Following traumatic injury, some patients report dizziness or balance problems. These complaints can be caused by many factors. Several different sensory systems affect the regulation of balance including the visual, vestibular and peripheral somatosensory systems. A 2007 study points to cervical spine injury as a common cause of balance disturbance or postural control deficits following trauma.
Researchers at the University of Ulm, Germany studied 40 patients with acute grade II whiplash injuries and 40 controls. Using tetra-ataxiametric posturography, a device that measures balance control, the researchers tested the whiplash patients and controls. Subjects with acute whiplash were found to have significantly poorer results than the healthy controls. Two months later, the subjects were retested. There was no significant difference in the result of the control group. However, significant changes were noted in the whiplash subjects. Of the 40 subjects, 17 reported no change in their pain intensity, 21 reported improvement in pain and 2 had deteriorated. The subjects who had improved showed significant improvement in balance control as compared to the other 19.
Interestingly, at initial testing, only 4 of the 40 whiplash patients reported any dizziness or balance disturbance despite objective evidence of balance impairment. At the two-month follow-up, no patients reported these symptoms. In whiplash patients, the peripheral somatosensory system is assumed to be impaired by damage to the proprioceptors in the neck.1 Since numerous systems are involved in balance control, the authors surmise that postural disturbances only become symptomatic when several subsystems are impaired at the same time.
When an acute whiplash patient reports dizziness or balance problems, this study suggests the problem may be related, at least in part, to the neck injury. However, since few subjects with only whiplash actually reported these symptoms, health care providers should be mindful of the possibility that other subsystems may be causing dizziness or vertigo, or that there can be a vestibular injury to the inner ear.
When a person is injured in a collision or other traumatic event, the insurance companies involved readily challenge the cause of symptoms such as dizziness and vertigo. Experienced counsel with the appropriate knowledge on trauma and injury can assist the victim of injury and the health care provider in establishing the cause of a condition and, therefore, secure coverage and reasonable compensation for the condition.
1 Dehner, C, Heym B, Maier D, Sander S, et al. Postural control deficit in actue QTF grade II whiplash injuries. Gait & Posture 2008;28:113-119.
