Dizziness, unsteadiness, visual disturbances, and sensorimotor control in traumatic neck pain: clinical commentary

Key points

1. 01Cervical afferent dysfunction is the primary suspected cause of post-traumatic dizziness, unsteadiness, and visual symptoms, especially in those with persistent pain
2. 02True vertigo is uncommon; symptoms are more often described as vague unsteadiness or light-headedness worsened by neck movement or pain
3. 03Assessment of cervical joint position sense, balance, and oculomotor function should be routine in all traumatic neck pain patients, not only those reporting dizziness
4. 04Differential diagnosis must consider vertebral artery dissection, benign paroxysmal positional vertigo, peripheral vestibular injury, concussion, and psychological factors
5. 05Treatment should be tailored to identified impairments and may combine cervical musculoskeletal management with targeted sensorimotor exercises for gaze, balance, and proprioception

How it was conducted

Design

Clinical commentary (narrative review)

Topic

Sensorimotor control disturbances following traumatic neck pain, including whiplash-associated disorder

Scope

Evidence synthesis covering symptoms, proprioception, balance, oculomotor control, differential diagnosis, and management

Population of interest

Adults with traumatic neck pain, whiplash-associated disorder, or concurrent concussion

Key clinical tests discussed

Cervical joint position sense, smooth-pursuit neck torsion test, cervical torsion test, static and dynamic balance, gaze stability, Dix-Hallpike, head impulse test

What they found

• Up to 35% of those with traumatic neck pain associated with higher forces may have peripheral vestibular damage such as benign paroxysmal positional vertigo, endolymphatic sac damage, or perilymph fistula
• Joint position error greater than 4.5 degrees is listed as a primary objective finding for cervicogenic sensorimotor disturbance
• Nystagmus greater than 2 degrees per second during sustained neck torsion positions is suggested as a positive cervical torsion test result
• Those with persistent WAD and dizziness showed greater joint position sense errors than those without dizziness in one cited study
• Individuals with traumatic neck pain with and without concussion showed similar balance impairment patterns, but those with concussion had greater deficits for stance and complex gait tasks
• In a clinical trial of specific neck muscle exercises combined with a behavioral approach, many participants continued to have symptoms of dizziness and signs of balance impairment after the intervention

Limitations

• This is a narrative clinical commentary, not a systematic review or meta-analysis; findings represent the author's synthesis of heterogeneous studies
• Many cited studies are small or have design limitations; effect sizes and confidence intervals are rarely stated
• Several promising assessment tools (trunk relocation test, cervical torsion test, virtual-reality movement accuracy) lack sufficient validation for routine clinical use
• Distinguishing primary cervical from secondary vestibular or CNS causes remains difficult in practice due to overlapping signs and concomitant injuries

Why it matters

For patients

People with neck pain, dizziness, or visual problems after a car accident or other neck injury should ask their physiotherapist for a thorough sensorimotor assessment, as these symptoms are treatable and may predict slower recovery if left unaddressed.

For clinicians

Routine assessment of joint position sense, balance, and oculomotor function is warranted in all traumatic neck pain patients, with differential diagnosis guiding a tailored treatment program that may include cervical manual therapy, proprioceptive retraining, gaze stability exercises, and vestibular rehabilitation as indicated.

For readers

This commentary provides a structured framework for understanding the overlapping causes of post-traumatic dizziness and a clinical table for differential diagnosis across cervical, vestibular, concussion, and psychological origins.