Cervical Dizziness Diagnosis & Management with Physical Therapy

02/13/2026

Can dizziness occur without severe neck pain and still be called Cervicogenic Dizziness?

When it comes to cervicogenic dizziness, many assume neck pain must be severe to justify the diagnosis.

However, here is the truth.

Dizziness, lightheadedness and unsteadiness are often the primary and most disabling symptoms --- not the neck pain.

Therefore, the nervous system doesn't "care" about the neck pain --- only what the more detrimental and excessive symptoms are.

Basically, dizziness is more of a threat than neck pain in the nervous system algorithm.

02/10/2026

Some thoughts here on micro tears that could occur in the suboccipitals.

Could this be a reason of too much activity in the muscles ? -- to over compensate for a structural fault?

02/06/2026

Do you find more positive BPPV tests in the morning patients??!!

New research shows that the timing of BPPV testing matters. In a large study of 929 patients, positional tests for BPPV were significantly more likely to be positive in the morning (72.5%) compared to the afternoon (64%). This suggests that BPPV may be more active and easier to detect earlier in the day, possibly due to how the inner-ear crystals settle overnight. For patients with dizziness, this highlights why morning appointments can improve diagnostic accuracy and reduce missed cases.

Citation: Lu Q, Zhan T, Xu J, Chen H, Zhou J, Liu H, Yang T, Strupp M, Zhang B. Positive diagnostic positional tests in BPPV are higher in the morning than in the afternoon: a retrospective study. Front Neurol. 2025 Oct 7;16:1689672. doi: 10.3389/fneur.2025.1689672. PMID: 41127286; PMCID: PMC12537766.

02/06/2026

Why you—and the Great Pyramid—shrink over time -

When the Great Pyramid of Giza was built around 2500 BC, it stood approximately 481 feet tall. Today, it measures about 455 feet.

02/03/2026

Differential diagnosis is the battleground framework for a clinician to figure out the cause(s) of dizziness and vertigo.

Here is a nice figure by Tarnutzer et al 2025 looking at duration of a single episode and differential diagnosis.

This is off of the work of "timing and triggers" that are 2 concepts that are highly recommended to know for dizziness differential.

We have this spelled out for Cervical Dizziness in our books and course, even though it is not listed in this figure by this group.

02/02/2026

Brainstem Irritation Model to help explain "why" dizziness can occur from the cervical spine.

02/01/2026

Brainstem Irritation Model.

This can help explain Cervicogenic Dizziness symptoms.

01/27/2026

What tests are available to help diagnose Cervicogenic Dizziness?

1. Cervical torsion test
2. Head-neck differentiation test
3. Certain items from the DHI can help

These aren't perfect. Honestly, a thorough subjective history is needed first. These items can just add cherry on top, alongside other manual and palpation objective measures.

01/26/2026

We have it all to help you help others.

Many different ways to learn!

Check out our educational materials.

01/23/2026

Does cervical manual therapy really help with dizziness?

A new 2025 systematic review and meta analysis looked at dizziness intensity, dizziness impact, neck pain and neck disability.

They examined articles focused on the upper cervical spine interventions.

They found manual therapy showed a statistically significant benefit over sham or control in reducing dizziness intensity and the impact of dizziness on daily life.

Detailed citation in carousel: Carrasco-Uribarren A et al 2025.

01/20/2026

A nice image by Hauser et al 2025 showing dysstructure as a potential etiology for vagus nerve dysfunction --- which can then be correlated with dizziness and cervical origin, hence, Cervicogenic Dizziness.

01/19/2026

Cervicogenic Dizziness can be quite challenging to treat.

What is the ultimate goal? Yes, to get symptoms out of there!, but, what strategy does your physio have to get it done?

Test yourself with these 2 slides.

Where do you feel it?