Is there a connection between America’s favorite age milestone and dizziness?  It’s common for 20 somethings to be called dizzy but it has a different meaning for those growing older.  Reaching an age of maturity often means settling into a sedentary lifestyle with a progressive career path which leads to more seat time and less physical activity.  This settling down is coupled with tissue changes in the aging body which lean more towards stiffness.  Movement is important as we age but it becomes vital for those over 50.  A recent study identified sarcopenia as ‘one of the most striking effects of age’ due to the involuntary loss of muscle mass, strength, and function.   Muscle mass decreases approximately 3–8% per decade after the age of 30.  The effects are even more striking for the less active.  Let’s face it, the body needs muscle activity to stabilize and mobilize our skeletal chain.  Less movement as we age results in increased stiffness especially in the areas dependent upon movement for position awareness.

Image Credit – https://healthplexus.net/article/sarcopenia-and-muscle-aging

 

Positional awareness is highly dependent upon the feedback our nervous system receives from highly tuned movement centers such as the upper portion of the cervical spine.  This region is known as the craniovertebral junction (CVJ) since it is the first spinal segments which serve as the connection between the head and neck.  This junction also happens to hold a few records for spinal mobility and stability.  The CVJ offers the highest degree of movement in the spine, just 2 spinal segments (C1-C2) are responsible for nearly 50% of rotation available in the entire neck.  Plus, since this region is lacking a disc, mobile support is offered by overlapping muscles, thick cartilage and strong ligaments to provide stability for head movements and protection of the brainstem.  A restriction in the CVJ drastically limits feedback to the nervous system making it difficult to discern correct position of the head.  In this article, symptoms of dizziness and imbalance are associated with cervical pathology in the CVJ.  Since a majority of balance centers (eyes, ears, vestibular system) are located in the head, any misrepresentation of head position can easily trigger a pattern of dizziness especially during head movements and transitions from one position to another.

Image Credit – https://web.duke.edu/anatomy/Lab01/Lab2_new2014.html

Hopefully, by now you are beginning to appreciate how closely neck mobility and muscle strength are related to positional awareness.  It’s an all too common malady which is often ignored as a primary cause of dizziness.  The combination of muscle weakness and joint stiffness is further accentuated when we choose more static postures.  No doubt, it’s just too tough reading all those screens while moving.  Screens for reading texts, answering emails, typing documents, searching the web.  It almost seems like our lives are centered around our screens.  Computers, tablets, phones, and watches all have screens which have become a necessity to complete daily tasks.   Still, we never tire of them as we relax with screens at home to watch TV or YouTube.  It’s useless to offer any ergonomic advice since screen viewing involves a variety of settings at the workplace, home, and car.  Screens tend to rule our lives and the domain becomes even more pronounced for the aging adult.   Perhaps increased reliance on viewing various screens has contributed to the rise of dizziness in the over 50 year old.

A comprehensive article by Francis Jung highlights the relationship between neck pain and dizziness.   Cervicogenic Dizziness is a diagnosis by exclusion (all other causes must be ruled out) which involves neck pain accompanied by dizziness, light-headedness, unsteadiness, and visual disturbances.  Cervicogenic dizziness is difficult to diagnose due to the myriad of other conditions which could be the primary cause of dizziness.  A thorough clinical examination is required to determine the root cause of dizziness.  In the case series presented by Dr. Jung, a definitive diagnosis of Cervicogenic Dizziness is necessary to guide specific treatment such as manual therapy and exercise which offers a strong  likelihood for improvement in symptoms of neck pain and dizziness.
Often times over 50 and dizzy means frequent consults with specialists and trials of medication which offer little or no relief.  Still, it’s important to rule out serious causes of dizziness but once pathology is no longer a concern, it’s reasonable to consider an evaluation by a physical therapist to assess for signs of Cervicogenic Dizziness.  With the proper diagnosis and skilled treatment, there’s hope for those with Cervicogenic Dizziness.  But beware, seeking treatment means you must be willing to change some behaviors.  Choose less screen time and more movement especially variable patterns which extend your range of motion beyond daily limits.  Don’t let the passing of time determine your posture and activity.  Stay active, get fit and move like you are forever young.  Who knows, maybe they will begin calling 50 somethings dizzy for a new reason.

Keith Poorbaugh

PT, ScD, OCS, CSCS, CMTPT, FAAOMPT

Dr. Keith Poorbaugh has completed specialty certifications, internships and a residency fellowship to develop mastery of manual therapy skills and clinical expertise. Throughout 20 years of clinical experience, he has discovered that clients consistently heal faster when the provider is both compassionate and skilled.

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