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Duncan Chiropractic Group Newsletter

Neck Pain and Dizziness

Dr. David L. Phillips - May Issue
Dr. David L. Phillips

Dizziness caused from neck problems is called cervical vertigo and is a common symptom. In my clinic, I see cases of cervical vertigo every day. The degree of dizziness varies from slight, fleeting and mild to severe, long lasting and debilitating. As there seems to be no practical and effective medical treatment (read "drug" here), these patients eventually seek alternative therapies. Most people who come into my office have made the connection that the problem of dizziness is somehow to do with their necks. Either the dizziness comes on with neck movements or they began to realize that the problem began after they injured their necks. These patients sometimes describe their symptoms as "lightheadedness", as being "unsteady", "off-balance" or just plain "clumsy" In fact, cervical vertigo occurs in about 80% of whiplash cases and after around 33% of other types of neck injuries. After pain, vertigo is the next most frequent whiplash complaint. Periods of dizziness last seconds to minutes and are usually related to sudden neck motions especially rotation with extension. Women are far more likely to suffer from dizziness after a cervical trauma than men. Vertigo is more likely implicated with chronic neck pain and its presence is generally a sign that recovery will be slow and incomplete (a poor prognosis, as we say).

According to a study in the Journal of Rehabilitative Medicine January 2003; 35:36-43, most patients put the intensity of dizziness on a scale of 1 (low) to 10 (high) as 4.8. Sitting quietly or standing still gives relief to 90% of subjects. Over half the patients studied had daily bouts of dizziness. Twenty-one percent said that they actually fell over when a wave of vertigo came. The symptoms of dizziness began either immediately or within 24 hours after the whiplash in 68% of cases studied while 15% had it start 1 week post-trauma.

There are other causes of vertigo that need to be considered. Most causes relate to the balance mechanism of the inner ear. There are 3 small semi-circular tubes in your ear, each oriented in a different direction. As you move your head or your body in space, the fluid in these canals sloshes around. This movement of fluid stimulates tiny hair-like projections and these in turn send impulses to your brain. From the impulses you get a sense of where you are. This phenomenon is part of the function of your nervous system called "Proprioception". The proprioceptive nervous system is vast and complicated. In a future article, I will discuss it in greater detail, so stay tuned. This is the part of the nervous system in which chiropractors work the most.

Infections, both bacterial and viral, inflammation, and brain damage from trauma or strokes all can cause vertigo. Another very common cause is crystal formation on the tiny hair-like projections in the semi-circular canals. These microscopic crystals occasionally break off and begin to slosh around with the fluid. This altered fluid motion sends false information to the brain, particularly with rapid head movement, and dizziness results. Fortunately there is a simple and harmless maneuver that can, in lots of cases, successfully shift these crystals into an area of the canals where they will no longer affect the brain signals.

How chiropractors can help is mainly in the area of dizziness coming from the neck, or cervicogenic vertigo. What happens here is, as a result of trauma to the neck, there is a shift in the proprioceptive impulses coming from the muscles, joints and tendons in the neck and going to the brain. This disturbance of sensory input results most frequently in dizziness, or some alteration of positional awareness. This phenomenon of cervicogenic vertigo has been recognized since the mid- 50´s and has been studied extensively since. Chiropractic is quite successful in treating cases of dizziness whereas medicine remains somewhat baffled as to how to help these patients.