Feeling Dizzy? Positional and Physical Exertion Induced Vertigo

I recently reviewed a malpractice case of a head-injured firefighter with positional “dizziness” who was released back to full active duty by his orthopedist, neurologist, and chiropractor. After returning to work, he climbed up a 20 foot ladder, suffered extreme “dizziness” and fell to the ground sustaining additional injuries.

The records included a variety of musculoskeletal tests, range of motion measurements of the cervical spine, orthopedic balance tests (Heel/Toe walk, Romberg’s sign) and x-rays. However, two critical referrals were missing.


A referral to an Ear, Nose & Throat (ENT) specialist is needed to differentiate “dizziness” from vertigo and to rule out inner ear infections, neurological damage and adverse reactions to drugs.


A Functional Capacity Evaluation (FCE), by Medical Legal Experts Medical Inc. is the only available test for both positional and physical exertion induced vertigo. To test for vertigo, a sustained static lift test with a heart rate monitor is recommended by Medical Legal Experts Medical Inc. (The Physicians’ Guide to Functional Capacity Evaluations, 2008).

Several active police officers and firefighters are currently suffering from positional and physical exertion induced vertigo due to head and neck trauma. This poses a real risk to these workers, their families and our community.

If you are unsure how to perform any of these tests or do not have the equipment, I would be happy to examine these injuries and identify any functional limitations to ensure a safe return to work.

Dr. Stephen Stepaniuk, DC, QME, FCE Expert, Los Angeles, CA