Is manual therapy effective for cervical dizziness? A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND The pathophysiology of cervical-related dizziness (CD) is unclear. Manual therapy has been shown to be a possibility for treating the symptoms of CD. The proposed manual therapy treatments may target the upper cervical spine or take a more comprehensive approach. However, it is still unclear which of these approaches produces better results. Therefore, the aim of this review and meta-analysis was to evaluate the effectiveness of manual therapy targeting the upper cervical spine and the global manual therapy interventions compared with control or sham on dizziness impact, intensity, frequency, pain intensity, and neck disability.

METHODS A comprehensive search was conducted on Cochrane Library, PubMed, PEDro, and Web of Science databases from inception to December 2, 2024. Randomized Controlled Trials (RCTs) were included. The studies had to apply manual therapy and compare it with a placebo or a control group in patients with CD. The methodological quality was evaluated using the PEDro scale, and the certainty of evidence was assessed based on GRADE guidelines.

RESULTS Six RCTs and three secondary analyses were included. Meta-analyses revealed statistically significant differences between manual therapy focused on the upper cervical spine and control/placebo for impact and intensity of dizziness. The certainty of evidence was downgraded to very low for pain intensity, low or very low for cervical range of motion, and disability.

CONCLUSION There is low to very low certainty evidence indicating a difference in effectiveness between upper cervical spine interventions and control/placebo treatments for improving the impact and intensity of dizziness in patients with cervical-related dizziness.

PROSPERO REGISTRATION ID CRD42024615329

SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s12891-025-08899-z.