It is without a doubt that treating a multi-system symptom of dizziness is challenging! Not only can dizziness be a vague phrase for similar descriptions such as vertigo, lightheadiness, unsteadiness or even drunkenness, it is hard to "capture" objectively.

Vestibular rehabilitation principles that have been present since mid-1940s is by far one of the best ways to rehabilitate dizziness from vestibular lesions. Prior to these approaches, the treatment of dizziness was usually wait-and-see, medication and/or manual therapies (i.e. chiropractic, acupuncture, osteopath --- as physio didn't really have much manual therapy at this time).

In the last half-decade, the understanding of correlating manual therapy and vestibular principles has yielded to be superior in the treatment of double entities (also known as double origin). We are now seeing a trend towards a third pillar of rehabilitation for some dizziness disorders, called proprioceptive cervical training.

To bring this to real-life circumstances, I take you to the recent retrospective review by Hammerle et al in 2019. In short, the study aimed to assess the outcomes of 2 treatments for patients with dizziness after mild traumatic brain injury (mTBI) who demonstrate abnormal cervical spine proprioception --- vestibular rehabilitation or cervical spine proprioceptive re-training (CSPR) --- alongside their facility's standard manual therapy approach.

Here are some of the major results:

"The logistic regression analysis indicated treatment as a significant predictor of dizziness improvement, indicating that those who received the CSPR treatment were approximately 30 times more likely to report improved dizziness relative to those who received usual care."

85% of the individuals in the CSPR group and only

18% in the usual care group had dizziness improvement

The authors go on to state:

These findings suggest that treatment directed toward cervical proprioception may be important for individuals with dizziness after mTBIwhere signs of altered CSP are demonstrated and no clear peripheral vestibular or consistent central signs are present.

Furthermore, here is the direct conclusion:

“The study results demonstrated that active-duty military patients after mTBI with dizziness, abnormal CSP tests, no active vestibular pathology, and no consistent central signs who had treatment directed toward CSP seem to improve in their dizziness symptoms more than the patients who had the usual care (consisting of VRT). “

If you are looking to find the most consistent blend of manual therapy, vestibular and sensorimotor training; we offer our systematic approach based off of evidence as you just read with the art of therapeutic planning and progression with not just your mTBI patients, but also neck pain and vestibular dysfunctions.