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1st Aug

2018

Dizziness and Unsteadiness Caused by Neck Trauma and Chronic Disorder

It is known that neck trauma, such as whiplash injury from car accidents, often results in various forms of dizziness, unsteadiness, loss of neck-trunk and eye coordination or control, and loss of postural stability and balance.

The most common cause, following such trauma, is altered input from sensory nerve fibers embedded in the ligamentous capsules of neck joints, and also from nerve receptors in neck musculature. These nerve fibers are quite sensitive, and even relatively low force trauma can result in such changes, as joint capsules and ligaments around neck joints have been sprained.

Another consequence of such trauma, is some loss of joint position sense, or proprioception, which is believed to also contribute to delay in tissue healing and restoration of normal stability and posture.

If the injury involved a high force, in particular with a direct hit to the head, other structures can be injured as well, such as the peripheral vestibular system, or the brain following a concussion. Symptoms then often tend to be described as vertigo, or spinning, disequilibrium, or nausea, as well as more pronounced visual and cognitive deficits following a concussion. Dizziness symptoms stemming from the neck tend to be reported more as unsteadiness or lightheadedness, although mild temporary spinning with repeated neck motions has been reported following only neck trauma.

Such alternative sources producing dizziness and related symptoms will not be described in detail here, but the literature has reported a number of specific tests to differentiate between them, and specific treatment for each one. It should also be mentioned, that it is quite common, to experience vertigo symptoms without having had any trauma, which most commonly stems from our vestibular system in the inner ear, such as dislodged crystals, or “ear stones” in the semicircular canals.

One interesting exception, is when true vertigo and nausea are caused by migraines, so called vestibular migraines, which mimic episodes of dislodged ear crystals, or BPPV, but can be differentiated with specific testing. These episodes typically resolve within 15-60 minutes (although they are often followed by headaches), just as episodes of auras for those with migraines who experience them. Just like BPPV, they are provoked by neck positions such as looking up or down, and lying down with the neck extended backwards and rotated to the side. Rapid eye movements, or nystagmus, are typically seen as well. The main reason why I mentioned these, is that for some people, migraines can be triggered by increased firing of sympathetic nerve fibers (part of the fight and flight system) located in the joints of our mid-cervical spine. This could happen as a result of localized tissue strain or compression, from e.g. abnormal joint mobility or stability, or degenerative changes, and traumas could make such episodes more frequent and pronounced. Of course, there are many other possible triggers for migraines.

In general, dizziness stemming from the neck following trauma should be episodic, typically come on more when the pain is more pronounced, and be brought on by neck movements or positions, and not be perceived as true vertigo, or pronounced spinning. Lightheadedness or unsteadiness due to chronic neck pain, or migraine attacks believed to stem from the neck, may not follow this pattern, but nevertheless can be treated with specific manual physical therapy.

The aim of physical therapy treatment after traumas, is to enhance healing of injured soft tissues in the neck, with related nerve receptors, decrease inflammation, and over time restore mobility and stability-muscle function in the neck, as well as coordination and postural control.

When dizziness comes on with neck movements following injuries such as a car accident, movements have to be performed slower and with less repetitions, or be stopped all together if symptoms are pronounced. Alternative movements and exercise will then be prescribed. Once the nerve receptors have become less sensitive, more exercises can again be added, which can also help to desensitize these nerve receptors.

As always after soft tissue traumas, frequent daily gentle movements without stretch are important, to enhance tissue healing. Once inflammation has decreased and neck mobility has improved, the exercise intensity can be progressed, to optimally activate stabilizing muscles, and restore coordination and tolerance to daily activities.

It can often take 9-12 months after significant whiplash injuries, before normal neck function has returned and nerve receptors in injured joint capsules have fully regenerated, although the pain and dizziness symptoms typically subside quicker. Therefor, it is recommended to continue with specific home exercise for at least a year.

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