Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness.

Cervicogenic dizziness, dizziness linked to problems in the neck, can disrupt daily life, but how best to treat it physically has not been clearly settled. This review pulled together 13 randomized trials involving 898 patients to compare treatments such as manual therapy and exercise therapy, pooling six of these trials for a combined analysis of dizziness, neck function, and balance outcomes. The broad result is that manual therapy on its own appears to reduce dizziness and related neck and balance symptoms, with moderate confidence in that finding. Adding exercise therapy to manual therapy seemed to boost the effect further, but that specific comparison is based on very low quality evidence.

A key limitation is that most trials didn't identify what was causing the dizziness in the first place, and the few that did produced mixed results for exercise alone, so it's unclear how these findings apply across different underlying causes.

If you experience dizziness that seems connected to neck problems, you might wonder what kind of physical treatment actually helps. This review looked at 13 studies involving a total of 898 people to compare approaches like hands-on manual therapy and exercise-based therapy for this type of dizziness, sometimes called cervicogenic dizziness. The findings suggest that manual therapy alone may ease dizziness, neck symptoms, and balance problems, and this result has moderate support.

When manual therapy is combined with exercises, the improvement looked even bigger, but that particular result comes from evidence rated very low quality, meaning it's much less certain. One important caveat is that most of the included studies didn't specify what originally caused people's dizziness, such as injury or another trigger, and the few that did test exercise therapy for injury-related cases found inconsistent results. This means the picture is still incomplete, and more carefully designed research is needed before firm conclusions can be drawn for specific causes of this condition.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis addresses a recurring clinical question: which physiotherapy approach, manual therapy, exercise therapy, or a combination, has evidence behind it for patients presenting with cervicogenic dizziness. The review pooled 13 randomized controlled trials totalling 898 patients, of which six were combined in meta-analysis, and quality was appraised using the Cochrane RoB 2.0 tool with GRADE ratings.

Included trials ranged from high (two), to moderate (five), to low (six) methodological quality, which tempers confidence in the pooled estimates. The headline finding is that manual therapy alone showed a moderate-quality evidence base supporting reductions in dizziness, cervical spine dysfunction, and balance impairment. When exercise therapy was added to manual therapy, the effect appeared larger across these same outcome domains, but this add-on comparison rested on very low quality evidence, so it should be interpreted as a less certain, exploratory signal rather than an established benefit of combining the two approaches.

Separately, only three trials specified the underlying cause of cervicogenic dizziness, and among these, exercise therapy alone produced inconsistent results for traumatic presentations, an isolated and heterogeneous subgroup finding that could reflect chance or true variability in response by etiology. The review does not establish causal mechanisms, does not clarify treatment effects by specific diagnostic subtype, and the abstract does not report adverse events.