manuelletherapie 2008; 12(2): 80-93
DOI: 10.1055/s-2008-1027384

© Georg Thieme Verlag KG Stuttgart · New York

Zervikogener Schwindel: Diagnose und manualtherapeutische Behandlung[1]

Cervicogenic Dizziness: Diagnosis and Manual Therapeutic TreatmentJ. Hauswirth1
  • 1Physiotherapie, Kantonsspital Bruderholz, CH-Bruderholz
Further Information

Publication History

Manuskript eingetroffen: 6.5.2007

Manuskript akzeptiert: 21.9.2007

Publication Date:
25 April 2008 (online)


Zervikogener Schwindel tritt zusammen mit pathologischen Befunden in der oberen HWS auf, die mit Manueller Therapie behandelbar sind. Das Ziel dieses Literarturreviews war es, die Studien aufzulisten, die zervikogenen Schwindel mit Manueller Therapie behandelten. Zurzeit besteht wenig Evidenz für die Wirksamkeit von Manueller Therapie bei der Behandlung zervikogenen Schwindels. Begrenzender Faktor sind die fehlenden randomisierten Studien. Bei der korrekten Diagnosenstellung von zervikogenem Schwindel zur Festlegung weiterer Tests und Maßnahmen spielt die Differenzialdiagnose von Schwindel eine wichtige Rolle.

Außerdem werden Diagnosekriterien, Evaluierung und Behandlung von auf die HWS zurückzuführendem Schwindel dargestellt, um zwischen den Fällen mit Manueller Therapie als Behandlung der Wahl und denen zu unterscheiden, die die Überweisung an einen Spezialisten erforderten.


Cervicogenic dizziness occurs in association with pathological findings in the upper cervical spine which can be treated with manual therapy. The objective of this literature review was to summarize the studies which used manual therapy to treat cervicogenic dizziness. At present there is limited evidence supporting the effectiveness of manual therapy in the management of cervicogenic dizziness. The limiting factor is the absence of randomized controlled trials. The differential diagnosis of dizziness plays an important role in cervicogenic dizziness assessment in order to determine appropriate further tests and interventions.

In addition, diagnostic criteria, evaluation and management of dizziness attributed to the cervical spine are outlined to differentiate between the cases where manual therapy was the first choice treatment and those where referral to a specialist was necessary.

1 Der Artikel wurde in teilweiser Erfüllung des Untersuchungsstadiums des IMTA Teachers’ Training Programms verfasst.


  • 1 Alund M, Ledin T, Odkvist L. et al . Dynamic posturography among patients with common neck disorders. A study of 15 cases with suspected cervical vertigo.  J Vestib Res. 1993;  3 383-389
  • 2 Badke M B, Miedaner J A, Shea TA. et al . Effects of vestibular and balance rehabilitation on sensory organization and dizziness handicap.  Ann Otol Rhinol Laryngol. 2005;  114 48-54
  • 3 Banfield G K, Wood C, Knight J. Does vestibular rehabilitation still have a place in the treatment of benign paroxysmal positional vertigo?.  The Journal of Laryngology & Otology. 2000;  114 501-505
  • 4 Bankoul S, Goto T, Yates B. et al . Cervical primary afferent input to vestibular neurons projecting to cervical dorsal horn: an anterograde and retrograde tracing study in the cat.  The Journal of Comparative Neurology. 1995;  353 529-538
  • 5 Barré M. Sur un syndrome sympathetic cervical postérieur et a sa frequent: l’arthrite cervicale.  Rev Neurol. 1926;  33 1246-1248
  • 6 Biesinger E. C2 and C 3 cervical nerve root syndrome: the influence of cervical spine dysfunction on ENT symptoms.  Manual Medicine. 1997;  35 12-19
  • 7 Bjorne A, Agerberg G. Symptom relief after temporomandibular and cervical spine disorders in patients with Menière’s disease: a three-year follow up.  The Journal of Craniomandibular Practice. 2003;  21 50-60
  • 8 Bogduk N. Cervical causes of headache and dizziness. Boyling J, Jull G, Boyling JD Grieve’s Modern Manual Therapy: The Vertebral Column Edinburgh; Churchill Livingstone 2004
  • 9 Borg-Stein J, Rauch S D, Krabak B. Evaluation and Management of Cervicogenic Dizziness.  Critical Reviews in Physical and Rehabilitation Medicine. 2001;  13 255-264
  • 10 Bracher E, Almeida C IR, Almeida R R. et al . A combined approach for treatment of cervical vertigo.  Journal of Manipulative and Physiological Therapies. 2000;  23 96-100
  • 11 Brandt T, Steddin S, Daroff R B. Therapy for benign paroxysmal positioning vertigo revisted.  Neurology. 1994;  44 796-800
  • 12 Brandt T, Bronstein A M. Cervical vertigo.  Journal of Neurology, Neurosurgery and Psychiatry. 2001;  71 8-12
  • 13 Browder D A, Erhard R E, Piva S R. Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series.  J Orthop Sports Phys Ther. 2004;  34 701-712
  • 14 Brown J J. Cervical contribution to balance: cervical vertigo. Berthoz As, Vidal PP, Graf W The Head Neck Sensory Motor System New York; Oxford University Press 1992
  • 15 Clendaniel R A. Cervical vertigo. Herdman SJ F.A. Davis Philadelphia; Vestibular Rehabilitation 2000
  • 16 Colledge N R, Barr-Mamilton R M, Lewis S J. et al . Evaluation of investigation to diagnose the cause of dizziness in elderly people: a community based controlled study.  British Medical Journal. 1996;  313 788-793
  • 17 Cooper B C, Cooper D L, Lucente F E. Electromyography of masticatory muscles in craniomandibular disorders.  Laryngoscope. 1991;  101 150-157
  • 18 De Boever J A, Keersmaker K. Trauma in patients with temporomandibular disorders: frequency and treatment outcome.  Journal of Oral Rehabilitation. 1996;  23 91-96
  • 19 De Jong P TVM, Jong J MBV, Cohen de B. et al . Ataxia and nystagmus induced by injection of local anaesthetics in the neck.  Ann Neurol. 1977;  1 240-246
  • 20 Ekvall-Hanson E, Mänsson N O. What happens with dizzy patients in primary health care? Does education influence treatment?.  Adv Physiother. 2004;  6 93-96
  • 21 Endo K, Ichimaru K, Komagata M. et al . Cervical vertigo and dizziness after whiplash injury.  Eur Spine J. 2006;  15 886-890
  • 22 Enloe L J, Shields R K. Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures.  Phys Ther. 1997;  77 890-903
  • 23 Epley J M. The canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo.  Otolaryngology Head and Neck Surgery. 1992;  107 399-404
  • 24 Froehling D A, Silverstein M D, Mohr D N. et al . Does a dizzy patient have a serious form of vertigo?.  JAMA. 1994;  271 358-388
  • 25 Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction.  European Spine Journal. 1998;  7 55-58
  • 26 Grimby A, Rosenhall U. Health-related quality of life and dizziness in old age.  Gerontology. 1995;  41 286-298
  • 27 Grimmer K. Cervical manipulation: Compliance with, and attitudes to the current APA protocol for pre-manipulative testing of the cervical spine: incidence of complications. Adelaide; University of South Australia, Centre for Physiotherapy Research 1998
  • 28 Hansson E E, Mansson N O, Hakansson A. Effects of specific rehabilitation for dizziness among patients in primary health care. A randomized controlled trial.  Clinical Rehabilitation. 2004;  18 558-565
  • 29 Hansson E E, Mansson N O, Ringsberg K A. et al . Dizziness among patients with whiplash-associated disorder: a randomized controlled trial.  J Rehabil Med. 2006;  38 387-390
  • 30 Heikkila H, Johansson M, Wenngren B I. Effects of acupuncture, cervical manipulation, and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study.  Manual Therapy. 2000;  5 151-157
  • 31 Heikkila H. Cervical vertigo. Boyling J, Jull G, Boyling JD Grieve’s Modern Manual Therapy: The Vertebral Column Edinburgh; Churchill Livingstone 2004
  • 32 Hulse M, Holzl M. Vestibulospinal reflexes in cervical disequilibrium. Cervicogenic imbalance.  HNO. 2000;  48 295-301
  • 33 Hulse M, Holzl M. The efficiency of spinal manipulation in otolaryngology. A retrospective long-term study.  HNO. 2004;  52 227-234
  • 34 Jacobson G P, Newman C W. The development of dizziness handicap inventory.  Arch Otolaryngol Head Neck Surg. 1990;  116 424-427
  • 35 Johnson G M. The sensory and sympathetic nerve supply within the cervical spine: review of recent observations.  Manual Therapy. 2004;  9 71-76
  • 36 Karlberg M, Magnusson M, Malmström E M. et al . Postural and symptomatic improvement after physiotherapy in patient with dizziness of suspected cervical origin.  Arch Phys Med Rehabil. 1996;  77 874-882
  • 37 Kerry R, Taylor A J. Cervical arterial dysfunction assessment and manual therapy.  Manual Therapy. 2006;  11 243-253
  • 38 Kessinger R C, Boneva D V. Vertigo, tinnitus, and hearing loss in the geriatric patient.  Journal of Manipulative and Physiological Therapeutics. 2000;  23 352-362
  • 39 Knuchel S, Schädler S. Differnezialtests bei Gleichgewichtsstörungen. Drei Systeme in der Balance.  physiopraxis. 2004;  11 / 12 28-31
  • 40 Konrad K, Gereneser F. Manual treatment in patients with vertigo.  Manual Medicine. 1990;  28 62-64
  • 41 Kristjansson E. The cervical spine and proprioception. Boyling J, Jull G, Boyling JD Grieve’s Modern Manual Therapy: The Vertebral Column Edinburgh; Churchill Livingstone 2004
  • 42 Magarey M E, Rebbeck T, Coughlan B. et al . Pre-manipulative testing of the cervical spine. Review, revision and new clinical guidelines.  Man Ther. 2004;  9 95-108
  • 43 Mahlstedt K, Westhofen M, König K. Therapy of Disorders of the Craniovertebral joints - combined with vestibular disorders.  Laryngo-Rhino-Otol. 1992;  71 246-250
  • 44 Maitland G D. Vertebral manipulation. London; Butterworths 5th ed
  • 45 Nashner L M. et al . Adaptation to altered support and visual conditions during stance: patients with vestibular deficits.  J Neurosci. 1982;  2 536-544
  • 46 Neuhuber W L, Bankoul S. Peculiarities of the innervation at the cranio-cervical transition.  Orthopäde. 1994;  23 256-261
  • 47 Olszewski J, Majak J, Pietkiewicz P. et al . The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis.  Otolaryngology-Head and Neck Surgery. 2006;  134 680-684
  • 48 Oostendorp R AB, Eupen A AJM, Erp van J. et al . Dizziness following whiplash injury: a neuro-otological study in manual therapy practice and therapeutic implication.  The Journal of Manual and Manipulative Therapy. 1999;  7 123-130
  • 49 Persson L, Karlberg M, Magnusson M. Effects of different treatments on postural performance in patients with cervical root compression. A randomized prospective study assessing the importance of the neck in postural control.  Journal of Vestibular Research. 1996;  6 439-453
  • 50 Reid van S A, Rivett D A. Manual therapy treatment of cervicogenic dizziness: a systematic review.  Manual Therapy. 2005;  10 4-13
  • 51 Revel M, Minguet M, Gergoy P. et al . Changes in cervicocephalic kinaesthesia after a proprioceptive rehabilitation program in patients with neck pain: A randomized controlled study.  Arch Phys Med Rehabil. 1994;  75 895-899
  • 52 Rivett D A. The vertebral artery and vertebrobasilar insufficiency. Boyling J, Jull G, Boyling JD Grieve’s Modern Manual Therapy: The Vertebral Column Edinburgh; Churchill Livingstone 2004
  • 53 Rupa V. Persistent vertigo following particle repositioning manoeuvres.  Arch Otolaryngol Head Neck Surg. 2004;  130 436-439
  • 54 Ryan GMS, Cope S. Cervical vertigo.  Lancet. 1955;  31 1355-1358
  • 55 Sackett D L, Richardson W S, Rosenberg W. et al .Evidence-based medicine: how to practice and teach EBM. New York; Churchill Livingstone 1997
  • 56 Schenk R, Coons L, Bennett S E. et al . Cervicogenic dizziness: A case report illustrating orthopaedic manual and vestibular physical therapy comanagement.  The Journal of Manual & Manipulative Therapy. 2006;  14 56-68
  • 57 Schubert M C, Minor L B. Vestibulo-ocular Physiology Underlying Vestibular Hypofunction.  Physical Therapy. 2004;  84 373-385
  • 58 Shummway-Cook A, Horak F B. Assessing the influence of sensory interaction on balance-suggestion from the field.  Physical Therapy. 1986;  66 1548-1550
  • 59 Sloane P D, Coeytaux R R, Beck R S. et al . Dizziness State of the Science.  Ann Intern Med. 2001;  134 823-832
  • 60 Stoll W, Most E, Tegenthoff M. Schwindel und Gleichgewichtsstörungen. Stuttgart; Thieme 2005
  • 61 Tinetti M E, Williams C S, Gill T M. Dizziness among older adults: a possible vertebral artery and geriatric syndrome.  Ann Intern Med. 2000;  132 337-344
  • 62 Tomita K, Tsuchiya H, Nomura S. Dynamic entrapment of the vertebral artery by the nerve branch. A new aetiology for transient cervical vertigo.  Neur-Orthopaedics. 1987;  4 36-43
  • 63 Treleaven J, Jull G, Low Choy N. Standing balance in persistent whiplash: A comparison between subjects with and without dizziness.  J Rehabil Med. 2005;  37 224-229
  • 64 Treleaven J, Jull G, Low Choy N. The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash.  Manual Therapy. 2006;  11 99-106
  • 65 Uhlemann C, Gramowski K H, Endres U. et al . Manual diagnosis and therapy in cervical giddiness.  Manual Medicine. 1993;  31 77-81
  • 66 Wing L, Hargrave-Wilson W. Cervical vertigo.  Australian and New Zealand Journal of Surgery. 1974;  44 275-277
  • 67 Wrisley D M, Sparto P J, Whitney S L. et al . Cervicogenic dizziness: a review of diagnosis and treatment.  J Orthop Sports Phys Ther. 2000;  30 755-766
  • 68 Yardley L, Owen N, Nazareth I. et al . Prevalence and presentation of dizziness in a general practice community sample of working age people.  Br J Gen Pract. 1998;  48 1131-1135
  • 69 Zhou W, Jiang W, Li X. et al . Clinical study on manipulative treatment of derangement of the atlantoaxial joint.  Journal of Traditional Chinese Medicine. 1999;  19 273-278

1 Der Artikel wurde in teilweiser Erfüllung des Untersuchungsstadiums des IMTA Teachers’ Training Programms verfasst.

Jürg Hauswirth, PT OMT svomp, IMTA Teacher

Physiotherapie, Kantonsspital Bruderholz

CH-4101 Bruderholz