As we have learned there are 3 systems that can cause dizziness, our eyes or vision, our inner ear or vestibular system, and lastly our neck or upper cervical spine.

Through strong connections between these systems that relay information, coordinate head motion in space and our eyes, these reflexes can be dysfunctional when one or more systems fail to work well.

Here is an example, if you have poor proprioception or loss of neck motion then turning your head to ‘see’ will cause an overshoot of the visual target and your eyes have to work harder to adjust. Your neck and your eyes did not work well together in this scenario. This creates more work on the brain. Common symptoms for this are eye fatigue and tension around the eyes, pain behind the eyes, brain fatigue or ‘fogginess’, and yes dizziness.

Tips to diagnose a neck problem

The head is not on straight

Our righting reflexes keep our eyes level and facing forward. When the head is turned or tilted sideways our eyes are no longer in a neutral position and to keep looking forward ocular muscle activation or contraction occurs. To override these powerful reflexes there needs to be a significant problem. Most of the time the neck is ‘stuck’.

Look for a head that is turned or tilted or both. This is usually an automatic neck problem of the upper cervical spine.

History of self-manipulation or stretching

People that are stretch their necks regularly or manipulate their necks have an upper cervical dysfunction. Other history involves regular chiropractic monthly and even other therapies such as PT or massage.

Pain and loss of upper neck motion

Patients love it when we ‘touch’ them. There is something that occurs when a practitioner does this. Physicians that sit back and diagnose through tests and taking a history do not get praised when these same patients come to therapy. The ones we hear consistently about at Cornerstone are the ones that laid hands and added palpation to their exam.

The head is not on straight

History of self-manipulation or stretching

Pain and loss of upper neck motion

Testing the upper neck

Look for tension and pain to the upper neck muscles. At times a reproduction of dizziness occurs when we are assessing. With one hand gently feel the forehead of your patient while you use your thumb and middle finger to feel the sides of the upper neck. Your touch will also tell you if there is symmetry in what you are feeling. The spinous process of the axis or C2 is very prominent. If you have trouble finding the spinous process of C2 have the patient nod their head. The first bump under the occiput is the spinous process. If it is off to the side then there is a problem.

Test the C1-2 rotation between the atlas and axis. Normal motion is closer to 40 degrees each direction. In the same position stabilize the axis now with a lumbrical grip getting good purchase around C2. Hold this position gently and try to turn the head on the neck with your hand on their forehead. Pain and stiffness and you have a positive test.

This video shows upper cervical testing.

The neck creates spatial orientation dizziness more than a spinning sensation.

A spinning sensation is more frequently an inner ear problem. The patient feels stable but the room is spinning. With an upper cervical problem the world is fine but they do not know their place in the world. A good question to ask is this:

“Do you feel like the room is spinning or do you feel like the world is fine but you do not know your place in it?”

Have your patients describe their dizziness. Their experience of dizziness can help you determine where it is coming from.

Treatment is not working

They have tried chiropractic or physical therapy and their problem still persists. What do you do?

Questions to ask

Did the treatment target the right area and was it successful? 

You can see if upper neck motion has changed. If it is still limited then the underlying cause has not been addressed.

Was vision and vestibular testing done?

Missing a secondary problem is pretty common. We can do video oculography and check the Dix Hallpike test as well as convergence and other vision tests to see if the eye muscles and nerves are involved. If we do not look then we do not know.

Is there a TMJ problem or other dental problem?

A jaw or occlusion issue can negatively impact the neck. This can prevent neck therapies from being successful. At Cornerstone every head and neck evaluation includes jaw function and specific testing.

There are some pretty amazing dentists in our city that look at the jaw and occlusion on a deeper level. Here are a few that I like to work with.

Colleen Jenson DDS

Robert Colt DDS

Christina Sletten DDS

Reflexes to check out

VOR Vestibulo-ocular Reflex, VSR Vestibulo-spinal Reflex, COR Cervico-ocular Reflex

If we do not look then we do not know.