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As physical therapists who navigate the intricate world of vestibular and balance disorders and as National Directors of Vestibular Education & Training at FYZICAL, a deeper understanding of cervical dystonia (CD) becomes paramount. While CD, a neurological movement disorder, causes involuntary neck muscle contractions leading to abnormal postures and often significant pain, evidence suggests that in some cases, an underlying, unaddressed vestibular dysfunction—particularly otolithic—could be a primary, usually silent, instigator. This perspective is not merely theoretical; it offers a critical lens through which both orthopedic and vestibular professionals can enhance collaborative assessment and management of these challenging patients, potentially leading to improved patient outcomes.

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Imagine this: a patient with classic geotropic horizontal canal BPPV (Benign Paroxysmal Positional Vertigo) receives a Gufoni maneuver, a specific repositioning technique involving a series of head movements. You feel confident. They walk out. But then, week after week, they're back, with the same symptoms and the same canal. You're left scratching your head, asking, 'Why isn't this clearing?'

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