Understanding the correct clinical tests for dizziness is fundamentally important since dizziness can be equally debilitating and frustrating for patients and practitioners. For those suffering from it, it impacts activities of daily living, work, relationships, energy levels, ability to function as well as to recover. It is difficult for practitioners since there are many underlying causes which clinically all present very similarly, yet often require completely different treatment approaches for lasting symptomatic improvement.

Without knowing exactly which kind of dizziness a patient presents with, results can vary significantly, and treatment success is not guaranteed (with a high risk of actually making the patient worse).

Having the right skills and toolset however can turn this challenging clinical entity into an area of competence and confidence which is equally appreciated and rewarded by patients and colleagues who seek advice or refer patients for treatment.

Understanding the variety of causes for dizziness is one of the prerequisites. There are of course inner ear disorders (Meniere’s disease, BPPV), but also neurological conditions such as stroke or tumours. Low blood pressure / hypotension, anaemia, certain medications, alcohol or drug use, anxiety or panic disorders, electrolyte imbalances, cardiac arrhythmias and severe migraines.

Some of these can be differentiated using vestibular function tests, imaging such as CT and MRI, neurological examinations, cardiovascular assessment, and blood tests.

One of the other interesting causes, which is quite common, and yet very commonly misdiagnosed, is cervicogenic dizziness. It’s believed to be caused by disruption of the normal cervical proprioceptive afferent input due to cervical dysfunction (as found in mechanical, degenerative, or inflammatory disorders).

In history taking, a temporal relationship between neck pain or stiffness and the reported dizziness reproduced in the physical examination of the cervical spine needs to be found (where the aggravating behaviour of dizziness in patients was episodic in nature, and associated with neck movement and body-position changes).

As a result of aberrant proprioceptive signals, patients with CGD have dizziness (due to central mismatch with the visual and vestibular systems), postural imbalance (due to abnormal cervico-collic and vestibulo-collic reflex activity), and are more visually dependent (due to increased reliance on visual information).

It is characterised by disturbed:

• proprioception (head-neck awareness)
• neck movement control
• neck range of motion
• oculomotor function
• balance
• postural stability
• coordination of head, spine and limbs

There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness. It requires a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses.

Once the other most plausible causes are ruled out, tests that are specific for cervicogenic dizziness facilitate honing in on the correct diagnosis. One of the most reliable and accessible methods is the Cervical Neck Torsion Test.