Comparative Effectiveness of Cervical Spine Mobilization vs. Neuromuscular Re-Education for Cervicogenic Dizziness on Pain, Balance, Function, and Cervical Mobility

Abstract

Background: Cervicogenic dizziness is characterized by dizziness and postural instability associated with cervical spine dysfunction and is often accompanied by neck pain and restricted cervical motion, yet comparative evidence for manual versus active sensorimotor rehabilitation remains limited. Objective: To compare the effectiveness of cervical spine mobilization versus neuromuscular re-education on pain, balance, dizziness-related disability, and cervical mobility in adults with cervicogenic dizziness. Methods: A prospective, single-blind randomized controlled trial enrolled 70 participants clinically diagnosed with cervicogenic dizziness and allocated them to cervical spine mobilization (n=35) or neuromuscular re-education (n=35). Interventions were delivered three times weekly for eight weeks. Outcomes included Visual Analogue Scale (VAS), Balance Error Scoring System (BESS), Dizziness Handicap Inventory (DHI), and active cervical range of motion (rotation and flexion), assessed at baseline, Week 4, and Week 8. Between-group mean differences, 95% confidence intervals, and Cohen’s d were reported. Results: Both groups improved significantly over time. At Week 8, cervical spine mobilization produced greater pain reduction (mean difference −1.20; 95% CI −1.63 to −0.77; p=0.001; d=−1.30) and greater improvements in rotation (12.0°; 95% CI 7.5–16.5; p=0.002; d=1.26) and flexion (8.0°; 95% CI 4.0–12.0; p=0.01; d=0.94). Neuromuscular re-education yielded superior balance improvement (BESS mean difference 3.40; 95% CI 2.27–4.53; p=0.01; d=1.44). DHI improvements were comparable (p=0.36). Conclusion: Both interventions are effective; mobilization favors pain and mobility, whereas neuromuscular re-education favors balance, supporting deficit-guided treatment selection