Case of the Week Aug 2, 2011 - Chronic Dizziness

A patient's close friend was suffering from dizziness for years. She referred her to my practice. She was seeing a local specialist who was medicating her and giving her upper cervical injections (she wasn't sure what kind) monthly. This went on for years with no change. One scary aspect of her case was that she had difficulty driving and she was a bus driver in my local school district!

History

She presented as a pleasant female in her mid 50s, endomorphic with fair sitting posture, protracted shoulders, forward head (of course). Her main complaint was constant dizziness and feeling lightheaded. She also c/o HA and cervical pain L > R radiating to upper traps. Symptoms were worse in the morning, at night, with prolonged sitting and driving.

Objective

Cervical flexion WNL, cervical extension showed moderate loss and pain during motion. Cervical rotation was limited severely bilaterally with hard end feels. Cervical SB was limited severely L > R. Passive intervertebral motion testing revealed severe restrictions in OA bilaterally, severe restrictions in C2-4 downglide L > R. Myofascia was L > R severely restricted along the occiput laterally to medially, and along paraspinals and upper traps proximally to distally. L > R 1st rib was grade 2 for inferior glide.

Discussion: I didn't perform special testing as I don't find it useful. She did not have any trauma and did not have enough restrictions in motion as to appear unstable. Vertebral artery testing is not reliable. I could have tested for BPPV, inner ear dysfunction, etc, but I thought it was cervicogenic based on her very limited cervical ROM and passive accessory motion.

Treatment: Tool Assisted STM to cervical paraspinals and upper traps

Rocabado "skull crusher" shear for OA distraction, this is an extremely effective technique for subcranial dysfunction and OA FB limitation. Great for cervicogenic HA as well. It will get it's own blog post soon.

TASTM was also performed to the upper traps

Home exercises were cervical retraction to be performed hourly, and scapula setting to restore upper quarter  posture. She purchased a lumbar roll for use in all sitting positions.



In one treatment, her dizziness, which was constant had decreased by 75%. Her active ROM in rotation improved by at least 20 degrees in both directions. She was completely symptom free by the 3rd treatment. We kept treating her using TASTM to her cervical paraspinals, upper traps, added first rib non-thrust manipulations. HEP was not changed as she was still symptom free for her last visits. She was treated in all 6 visits, the last of which was two weeks after the 5th. She had near full ROM in all planes, including extension with no reproduction of any dizziness, HA, or cervical pain. She was very pleased, and we were both relieved that school kids were no longer in danger of the dizzy bus driver!