Question
I was diagnosed with cervicogenic vertigo from a whiplash injury a few years ago.  I have done special exercises given to me by a vestibular physiotherapist but haven't seen a lot of improvement.  Is there anything else I can do?  Can this be permanent, or is it just a matter of time before it heals?

Answer
Dear Mary,

Cervicogenic vertigo is named due to the origin of the problem...from within the neck...and this is a common finding in patients who have sustained a whiplash injury.  This occurs due to abnormal proprioceptive input to the brain from the muscle spindles in the neck.  Proprioception is your bodies own awareness of where it is in space without the aid of visual cues.  Therefore is the proprioceptive input from the muscle spindles of the neck are firing improperly, it can upset your balance mechanism.

By cross sectional area of the muscle fiber, the neck musculature has more proprioceptors per square centimeter than any other tissue in the body.  That is why the firing patterns in the neck are so important. Exercises to mimic normal joint motion are appropriate to help with increasing balance and reducing dizziness symptomatology, however if the joint mechanics continue to remain abnormal in motion or movement, then the muscular system will retain dysfunctional patterns and continue to fire inappropriate signals to the brain about position sense.

Due to the nature of the whiplash mechanism of injury, the facet joints in the neck as well as the ligamentous complexes that stabilize them, become injured through an acceleration effect, compression and shear stress.  So if you are not addressing the specific joint motion of the neck as well as the ligamentous stretch reflex of the joint capsule then you will likely not gain any further improvement.  So to correct this issue, I would suggest that you find a good local chiropractic physician and have then examine and adjust the vertebral joints of the neck and to focus especially on the upper cervical joint spaces which are intricately involved in balance and proprioception.  There are numerous research studies that have validated these finding and the ability of chiropractic upper cervical adjustments to reduce and often eliminate vertiginous symptoms that arise from the neck.  I would also suggest that you try to find a chiropractor who has some advanced training in either whiplash injury mechanisms, neurology, or a specific upper cervical technique...ask for credentials to the classes they have taken and any certifications they may have.

Additionally, I would suggest that you review The Spine Research Institute of San Diego's website which is dedicated to crash injuries and has a focus on whiplash associated disorders:  www.srisd.com

Good luck Mary, hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net