The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study

Eur J Phys Rehabil Med. 2017 Feb;53(1):57-71. doi: 10.23736/S1973-9087.16.04179-4. Epub 2016 Aug 30.


Background: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself.

Aim: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness.

Design: A randomized controlled study with a 1 year and 10 weeks' follow-up.

Setting: University research laboratory.

Population: Seventy-two patients (25 female) between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group.

Methods: Both groups received the multimodal program; additionally, the experimental group received the Denneroll™ cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and follow-up at 1 year and 10 weeks.

Results: Significant group × time effects at both the 10 week post treatment and the 1-year follow-up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P=0.09), HRA (P=0.1) and neck pain (P=0.3). At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3;-1.8], P<0.0005), cervical lordosis (-14.4° [-11.6;-8.3], P<0.0005), dizziness handicap inventory (29.9 [-34.4;-29.9], P<0.0005), severity of dizziness (5.4 [-5.9;-4.9], P<0.0005), dizziness frequency (2.6 [-3.1;-2.5], P<0.0005), HRA for right rotation (2.8 [-3.9;-3.3], P<0.005), HRA for left rotation (3.1 [-3.5;-3.4, P<0.0005], neck pain (4.97 [-5.3;-4.3], P<0.0005); indicating greater improvements in the experimental group.

Conclusions: The addition of Denneroll™ cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long-term follow-up.

Clinical rehabilitation impact: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cervical Vertebrae / injuries
  • Cervical Vertebrae / pathology
  • Cervical Vertebrae / physiopathology*
  • Dizziness / etiology
  • Dizziness / rehabilitation*
  • Female
  • Humans
  • Lordosis / complications
  • Lordosis / rehabilitation*
  • Male
  • Manipulation, Spinal / methods*
  • Middle Aged
  • Neck Injuries / complications
  • Neck Injuries / etiology
  • Neck Injuries / rehabilitation*
  • Neck Pain / etiology
  • Neck Pain / rehabilitation*
  • Postural Balance
  • Prospective Studies
  • Range of Motion, Articular*
  • Traction / instrumentation
  • Traction / methods*
  • Transcutaneous Electric Nerve Stimulation / methods*
  • Treatment Outcome