Understanding Cervicogenic Dizziness: Diagnosis and Treatment Explained

Vestibular physical therapists Abbie Ross, PT, DPT, NCS, and Danielle Tolman, PT, DPT, sit down with Rob Landel, PT, DPT, FAPTA, to unpack cervicogenic dizziness (CGD) — what it is and isn’t, how to tell neck-driven dizziness apart from inner ear causes, and the clinical tools that actually make a difference.

They dive into the head–neck differentiation test, cervical joint position error (JPE) testing with a laser, and why CGD rarely causes vertigo or spinning. You’ll also hear how concussion, whiplash, BPPV, and migraine can overlap with neck-related dizziness — plus practical insights on manual traction, cervical strength and endurance training, “pain-first” strategies, and when a short-term collar might help (despite its bad reputation).

Episode Resources:

Website: skillworks.biz

Email: rlandel@me.com

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Hosted by:

🎤 Dr. Abbie Ross, PT, NCS

🎤 Dr. Danielle Tolman, PT

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Timestamps:

00:00 – Welcome & show open

00:45 – Dr. Lindell’s background & early vestibular days

03:01 – How far vestibular rehab has come

03:58 – Defining CGD clinically

05:26 – Symptoms CGD

06:26 – CGD with vestibular or central issues; trauma link

07:25 – Secondary CGD from guarding & “moving in blocks”

08:31 – Is CGD over- or under-diagnosed?

12:11 – BPPV + trauma: when to probe the neck

14:10 – Migraine, vestibular migraine, cervicogenic headache—untangling overlap

16:26 – How neck input feeds spatial orientation

19:43 – Mismatch analogy: why CGD feels like seasickness

21:10 – History taking: get precise about “dizzy”

22:38 – Traumatic vs. atraumatic onset; red flags & neuro screen

26:28 – Exam flow once central/peripheral causes are ruled down

27:22 – Head–Neck Differentiation Test (separating head vs. neck motion)

30:17 – Cervical Relocation / Joint Position Error (JPE) Test with laser

33:27 – Testing extension: stabilizing neck vs. moving head in block

35:03 – Treatment blueprint: mobility, pain, motor control, strength/endurance

37:26 – Laser tracing progressions

38:20 – Timelines: why strength/endurance take the longest

46:18 – Why one therapist managing vestibular + MSK is ideal

49:18 – Evidence & experience with traction/manipulation for CGD

50:43 – “Heavy-headedness”

53:22 – Fatigue → increased sway; training normalizes it

54:48 – Wrap-up & future part 2 ideas