A case report of an adolescent with cluster headaches following neck trauma: Coincidence or trigger?

Posttraumatic headaches usually have tension-type or migraine-like characteristics. A correlation between head trauma and cluster headaches (CH) has been previously reported. CH in children are rare and require thorough differential diagnosis. We present an original case of a 15-year-old boy with cluster headaches associated with allodynia probably evoked by a neck trauma. Severe headache attacks started one month after neck trauma. At the beginning clinical presentation of our patient's headaches was very misleading. Headaches were bilateral and associated with infection. Initial diagnosis of sinusitis was made. During further observation headaches have become unilateral with typical for CH associated symptoms and additionally with allodynia. Other causes of secondary CH like cervicogenic headaches, brain tumor and vascular malformation have been excluded. The boy has undergone prophylactic treatment based on flunarizine and gabapentin with good result. Possible pathogenesis of our patient's headaches has been proposed and diagnostic traps discussed.

Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial.

OBJECTIVE: To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness. DESIGN: Randomized controlled trial with 12-week follow-up using blinded outcome assessment. SETTING: University School of Health Sciences. PARTICIPANTS: Participants (N=86; mean age ± SD, 62.0 ± 12.7 y; 50% women) with chronic cervicogenic dizziness. INTERVENTIONS: Participants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks. MAIN OUTCOME MEASURES: Cervical ROM, head repositioning accuracy, and balance. RESULTS: SNAG therapy resulted in improved (P ≤.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, -7.5°; 95% confidence interval [CI], -13° to -2.0°) and right rotation (mean difference, -6.8°; 95% CI, -11.5° to -2.1°) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy. CONCLUSIONS: SNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.

[Surgical strategy for neck burns and their sequelae]. / Stratégie chirurgicale des brûlures du cou et de leurs séquelles.

Burns of the neck are common and expose them to functional and aesthetic complications which are sometimes very serious. Care in the acute stage and treatment of sequelae contribute to a common goal of restoration: Maintain or recreate a chin-neck angle and get a quality skin as close as possible to the original skin, in terms of flexibility, texture, thickness and color. The wide variety of cases encountered requires knowing the armamentarium available to us today, and the anatomical basis and clinical underlying indications.

Spinal Accessory and Suprascapular Nerve Injury After Human Bite.

ABSTRACT: This is a unique clinical case of spinal accessory and suprascapular nerve injury related to a human bite not yet described elsewhere. The case emphasizes the importance of considering local trauma of the posterior triangle of the neck in case of shoulder weakness with electrophysiologic evidence of combined spinal accessory and suprascapular nerve injury.

Muscle activity during functional coordination training: implications for strength gain and rehabilitation.

The purpose of this study was to evaluate if different types, body positions, and levels of progression of functional coordination exercises can provide sufficiently high levels of muscle activity to improve strength of the neck, shoulder, and trunk muscles. Nine untrained women were familiarized with 7 functional coordination exercises 12 times during 4 weeks before testing. Surface electromyographic (EMG) activity was obtained from rectus abdominus, erector spinae, obliquus externus, and trapezius during the exercises with 2-4 levels of progression. Electromyography was normalized to the maximal EMG activity during maximal voluntary contractions, and a p value < 0.05 was considered significant. All recorded muscles reached sufficiently high levels of activity during the coordination exercises for strength gain (>60% of maximal EMG activity). Type of exercise played a significant role for the attained muscle activity. Body position during the exercises was important for the activity of the erector spinae, and level of progression was important for the activity of the trapezius. The findings indicate that depending on type, body position, and level of progression, functional coordination training can be performed with a muscle activity sufficient for strength gain. Functional coordination training may therefore be a good choice for prevention or rehabilitation of musculoskeletal pain or injury in the neck, shoulder, or trunk muscles.

Core stability and bicycling.

Bicycling is a popular fitness activity in the United States and around the world. Because of the nature of the bicycling position, the neck and back are at risk for injury. One method to prevent these injuries is to ensure that the body's "core" is strong and stable. A strong and stable core also provides a platform to maximize power transfer, improving performance. Core exercises also may enhance recovery from intense bicycling efforts. Simple stability exercises can improve performance and may prevent injuries in bicyclists.

Muscle dysfunction in cervical spine pain: implications for assessment and management.

SYNOPSIS: There is irrefutable evidence of an association between mechanical neck pain (MNP) and dysfunction of the muscles of the cervical spine. A myriad of impairments have been demonstrated that include changes in the physical structure (cross-sectional area, fatty infiltration, fiber type), as well as changes in behavior (timing and activation level), of the cervical muscles. Such changes suggest an impaired capacity of the cervical muscles to generate, sustain, and maintain precision of the required levels of torque needed for optimal function. In the context of physical support, these changes potentially have deleterious consequences for the cervical region, which relies heavily on its muscles for mechanical stability. While interventions focused on the retraining of cervical muscle function have shown favorable responses in alleviating MNP, the development of best practice strategies for the assessment and management of cervical muscle dysfunction is still a work in progress. One obstacle in researching the efficacy of cervical muscle training is that, as yet, we do not possess the capacity to optimally measure and classify those patients most likely to respond to different methods of training that would enrich clinical practice. While gains in this area are emerging, the ability of a clinician to best identify the need and implement the most appropriate method of training cervical muscle function is still largely dependent on a comprehensive examination of the patient that considers all aspects of the patient's disorder and functional requirements. LEVEL OF EVIDENCE: Level 5.

Nursing practice and effect evaluation of cupping therapy in the rehabilitation of sports-induced cervical spine injuries

Cupping has been extensively used in the treatment of various medical conditions since antiquity. In this randomized controlled trial, we investigated the effects of wet cupping therapy on the outcomes of football athletes with cervical spine injuries and low back pain. Our study was conducted at the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine involving 40 athletes consisting of 28 males and 12 females. Single blinding was used and participants were divided into an intervention (wet cupping) and a sham group. Our findings showed significant reduction in pain intensity scores from the pre-intervention (7.2 ± 1.5) to post-intervention (4.5 ± 1.2), suggesting a positive effect of wet cupping therapy on cervical spine injuries (Mean Difference [MD] = -2.7 ± 1.3, p = 0.001). Statistically significant increase in functional improvements in the intervention group from pre-intervention (28.3 ± 4.0) to post-intervention (18.9 ± 3.5) due to the wet cupping therapy (MD = -9.4 ± 2.1, p = 0.021). Significant improvements in the range of motion assessed from cervical flexion, cervical extension, cervical lateral flexion, and cervical rotation. Sleep quality based on Pittsburgh Sleep Quality Index (PSQI) scores exhibited a mean difference of -1.4 ± 1.2 which was statistically significant (p = 0.001). Muscle strength of Neck Flexors, Neck Extensors, Upper Trapezius, Rhomboids, Cervical Rotators, Deltoids and Biceps were significantly while minimal adverse outcomes were observed in the intervention group. In conclusion, the application of wet cupping therapy could be an effective treatment for alleviating pain, improving muscle strength, quality of life, range of motion, functional improvements and reducing adverse outcomes in athletes with cervical spine injuries (AU)

Head and neck burns are associated with long-term patient-reported dissatisfaction with appearance: A Burn Model System National Database study.

INTRODUCTION: Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients' social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas. METHODS: Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Database collected between 1996 and 2015 were used to investigate differences in outcomes between those with and without H&N burns. Demographic and clinical characteristics for adult burn survivors with and without H&N burns were compared. The following patient-reported outcome measures, collected at 6, 12, and 24 months after injury, were examined: satisfaction with life (SWL), community integration questionnaire (CIQ), satisfaction with appearance (SWAP), short form-12 physical component score (SF-12 PCS), and short form-12 mental component score (SF-12 MCS). Mixed regression model analyses were used to examine the associations between H&N burns and each outcome measure, controlling for medical and demographic characteristics. RESULTS: A total of 697 adults (373 with H&N burns; 324 without H&N burns) were included in the analyses. Over 75% of H&N injuries resulted from a fire/flame burn and those with H&N burns had significantly larger burn size (p<0.001). In the mixed model regression analyses, SWAP and SF-12 MCS were significantly worse for adults with H&N burns compared to those with non-H&N burns (p<0.01). There were no significant differences between SWL, CIQ, and SF-12 PCS. CONCLUSIONS: Survivors with H&N burns demonstrated community integration, physical health, and satisfaction with life outcomes similar to those of survivors with non-H&N burns. Scores in these domains improved over time. However, survivors with H&N burns demonstrated worse satisfaction with their appearance. These results suggest that strategies to address satisfaction with appearance, such as reconstructive surgery, cognitive behavior therapy, and social skills training, are an area of need for survivors with H&N burns.

Head and neck position sense.

Traumatic minor cervical strains are common place in high-impact sports (e.g. tackling) and premature degenerative changes have been documented in sports people exposed to recurrent impact trauma (e.g. scrummaging in rugby) or repetitive forces (e.g. Formula 1 racing drivers, jockeys). While proprioceptive exercises have been an integral part of rehabilitation of injuries in the lower limb, they have not featured as prominently in the treatment of cervical injuries. However, head and neck position sense (HNPS) testing and re-training may have relevance in the management of minor sports-related neck injuries, and play a role in reducing the incidence of ongoing pain and problems with function. For efficacious programmes to be developed and tested, fundamental principles associated with proprioception in the cervical spine should be considered. Hence, this article highlights the importance of anatomical structures in the cervical spine responsible for position sense, and how their interaction with the CNS affects our ability to plan and execute effective purposeful movements. This article includes a review of studies examining position sense in subjects with and without pathology and describes the effects of rehabilitation programmes that have sought to improve position sense. In respect to the receptors providing proprioceptive information for the CNS, the high densities and complex arrays of spindles found in cervical muscles suggest that these receptors play a key role. There is some evidence suggesting that ensemble encoding of discharge patterns from muscle spindles is relayed to the CNS and that a pattern recognition system is used to establish joint position and movement. Sensory information from neck proprioceptive receptors is processed in tandem with information from the vestibular system. There are extensive anatomical connections between neck proprioceptive inputs and vestibular inputs. If positional information from the vestibular system is inaccurate or fails to be appropriately integrated in the CNS, errors in head position may occur, resulting in an inaccurate reference for HNPS, and conversely if neck proprioceptive information is inaccurate, then control of head position may be affected. The cerebellum and cortex also play a role in control of head position, providing feed-forward and modulatory influences depending on the task requirements. Position-matching tasks have been the most popular means of testing position sense in the cervical spine. These allow the appreciation of absolute, constant and variable errors in positioning and have been shown to be reliable. The results of such tests indicate that errors are relatively low (2-5 degrees). It is apparent that error is not consistently affected by age, a finding similar to studies undertaken in peripheral joints. Furthermore, the range of motion in which subjects are tested does not consistently affect accuracy in a predictable manner. However, it is evident that impairments in position sense are observed in individuals who have experienced whiplash-type injuries and individuals with chronic head and neck pain of non-traumatic origin (e.g. cervical spondylosis). While researchers advocate comprehensive retraining protocols, which include eye and neck motion targeting tasks and coordination exercises, as well as co-contraction exercises to reduce such impairments, some studies show that more general exercises and manipulation may be of benefit. Overall, there is limited information concerning the efficacy of treatment programmes.

Reaching training in rats with spinal cord injury promotes plasticity and task specific recovery.

In the current study we examined the effects of training in adult rats with a cervical spinal cord injury (SCI). One group of rats received 6 weeks of training in a single pellet reaching task immediately after injury, while a second group did not receive training. Following this period changes in cortical levels of BDNF and GAP-43 were analysed in trained and untrained animals and in a group with training but no injury. In another group of rats, functional recovery was analysed in the reaching task and when walking on a horizontal ladder. Thereupon, the cortical forelimb area was electrophysiologically examined using micro-stimulation followed by tracing of the lesioned corticospinal tract (CST). We found that trained rats improved substantially in the reaching task, when compared to their untrained counterparts. Trained rats however, performed significantly worse with their injured forelimb when walking on a horizontal ladder. In parallel to the improved recovery in the trained task, we found that the cortical area where wrist movements could be evoked by micro-stimulation expanded in trained rats in comparison to both untrained and uninjured rats. Furthermore, collateral sprouting of lesioned CST fibres rostral to the injury was increased in trained rats. Post-injury training was also found to increase cortical levels of GAP-43 but not BDNF. In conclusion we show that training of a reaching task promotes recovery of the trained task following partial SCI by enhancing plasticity at various levels of the central nervous system (CNS), but may come at the cost of an untrained task.

Burn scar contractures of the pediatric neck.

Neck deformities remain a cause of significant morbidity in children who sustain burns. Reconstructive efforts must be directed not only at restoring satisfactory head position, flexion/extension, and rotation but also at satisfying the cosmetic and functional needs of the individual patient. We present the management of these complex patients, from the acute management of neck burns to the various reconstructive options available.

Is it time for a population health approach to neck pain?

OBJECTIVE: Neck pain and its associated disorders (NPAD) cause significant health burden in the general population and after road traffic and occupational injury. Individual-level health care treatments have been well studied, but population-health approaches to this problem have not. We used a best-evidence synthesis to examine population-level approaches to the prevention and control of NPAD. METHODS: The systematic review examined studies published between 1980 and 2006 that addressed the incidence, prevalence, risk factors, prevention, cost, assessment and classification, interventions, and course and prognostic factors for NPAD. Citations were screened for relevance, scientifically reviewed, and synthesized. Valid studies addressing public policies or population-level approaches to the prevention and control of NPAD were identified and used in the evidence synthesis. RESULTS: Only 8 of the 552 scientifically admissible studies were considered relevant to a public or population health approach to preventing and controlling the burden of NPAD. For whiplash-associated disorders, active head restraints and seat backs were protective in rear-end collisions; insurance policies affected the incidence and recovery; government funding of multidisciplinary rehabilitation programs did not benefit recovery; and early intensive health care delayed recovery. In the workplace, 2 randomized trials failed to show any preventive effect for ergonomic interventions or physical training and stress management. One study documented the societal cost of neck pain. CONCLUSIONS: There is little evidence on which to make public or population-level recommendations, despite the important public health burden and costs of NPAD. Population-level approaches to preventing and controlling NPAD should be investigated.

Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged "super-thin flaps": A retrospective analysis of 82 cases in Vietnam.

BACKGROUND: The concept of the "super-thin flap" (also known as the subdermal vascular network flap) was introduced in Japan in 1994. Its distinctive characteristic is its extreme thinness: it is thinned to the point that the subdermal vascular network (subdermal plexus) can be seen through the minimal fat layer. Since 2006 in Vietnam, we have used circumflex scapular artery-supercharged occipito-cervico-dorsal (OCD) super-thin flaps to reconstruct cases of neck and face scar contracture. MATERIALS AND METHODS: This case series comprised all 82 patients with neck and face scar contracture who underwent reconstruction with an OCD supercharged super-thin flap from 2006-2015 at the Vietnam National Institute of Burns. The flap was thinned and anastomosed at the distal area after elevation. All patients received one flap. RESULTS: Of the 82 flaps, 77 survived completely. The remaining five developed distal superficial necrosis (n=3) and interruption of the sutures due to infection; these required resuturing (n=2). In two of the three necrosis cases, the necrotic area affected 50% of the flap. Eighty of the eighty-two patients were satisfied with both the functional and aesthetic results. CONCLUSIONS: The OCD super-thin flap has clear benefits, and although it is thin, its vasculature is reliable. Thus, it may be one of the best choices for reconstruction of neck and face scar contractures.

[Cervical spine and pain]. / Omurganin servikal bölümü ve agri.

Chronic pain originating from the cervical spine, that may have diverse etiological factors, is a common condition in the clinical practice. Having distinct properties in the spine, cervical column has a wide range of motion and is commonly subject to traumatic injury. In this review, after the anatomical properties that has clinical significance and the evaluation of a patient with cervical pain are explained, the common cervical spinal pain conditions are discussed by emphasizing the therapeutic approaches in each condition.

Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial.

BACKGROUND: It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE: The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS: Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS: Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION: The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury.

OBJECTIVE: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. DESIGN: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. Arm and hand function tests (Jebsen-Taylor Hand Function Test, Action Research Arm Test), strength of upper limb (upper limb motor score, grip, and pinch strength), and independence in daily living activities (Spinal Cord Independence Measure II) were performed at baseline, end of training, and 6 mos later. RESULTS: After 12 sessions of training, improvements in arm and hand functions were observed. Jebsen-Taylor Hand Function Test (0.14[0.04]-0.21[0.07] items/sec, P = 0.04), Action Research Arm Test (30.7[3.8]-34.3[4], P = 0.02), American Spinal Injury Association upper limb motor score (31.5[2.3]-34[2.3], P = 0.04) grip (9.7[3.8]-12[4.3] lb, P = 0.02), and pinch strength (4.5[1.1]-5.7[1.2] lb, P = 0.01) resulted in significant increases. Some gains were maintained at 6 mos. No change in Spinal Cord Independence Measure II scores and no adverse events were observed. CONCLUSIONS: Results from this pilot study suggest that repetitive training of arm movements with MAHI Exo-II exoskeleton is safe and has potential to be an adjunct treatment modality in rehabilitation of persons with spinal cord injury with mild to moderate impaired arm functions.

Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review.

BACKGROUND: Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. PURPOSE: Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. METHODS: Two men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. RESULTS: At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days. CONCLUSION: Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population.

Catastrophic cervical spinal injury in an amateur college wrestler.

A young amateur wrestler presented with a burst fracture of the seventh cervical vertebra with complete paraplegia. He was treated with surgery for spine stabilisation and was actively rehabilitated. Adolescents and teenagers are indulging in high-contact sports like wrestling, without proper training and technical know-how, which can lead to severe injuries and possibly, permanent handicap or death. Trainers, assistants and institutions should be well equipped to diagnose and provide initial care of people with a spinal injury to prevent a partial injury from progressing to complete injury. Athletes, coaches and the public should be aware of methods of first aid and how to transport a patient with a cervical spine injury. Authorities should take steps to improve infrastructures in training institutions and ambulance services. Specialised spinal centres should be established throughout the country for management and rehabilitation of patients with paraplegia.

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

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.