Chiropractic, Dizziness and Vertigo

Dizziness and vertigo are fairly common symptoms after an auto injury.

The most common cause of dizziness is injury to the tissues of the neck. When the ligaments and discs of the neck are injured, inflammation and scar tissue can affect the nerves of the spine that help us regulate balance. In fact, recent studies show that most patients suffer from balance problems after an auto accident, even if they don’t have symptoms of dizziness.

In some cases, vertigo can be caused by direct or indirect brain injury.

Postural Stability and Neck Trauma

Dizziness and vertigo are common symptoms of whiplash injuries. The issue of posture control is a relatively new area of study in the field of whiplash injuries, but one that is providing many new clues into the nature of such injuries. Because postural control is such a complex mechanism, much can be learned about the nature of whiplash injuries if we can understand what aspects of the postural control system are altered after an injury.

There are three components to the Postural Control System:

The Visual System provides information to the brain on where the body is positioned in space.
The Vestibular System consists primarily of the inner ear, and provides information to the brain on the motion of the head.
The Somatosensory portion of the PCS informs the brain of the position of the body. Organs and receptors in the muscles and joints of the body perform this function, which is commonly referred to as "proprioception."

Most of the research on the problem of dizziness after whiplash has been focused on proprioceptive dysfunction. Injury to proprioceptors in the cervical spine could lead researchers to understand exactly what kind of injury mechanism is responsible for whiplash pain and symptoms.

The goal of this current study was to see if there was a difference in balance between healthy subjects and patients with neck trauma. The researchers performed postural stability tests on 32 healthy subjects (no neck complaints or reports of vertigo), and ten whiplash patients. None of the subjects were told the purpose of the study. The healthy subjects were divided into five groups, by age (20s, 30s, 40s, and 50s).

The graph on the following page shows the results between the five groups of subjects.

The researched found two interesting pieces of information. First, all of the subjects had more trouble maintaining balance with the head in the backwards position. Secondly, whiplash patients had significantly reduced postural control functioning.

The authors conclude, “Patients with a whiplash injury and subjective neck complaints have impaired postural control compared with control subjects.”

This seems to be a fairly objective test, since the test subjects did not know what was being studied, making it more difficult to “fake” results.

Proprioception and Whiplash

Over the last few years, a number of researchers have investigated the role of proprioception in the problem of whiplash. Some researchers have hypothesized that injury to the cervical facet joints may result in dysfunction of that part of the nervous system responsible for balance. (For a review of these studies, see our book Low Velocity Whiplash Biomechanics.)

A recent study again looked at this problem by studying the cervical movements, the cervical range of motion, and the oculomotor function of 27 whiplash patients. They compared these patients to 25 healthy control subjects, and found significant differences. They found that, “Repositioning dysfunction was present in 62% of subjects with whiplash trauma 2 years after the trauma.” They also showed dysfunction in the oculomotor tests, indicating that “restriction of cervical movements and changes in the quality of proprioceptive information from the cervical spine region affect voluntary eye movements.”

These dysfunctions could possibly result in dizziness or vertigo—a common symptom of whiplash injury—and also may indicate that if the proprioceptive function of the nerves in the facet joints are injured, the nociceptive—or pain carrying—nerves may also be involved as well. This could explain the chronic neck pain experienced by whiplash patients.

“Previous studies illustrate the presence of mechanoreceptive and nociceptive nerve endings in cervical facet capsules proving that these tissues are monitored by the central nervous system and implying that neural input from the facets is important to proprioception and pain sensation in the cervical spine. In our study significant correlations occurred between active range of cervical motion and oculomotor performances as well as kinesthetic sensibility, which could indicate that the zygapophysial joints’ dysfunction mediates this proprioceptive dysfunction.”

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