Dizziness - Level 3 Upper Quadrant - What Is Causing It?

Sep 5, 2026

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A clinical overview of dizziness within the “Level 3 Upper Quadrant” framework, outlining a wide differential for the underlying cause. The material organizes potential etiologies across vertebrobasilar or carotid arterial causes, vestibular and cervicogenic sources, concussion/TBI, mental health factors such as anxiety and panic, systemic and neurologic conditions, and medication or medical risk factors. It links patient-reported descriptors to differentiating likely systems, maps which assessments test which system, and provides management pathways for manual therapy, motor control, and vestibular rehabilitation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

A Patient Presents With Dizziness - What Is Causing It?

Possible causes across systems

When is it relevant for ortho physios?

Subjective descriptors to differentiate the cause

Tests and further assessment

Management

Manual therapy when indicated

Motor control when indicated

Vestibular rehabilitation when indicated

Select references

DIZZINESS LEVEL 3 UPPER QUADRANT KATE KENNEDY BSCPT, FCAMPT 1 A PATIENT PRESENTS WITH DIZZINESS – WHAT IS CAUSING IT? 2 A PATIENT PRESENTS WITH DIZZINESS – WHAT IS CAUSING IT? • VERTEBROBASILAR (OR CAROTID) ARTERIAL SYSTEM • VESTIBULAR (MECHANICAL AND PATHOLOGICAL) • CERVICOGENIC (UPPER C/SPINE VIA TRIGEMINAL NUCLEUS) • CONCUSSION, TBI • MENTAL HEALTH (ANXIETY, DEPRESSION, PANIC) • HYPERVENTILATION • DEHYDRATION • FLU • CNS TUMOUR • SEIZURE DISORDER • VISUAL IMPAIRMENT • CARDIAC • HYPOTENSION • LOSS OF BLOOD VOLUME • STROKE, TIA • CEREBELLAR DISEASE • MS OR OTHER NERVOUS SYSTEM PATHOLOGY • MEDICATIONS • ANEMIA • HYPOGLYCEMIA • CARBON MONOXIDE OR OTHER POISONING • SEVERE ALLERGIES • PREGNANCY • ALTITUDE SICKNESS • THYROID DISORDERS 3 BUT THAT’S A LONG LIST! 4 WHEN IS IT RELEVANT FOR ORTHO PHYSIOS? • VERTEBROBASILAR (OR CAROTID) ARTERIAL SYSTEM • VESTIBULAR (MECHANICAL AND PATHOLOGICAL) • CERVICOGENIC (UPPER C/SPINE VIA TRIGEMINAL NUCLEUS) • CONCUSSION, TBI • MENTAL HEALTH (ANXIETY, DEPRESSION, PANIC) • HYPERVENTILATION • DEHYDRATION • FLU • CNS TUMOUR • SEIZURE DISORDER • VISUAL IMPAIRMENT • CARDIAC • HYPOTENSION • LOSS OF BLOOD VOLUME • STROKE, TIA • CEREBELLAR DISEASE • MS OR OTHER NERVOUS SYSTEM PATHOLOGY • MEDICATIONS • ANEMIA • HYPOGLYCEMIA • CARBON MONOXIDE OR OTHER POISONING • SEVERE ALLERGIES • PREGNANCY • ALTITUDE SICKNESS • THYROID DISORDERS 5 WHAT SUBJECTIVE DESCRIPTORS WILL HELP YOU DIFFERENTIATE THE CAUSE? | Vascular (VBI) | | | --- | --- | | Vestibular | | 6 WHAT SUBJECTIVE DESCRIPTORS WILL HELP YOU DIFFERENTIATE THE CAUSE? | Cervicogenic – articular, muscular | | | --- | --- | | Cervicogenic – somatosensory | | 7 WHAT SUBJECTIVE DESCRIPTORS WILL HELP YOU DIFFERENTIATE THE CAUSE? | Concussion | | | --- | --- | | Other | | 8 FROM OUR SCAN, WHICH TESTS ASSESS WHICH SYSTEM? | |
Vascular |
Vestibular | Cervicogenic |
Concussion |
Other | | --- | --- | --- | --- | --- | --- | | Cspine AROM | | | | | | | Neuro (seg, UMNL)
| | | | | | | Cranial n’s
| | | | | | | CV stability
| | | | | | | Carotid pulse
| | | | | | | Hautard’s
| | | | | | 9 WHAT FURTHER TESTING IS REQUIRED? | Vascular | Vestibular | Cervicogenic | Concussion | Other | | --- | --- | --- | --- | --- | | | | | | | 10 | CAN WE DIFFERENTIATE
WITH CONFIDENCE? | | | | --- | --- | --- | | | [Madaboutmemes.com](Madaboutmemes.com) | | 11 MANAGEMENT • IF MANUAL THERAPY IS INDICATED: • JOINT MOBILIZATION INCLUDING SNAGS • SOFT TISSUE TECHNIQUES • NEURAL/DURAL MOBILIZATION [mulliganconcept.files.wordpress.com](mulliganconcept.files.wordpress.com) Jack Miller digitalconcepts SA Reid, et al. (2008) Manual Therapy 13:357–366 [cmdtherapy.com](cmdtherapy.com) 12 MANAGEMENT • IF MOTOR CONTROL IS INDICATED: • DEEP NECK FLEXOR AND EXTENSOR ACTIVATION • POSTURAL CORRECTION • STRENGTH AND ENDURANCE • KINAESTHETIC AWARENESS – NEUTRAL REPOSITIONING, EYE MOVEMENT CONTROL, ACTIVE SEGMENTAL FLEXION/EXTENSION/ROTATION • BALANCE RETRAINING (POSTURAL SWAY) [sprintphysio.co.uk](sprintphysio.co.uk) [Cottesloephysiotherapy.com.au](Cottesloephysiotherapy.com.au) 13 MANAGEMENT • IF VESTIBULAR REHABILITATION IS INDICATED: • SEVERAL MOVEMENT RELATED MANEUVERS MAYBE RELEVANT • GAZE STABILIZATION • MOTION HABITUATION EXERCISE • BALANCE, POSTURAL SWAY [fabhow.com](fabhow.com) [dartmouth-hitchcock.org](dartmouth-hitchcock.org) Bell, DR et al (2011) Sports Health 14 SELECT REFERENCES • HUTTING, N., ANTONIUS, H., & KERRY, R. (2020). YES, WE SHOULD ABANDON PRE-TREATMENT POSITIONAL TESTING OF THE CERVICAL SPINE. MUSCULOSKELETAL SCIENCE AND PRACTICE, 49, 102181. • REID SA, ET AL. (2008) SUSTAINED NATURAL APOPHYSEAL GLIDES (SNAGS) ARE AN EFFECTIVE TREATMENT FOR CERVICOGENIC DIZZINESS. MANUAL THERAPY 13:3

FAQs

What main categories of causes are listed for patient dizziness?

The slides group causes into vertebrobasilar (or carotid) arterial system, vestibular (mechanical and pathological), cervicogenic (upper C/spine via trigeminal nucleus), concussion/TBI, mental health (anxiety, depression, panic), and additional medical causes such as dehydration, cardiac issues, hypotension, stroke/TIA, medications, anemia, hypoglycemia, and thyroid disorders.

Which subjective descriptors help differentiate the likely dizziness system?

The content highlights subjective descriptors that distinguish vascular/vestibular patterns, cervicogenic subtypes (articular/muscular and somatosensory), and concussion versus other causes.

How does the document guide testing and management after identifying the system?

It maps which tests assess which system (e.g., cervical spine AROM, neurologic segment and UMNL, cranial nerves, CV stability, carotid pulse, and Hautard’s). Management then branches into manual therapy, motor control (deep neck flexor/extensor activation, postural correction, strengthening, and balance retraining), or vestibular rehabilitation with movement, gaze stabilization, and habituation exercises.

Sep 5, 2026

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