

Whilst physiotherapy is a cornerstone of treatment for cervicogenic dizziness there are additional techniques that can aid in symptom relief and prevent reoccurrence such as:

  • Lifestyle Modifications – Adjusting work ergonomics, taking breaks from screen use, and maintaining good posture.
  • Stress Management – Relaxation techniques such as deep breathing, meditation, or counselling may help reduce muscle tension.
  • Medication – While not a primary treatment, anti-inflammatory medications or muscle relaxants may be prescribed in cases where pain and muscle tightness are severe.