Dizziness and Vertigo are amongst the top complaints from somebody suffering from a concussion. They can often bring debilitating symptoms for anyone who experiences them. Although these symptoms often resolve, they may also linger or stay put.
One of the toughest things about Vertigo/Dizziness is it is an invisible entity. If someone has a broken arm, the doctor will put a cast on for everybody to see. It is frustrating that people may not view debilitating dizziness in the same light as the broken arm. Furthermore, MRI and CT scans often yield no findings which further adds on to the frustration.
The good news is that if you have suffered a concussion and now experience dizziness, there are ways forward for improvement. Treatment options can be offered which are evidence-based and generally highly effective.
There are different types of dizziness that can be experienced after a concussion. With each type of dizziness experienced, your healthcare practitioner will recommend a different treatment approach. Common types of dizziness following a concussion are:
- Vertigo (contribution from the ears)
- Oculomotor Dizziness (contribution from the eyes)
- Cervicogenic Dizziness (contribution from the neck)
- POTS
Three systems work together smoothly to give most people their sense of ‘self in space’. Nerve fibres from the inner ear, eyes and neck meet together in the brain. The brain then tries to make sense of the information provided by each of those structures. If, however, one system gives information which doesn’t match the other information received, the brain gets confused!
Think of being on a rocking boat: The waves are causing the boat to rock and you can physically see the boat rocking up and down. However, the inner ear and the neck do not register any change to the conditions. So, a massive disconnect between your eyes and your neck/ears will cause cause dizziness.
The reason so many people feel dizzy after a concussion is that the force sustained can disrupt one of the balance systems! Let us look closer at the different types of dizziness and what can be done about it!
- Vertigo
BPPV (Benign Paroxysmal Positional Vertigo) is a common type of vertigo. This is short lasting (30-60secs), is triggered by changing your head position and feels like the room is spinning. Rolling over in bed, looking over your shoulder or looking upwards may lead to feelings of dizziness. Why does BPPV come after a concussion? Let’s look closer at the inner ear to find out.
Here is a very detailed diagram of your beautiful inner ear. In the semicircular canals of the inner ear there is a viscous fluid that moves within it as you move your head. Small hairs in the canals sense that the fluid is moving and sends that information to your brain. That is one way the brain can tell where your head is in relation to space.
In BPPV, the calcium crystals attaching to these canals break loose and float in the fluid. This may have happened simultaneously with the head force causing the initial concussion. Then, when you move your head, the crystals travel through the canals at a faster speed than the fluid. This can lead to a mismatch of information sent to the brain which can lead to some serious dizziness!
Despite it sounding quite scary, there really is a quick fix to this! Once your healthcare practitioner has established that BPPV is the cause of your dizziness, they will, most likely, perform the Eppley’s manoeuvre. This is a series of simple head movements that will cause the crystals to leave the semicircular canal. Once they are out of the semi-circular canal you should not feel dizzy anymore!
2. Vestibulo-Occular Dizziness
This is the visual and vestibular (inner ear) system combined! These two systems form a natural equilibrium that allows you to do things like focusing on an object when you turn your head. These systems, combined, also are at play for reading or focusing on an object or even driving. With this type of dizziness, you may feel you easily lose your page when you read, or experience dizziness when you drive. Generally, if any visual heavy task provokes your dizziness, its likely this system is highly involved.
Treatment for this kind of dizziness will be more complicated and will take a little bit more time. Think of it like going to the gym; the system needs to be strengthened through exercise. Once the system is strengthened, the dizziness really should be minimal. Some exercise which may be prescribed to you by your healthcare practitioner can include:
- Finger tracking exercises
- Gaze stabilization exercises
- Gradual exposure to provoking circumstances
- Referal to a neuro-optometrist for prescription of lenses
- Other vision therapy exercises
3. Cervicogenic Dizziness
Does it ever seem like when your neck hurts you start to feel dizzy, as well? Have you ever thought that your neck may be involved in your dizziness, but you weren’t sure? It definitely is a valid thought and it is, in fact, quite common for your neck to be involved in dizziness.
Your neck is made up of muscles, bones, ligaments, tendons, joint capsules, and many other structures that provide information to the brain. Let’s say you move your head to the right, some of the left-sided neck muscles stretch. When these left sided neck muscles stretch it tells the brain that they have stretched as well. The brain then realizes that your neck has turned to the right side.
After a concussion there is always a neck whiplash injury. A lot of force goes through the neck and can lead to a strain of certain neck muscles and joints. This can lead to tightness in certain joints in the neck. This process of a newly tight part of the neck may trick the brain into thinking your head is rotated to one side. The input from your neck muscles is mismatched with the input from the visual and vestibular systems. This causes the brain to be a bit confused and leads to dizziness.
For those with cervicogenic dizziness it feels like being on a boat or general unsteadiness. Overall, its just a feeling off ‘being off’. Things that typically provoke the dizziness are quick movements of the head or looking up. The great news is that even if the neck is contributing to your overall dizziness, there are steps we can take! Providing targeted manual therapy to the neck can be extremely effective in address neck issues. This is done reducing the stiffness of ‘dizziness provoking’ joints in your neck. Practitioners at Sydney Concussion Centre will expertly assess and treat the neck, if required. This would likely be in combination with exercise or vestibular therapy.
4. POTS
POTS stands for Postural Orthostatic Tachycardia Syndrome. It sounds a little confusing but what its really describing is an unusual increased heart rate during certain positions. These positions are usually standing from a sitting or a lying down position. Normally, when you stand up there is an increase in blood pressure to help the heart rate stay steady. Blood flow, throughout the body against gravity, is most efficient when blood pressure increases. However, sometimes after a concussion, those blood pressure changes when standing may not happen. In these cases, there is not a strong enough change in the blood pressure, so the heart has to work harder to compensate.
The reasons why this happens in the first place are, most likely, due to the autonomic (or automatic) nervous system. This system controls all of our automatic responses like blood pressure, sweating and breathing. After a concussion, this system may be disrupted leading to ongoing symptoms. Common symptoms of POTS can include:
- Dizziness or light-headedness when standing
- Excessive sweating
- Light sensitivity
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