Whiplash, Dizziness, and Chiropractic

Car accidents cause damage to your car, which is often the first thing we think about after an accident. After all, we can see the twisted metal, broken headlights, and scratched paint job.

Car accidents can cause a devastating amount of damage to your body, which is a lot harder to see. An insurance company can tell you exactly how much damage occurred to your vehicle, but it's difficult to say exactly how much damage occurred to you.

Some people who have whiplash, for example, can undergo symptoms for months and months, even if they are treated immediately after the accident. Many of the people who have whiplash also have dizziness.

Two Swiss researchers investigated the dizziness in some chiropractic patients who have whiplash. They published an article in the journal Chiropractic & Manual Therapies recently in which they asked two important questions: 1) does whiplash with dizziness take longer to improve; and 2) do men or women usually have dizziness with whiplash?

And they came up with these surprising answers:

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A high proportion of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months. Although neck pain patients with dizziness undergoing chiropractic treatment reported significantly higher pain and disability scores at baseline compared to neck pain patients without dizziness, there were no significant differences in any outcome measures between the two groups at 6 months after start of treatment. Neck pain patients with dizziness were much more likely to be female and females with dizziness report higher levels of depression compared to males with dizziness at all data collection time points.

The researchers began their article by stressing the importance and prevalence of neck pain:

The complaint of neck pain is second only to low back pain in terms of common musculoskeletal problems in society today with a lifetime prevalence of 26-71% and a yearly prevalence of 30-50%. Most concerning is that many patients, particularly those in the working population or who have suffered whiplash trauma, will become chronic and continue to report pain and disability for greater than 6-months. In terms of symptoms, dizziness and unsteadiness are the most frequent complaints following pain for chronic whiplash sufferers with up to 70% of patients reporting these problems. Apart from whiplash trauma, little is known about dizziness in the chronic neck pain population and much remains unknown about the etiology of chronic neck pain in general.

The researchers then compared 405 patients' initial pain and dizziness findings (the "baseline" sample) with their pain and dizziness findings after 1 month of chiropractic care, after 3 months of chiropractic care, and again after 6 months of chiropractic care:

At baseline neck pain patients with dizziness reported statistically significantly higher levels of neck pain, arm pain, physical and social disability, anxiety, depression,work fear avoidance and less control over their pain condition (locus of control) compared to those without dizziness. As a result, the BQN [the Bournemouth Questionnaire for Neck, a scoring device to quantify a patient's pain] total scores were significantly different between those with and without dizziness, being significantly higher in neck pain patients with dizziness.

There was a steady report of increased improvement for both neck pain and dizziness at each of the three follow-up data collection periods with no differences in outcome between patients with and without dizziness...

By 1 month after the start of treatment, the only areas where the neck pain with dizziness patients reported significantly higher scores were arm pain, social disability and depression but there was no significant difference in the BQN total score between the two groups. Three months after the start of treatment only social disability and depression were scored significantly higher in patients with dizziness and by 6 months there were no significant differences between neck pain patients with and without dizziness for any of the outcome measures due to the significantly higher baseline to 6 month change scores in the BQN subscales ‘physical disability’, ‘anxiety’, ‘depression’ and ‘locus of control’ for patients with dizziness.

Excellent! So, not only did the whiplash patients improve under chiropractic care, but the whiplash patients with dizziness improved so much that they matched the other patients' improvement levels!

The researchers also found a striking difference between men and women: many more women than men said they had dizziness as a component of their whiplash syndrome:

There was a significant association between being female and reporting ‘dizziness’ with 133 of the 177 patients stating that they had neck pain and dizziness being female (75%).

Here's how the researchers sum up their two surprising findings:

The findings from this study are very encouraging for neck pain patients undergoing chiropractic treatment who also suffer from dizziness. A high proportion of neck pain patients with and without dizziness reported clinically relevant improvement at 1 month, 3 months and 6 months,with 80% of patients with dizziness reporting that they were significantly ‘improved’ specifically relating to their dizziness symptoms at 6 months. Only the scores of ‘much better’ or ‘better’ (1 or 2) were counted as clinically relevant improvement. ‘Slightly better’ was not considered to be improved in order to error on the side of caution. Statistically significant decreases in all secondary outcome measures at every data collection time point were also found for both groups, although arm pain was somewhat slower to respond in females. However, the low mean baseline NRS scores [Numerical Rating Scale scores, such as "0" is no pain and "10" is agonizing pain] both for the patients with and without dizziness shows that compared to other pain, disability and functional measures, arm pain was the least problematic. It is important to point out that at baseline neck pain patients with dizziness reported significantly higher scores for severity of neck pain, arm pain, all subscales on the BQN as well as the BQN total score compared to the neck pain patients without dizziness. However, overtime fewer differences between these two groups were found with no significant differences between the two cohorts at the 6 month data collection time point...

It was somewhat surprising to find that nearly 44% of neck pain patients presenting to Swiss chiropractors stated that they had associated dizziness. However, the fact that 75% of neck pain patients with dizziness in this study were female is not surprising. It is well documented that females are more likely to suffer from neck pain in general and that a large proportion of chronic whiplash sufferers report symptoms of dizziness and unsteadiness. However, what is unusual in this study is that there was no difference between neck pain patients with and without dizziness in terms of a trauma onset.

The researchers explain why whiplash to the neck can cause dizziness (called cervicogenic dizziness, or dizziness whose origin is in the neck) by using some in-depth medical terminology. They also theorize why chiropractic care can help cervicogenic dizziness:

Cervicogenic dizziness or dizziness of suspected cervical origin with or without unsteadiness can arise from mechanical, degenerative, inflammatory or traumatic problems affecting various structures of the neck. In particular, altered afferent information from dysfunctional mechanoreceptors in the cervical facet joints and deep cervical tissues and neck muscles, especially in whiplash patients, may lead to cervicogenic dizziness.The dizziness and unsteadiness is thought to arise from dysfunction of the cervical somatosensory system. In particular there is a mismatch of sensory information from the dysfunctional deep cervical tissues and proprioceptors compared to the vestibular and oculomotor afferent impulses.

Therefore it is hypothesized that manual therapy such as spinal manipulation may be effective in treating cervicogenic dizziness by restoring normal movement of the zygoapophyseal joints, reducing pain and muscle hypertonicity and thereby restoring normal proprioceptiveand biomechanical functioning of the cervical spine. Indeed, current evidence, although limited, supports a neuroanatomical and neurophysiological basis for cervicogenic dizziness and that manual therapy particularly in the upper cervical spine may be helpful in reducing cervicogenic dizziness.

Click here to read the whole study and see the footnotes.

Humphreys and Peterson: Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow-up. Chiropractic & Manual Therapies 2013 21:3.