concussion dizziness is not just inner ear—vision and neck are often involved
4 minute read
dizziness after a concussion can come from the inner ear, the neck, the visual system, or a mix of all three.
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dizziness after a concussion is one of the most common symptoms experienced. many people are sent straight to vestibular therapy, which helps some, but it often is not enough on its own because other systems can be involved. the neck, for example, plays a key role in balance through sensors in its joints and muscles, which tell your brain where your head is in space.1 problems in the neck can look a lot like vestibular dizziness and may keep symptoms going if they are missed.2 research in athletes also shows that combining neck and vestibular care can speed recovery compared with usual care.3 a critical review of vestibular rehabilitation after concussion injuries found that between two to four people would need vestibular rehabilitation for one person to have complete relief of dizziness symptoms, which suggests an effectiveness rate of only 25 to 50 percent when vestibular rehab is used in isolation.4
your eyes, neck, and inner ears work as a team to keep you steady. if one of these systems is off, your brain has trouble integrating the signals.2 if the neck is stiff or sore, for example, its position signals can provide the brain with inaccurate information about where the head is in space, and you feel dizzy, experience weird visual symptoms, or just feel off. your eyes and neck are linked. when your eyes move, your neck muscles prepare to turn your head. if those neck muscles are irritated, reading, scrolling, or driving can trigger neck pain and headaches. treating the neck often makes those visual tasks easier.1
vision problems and targeted treatment
after a concussion, many people notice light sensitivity, blurred or double vision, eye strain, losing their place while reading, or feeling overwhelmed in busy stores. careful testing with a neuro-optometrist can identify specific problems like poor eye coordination and focusing, even when basic eyesight is normal.6 targeted vision therapy can help when these problems are clearly identified, and many people report less eye strain and better reading after exercises for focusing and eye teaming. at the same time, eye experts note that the research for some popular tools is still limited, so treatment should focus on well-defined problems and be coordinated with vestibular and neck care.5
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vestibular therapy: useful, but often needs partners
vestibular therapy can reduce dizziness and imbalance, especially when paired with neck care. in athletes with ongoing symptoms, adding a cervicovestibular program helped people get cleared to return to sport faster than usual care.3 still, not everyone improves with vestibular therapy alone, which is why combining it with vision and neck treatment is often the best path.4
neck treatment: hands-on plus the right exercises
neck driven dizziness, sometimes called cervicogenic dizziness, comes from disturbed signals from the neck to the balance and eye movement systems. manual therapy for the neck can improve range of motion, head repositioning accuracy, and balance.2 for neck related headaches, the strongest results come from manual therapy as the base, with exercises added to make the improvements last. a good plan usually starts by calming painful tissues and restoring movement, then adds joint position training and, later, strength and endurance work.7 8
the bottom line
dizziness after a concussion can come from the inner ear, the neck, the visual system, or a mix of all three. autonomic problems can add lightheadedness and motion intolerance too. the best results come from building a foundation first, like calming the nervous system and using graded aerobic activity, then adding targeted rehab for the neck, eyes, and vestibular system so all three send the same message to your brain.1–4 5–8 good concussion clinicians understand this holistic, multidisciplinary approach and will often have a good network of referral sources to help point you in the right direction.
dr. cameron marshall, dc, frccss(c) is a sport-specialist chiropractor and founder of complete concussions, as well as a co-founder of concussion fix.
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references
- treleaven j. sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. man ther. 2008;13(1):2-11.
- reid sa, callister r, katekar mg, rivett da. effects of cervical spine manual therapy on range of motion, head repositioning, and balance in cervicogenic dizziness: a randomized controlled trial. arch phys med rehabil. 2014;95(9):1603-1614.
- schneider kj, meeuwisse wh, nettel-aguirre a, et al. cervicovestibular rehabilitation in sport related concussion: a randomized controlled trial. br j sports med. 2014;48(17):1294-1298.
- booth m, powell j, mckeon po, medina mckeon jm. vestibular rehabilitation therapy for management of concussion: a critically appraised topic. int j athl ther train. 2019;24(3):100-107.
- american academy of ophthalmology; north american neuro ophthalmology society. consensus statement on visual rehabilitation in mild traumatic brain injury. ophthalmology. 2022;129(2):e1-e11.
- chisholm a, nwabara o, macintosh pw, rizzo jf. visual disturbances after concussion. curr phys med rehabil rep. 2023;11:187-199.
- jull g, trott p, potter h, et al. a randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. spine. 2002;27(17):1835-1843.
- fernández-de-las-peñas c, florencio ll, plaza-manzano g, et al. effectiveness of manual and exercise therapy on cervicogenic headache: systematic review and meta analysis. chiropr man therap. 2022;30:47.
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