Spinal Manipulative Therapy for Atypical Cervicogenic Symptoms: A Review

There is considerable evidence to support the importance of cervicogenic spinal dysfunction in musculoskeletal complaints, and the development of atypical symptoms including dizziness, dysphagia, angina, and visual disturbances. However, there are other possible causes for these symptoms, and secondary adaptive changes should also be considered in differential diagnosis. Understanding the pathophysiology of these symptoms and differential diagnosis of their potential origin is important for therapy. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits. Once adequately assessed, appropriate tailored management should be implemented. Research to further assist differential diagnosis and to understand the most important contributing factors associated with abnormal cervical afferent input and a subsequent disturbance to the sensorimotor control system, as well as the most efficacious management of such symptoms and impairments, is important for the future.