For instance, if an individual is suffering with BPPV and has severe neck pain...and can barely move their neck, which should be treated first? In my opinion, generally speaking, the BPPV should be treated first if the goal is to help the person get rid of their problem as quickly and comfortably as possible. One might ask, won't you hurt the neck more by completing the repositioning maneuvers? The way I complete repositioning maneuvers, the answer is no. I complete repositioning maneuvers working toward minimal stress to the neck through proper positioning, pillow placement and manual therapy table use.
Once BPPV is corrected, the vestibulocollic reflex is no longer hyperactive, the individual is no longer punished for trying to move their neck and the neck pain/discomfort usually resolves very quickly without even having to begin neck therapy.
Stay tuned for more entries on when the neck should be treated prior to the ear when individuals are dizzy.