The neck is one of the most common causes of Vertigo and Dizziness. How does it happen… and what the heck is the Vestibular System?
Working in the field of Vestibular Rehabilitation as physiotherapists – we see so many types and causes of dizziness, vertigo and imbalance.
One of the most common of these causes is called Cervicogenic Dizziness This is simply dizziness that is caused by your neck.
In this short blog post I will be describing how the neck relates to your Vestibular System (the system that helps you maintain equilibrium).
After this introduction, I will delve into some of the issues that can arise in the neck and Vestibular System that can create feelings of dizziness, vertigo, nausea and imbalance.
At the end of the article I will also give some recommendations as to what you can do to treat and manage your symptoms.
Let’s dive in and learn more about necks, dizziness, vertigo and the vestibular system!
First up: what is the Vestibular System
The Vestibular System is made up of all the systems in your body that tell your brain where you are in space at any given moment.
It tells your brain whether you are standing on a slope. It tells your brain if your car is going up a hill or around a corner. It tells you whether your body is moving or whether the world around you is moving.
It does all this by combining all the messages sent to your brain from the following key sensory areas:
- Your eyes (vision)
- Your inner ear (acceleration, velocity and tilt)
- Your muscles and joints (providing tactile sense of where you are positioned in relation to surfaces and other body parts)
These messages are all sent along nerve pathways and then your brain puts it all together and tells you information like:
- “I am leaning to the left”
- “My car is going around a corner”
- “A car is driving past me but I am still”
How does is the Neck involved in the Vestibular System and what is Cervicogenic Dizziness
The neck fits into the third key sensory area that I listed above.
It provides a sense of where your head is in space because when your head moves, joints and muscles in your neck will of course move in a certain way to allow for this motion and also control the speed that your head is moving.
When this happens, nerve endings will send messages from your neck to your brain. For example if your head tilts to the left, the joints on the left side of your neck will close and the nerve endings will tell your brain that these joints have closed up – your brain will use this information to form a better idea of where your head is in space.
This system works best when all your sensory systems are telling your brain information that makes sense together. For example, both your visual and inner ear systems can confirm that your head is indeed tilted to the left.
Cervicogenic or Neck related dizziness often occurs when the messages don’t add up and are a bit mismatched. So for example if you have a lot of tightness in your neck or you have injured a muscle in your neck – the information it is picking up may not be completely accurate (this is a normal adaptation to injury).
Because of this your neck might be telling you that your head is centred when in fact you are actually tilting it to the left!
What came first: Chicken or the Egg? The Neck or the Vestibular system?
It can actually go both ways! The example above explained how an injury or tightness in the neck can affect your vestibular system. This is quite common, but it can also go the other way.
Some people with a condition affecting their inner ear such as Vestibular Neuritis can start to get problems with neck tightness or neck pain due to their altered perception of where their head is in space.
For example, if your inner ear is telling you that you are falling to the left – your neck muscles on the right may tighten to try an “right” your position and keep you upright.
Also people who have conditions which affect their inner ear (such as BPPV, Vestibular Neuritis, Meniere’s and more) will often have a loss of balance. People who feel at risk of falling will often tense muscles in their neck, legs and core to try and compensate for this loss of balance.
Treatment for Cervicogenic Dizziness and other Vestibular Conditions
There are many treatment options available for Cervicogenic Dizziness and a wide range of other vestibular disorders.
The main thing we need to do in Vestibular Rehabilitation as physiotherapists is first assess to see which system has been affected. Is it the neck, the inner ear, the eyes, or another system causing the problem.
Once we determine the underlying cause is the neck or is cervicogenic in origin we can commence putting together a Vestibular Rehabilitation program. This can consist of the following:
- Manual Treatment (such as joint release, soft tissue therapies and dry needling) to release tight muscles and joints that may be causing an altered sense of head positioning)
- Exercise and postural correction – sometimes you may need to strengthen the muscles required to keep your head centred and balanced. You may also need to retrain your sense of joint position with the help of physio feedback, mirrors, video and more
- Vestibular Rehabilitation exercises – these may involve eye tracking and head positioning exercises to help better match the messages sent from your eyes and inner ear to the messages you are getting from the nerves in your neck