Dizziness Following Whiplash Injury
Dizziness is a common symptom after whiplash injuries, affecting between 40 and 70% of all patients with chronic pain. Patients with dizziness may report loss of balance or falls from the disorder. Symptoms of dizziness after whiplash have been attributed to brain injury or even trauma to the inner ear. The latest studies, however, seem to point towards the cervical spine as the culprit.
A group of Australian researchers has just published a study that looks specifically at the cervical spine to see if dizziness arises from lesions in the neck.
The authors used a technique known as "joint position error testing" (JPE). The technique uses motion sensors to record a patient's ability to position his or her head in space after flexion/extension and rotation of the neck. In previous studies, patients with neck pain (traumatic or non-traumatic) were found to have deficits with JPE testing.
This study examined 102 patients with persistent whiplash pain and compared them to 44 control subjects. Each participant completed a set of pain and dizziness questionnaires. The results were then analyzed:
- Of the 102 whiplash patients, 76 reported dizziness or unsteadiness.
- The whiplash patients with dizziness had higher scores on the neck pain index than did the whiplash patients without dizziness.
- On the joint position error tests, whiplash patients had significantly higher JPEs than the non-whiplash control subjects.
- Within the whiplash group, the patients with dizziness or unsteadiness had significantly more joint position errors than the non-dizziness patients.
- For those patients with dizziness, the words most commonly used to describe the symptoms were "lightheaded," "unsteady," and "off-balance."
Delayed Onset of Symptoms
The authors found that 17% of the patients reported a delayed onset of symptoms after their whiplash trauma. They found that these patients with delayed onset also had significantly higher joint position errors.
"This perhaps suggests that the development of symptoms may be as a result of prolonged altered range of movement and decreased neuromuscular control rather than random occurrence. The tendency for larger JPEs in the group with delayed onset may also suggest that prolonged altered range of movement and neuromuscular control generates as much if not more problems for cervical proprioception than the initial proprioceptive barrage following the accident."
The authors also recorded the other symptoms associated with dizziness in the whiplash patients:
Description of Symptoms:
Lightheaded - 60% Giddy - 27% Falling/veering to side - 23% Vague imbalance - 19% Unsteady - 52% Imbalance - 25% Trouble with stairs - 21% Fainting - 15% Off-balance - 48% Focus when walk - 25% Imbalance in dark - 21% Might fall - 15% Clumsy - 30% Motion sickness - 25% Vision/eyes jiggle - 21% Exacerbating Factors:
Increased neck pain - 60% Neck movements - 44% Moving quickly - 36% Stress - 21% Standing/sitting up - 57% Neck positions - 42% Associated Symptoms:
Headache - 56% Decreased concentration - 35% Sweating - 30% Confusion - 21% Nausea - 40% Blurred vision - 38% The authors conclude:
"The increased JPE in the WAD subjects complaining of dizziness suggests a cervical cause of the dizziness. The description of the dizziness and or unsteadiness provided by the WAD subjects reinforces this suggestion. The common reports of unsteadiness and lightheadedness are those previously nominated for dizziness of cervical origin. Furthermore, 48% of subjects with these symptoms reported at least one episode of loss of balance with 21% reporting an associated fall which relates well to those symptoms reported from experimentally induced cervical vertigo."
From this study, it seems that most dizziness after whiplash injury originates in the cervical spine mechanoreceptors. Treatment of the cervical spine injury-and specifically the joint capsules with injury-should reduce the symptoms of dizziness experienced by these patients.
Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of Rehabilitation Medicine 2003;35:36-43.
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