Dizziness from Neck with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum from Insync Physio in Burnaby. He's the clinical director director of the North Burnaby office. Insync has two offices in Vancouver and in North Burnaby. And today we're going to talk about dizziness from your neck. From your neck? How do you get dizzy from your neck?

Iyad: That's a good question, Mark. So basically the way you find yourself when you're walking, when you're moving, when you're doing all kinds of stuff is your brain gets signals from all over the body. And then it puts them together and in a way, processes them. And then you get this kind of thing where you're able to sit up straight and, you know, walk in a straight line and all that stuff. So some of the feedback that we get comes from our neck. And our neck's, really a rich area when it comes to all these kinds of little sensory nerves that send lots of signals to our brain to interpret. 

So sometimes we get people who, let's say a hockey player who, you know, smacked really hard into the boards. And they get diagnosed with a concussion and then a few weeks on, a few months on, they're still experiencing some headaches and some dizziness. 

So I know like last week, my colleague, Heather filmed an excellent video with you about headaches that could originally I guess started from the neck where the neck gets really sensitized and it can kind of give you these fake symptoms that look like you have head symptoms, face symptoms.

And this is really no different. The way you want to think about it is this, we have our vision that tells us what's happening. So you get to see what's in front of you. You could tell what's straight and what's not. We have our inner ear, which helps us figure out where our head is moving. So that's the vestibular organ. And then you have our neck.

So for example, imagine if you have a mismatch in those three signals, so your eyes are telling you you're facing straight ahead, your inner ear is showing you facing straight ahead and you're not moving. But your neck is kind of perceiving a movement, slightly different. So it says maybe you're a bit on your side or you're a little bit there.

So that mismatch is basically what could produce some feeling of unsteadiness and most people just label it dizziness which this general vague term. But really it's just a confusion between your senses. 

Mark: So the symptoms are dizziness. Is it more from when you're moving? You would notice, because that's sometimes I think we talked about that the last time. Is that a movement thing or is it you're still and you just you're like you described your one spot and you're feeling dizzy suddenly. How does it manifest? 

Iyad: Yeah. Most people will feel it when they're moving. And that's when they'll tell you, like, you know, I turn my head and I get this and they think, you know, you go on your Google and you think, oh, I got this loose crystal that's in my inner ear that's causing this. And you know, that very well could be a thing. But most people will feel that with movement. If in really sensitive cases where it's like super aggravated, you will sometimes feel it at rest, but you'll feel just a bit off. You know, that's kind of the sensation, they'll say, oh, I feel like I'm on a boat. I'm just kind of, things are rocking a bit slowly here. 

So yeah, most people, I would say it's an impairment with movement and, you know, that's, I think if you think about that, that's the whole purpose of rehab is to kind of help you get more comfortable with movement. And that's where I guess a treatment program will be very helpful. 

Mark: So how do you go about diagnosing this?

Iyad: There's quite a few tests. So what we will do usually in an exam is we will do a neck exam. If we suspect a concussion, we could do some kind of tolerance test where we get the heart rate up a bit to see if just a spike in heart rate will cause this symptom. So that's one potential reason. 

The other thing is we'll do an assessment to the vestibular system where we try to kind of challenge some of those reflexes that our inner ear is responsible for. So usually it's a bit of a process of elimination. It's not this. It's not this, it's not that. And then we have some specific tests for the neck where we basically test how well you can locate centre with your eyes closed, for example, and we have these tests that test for joint position error. We get you to close your eyes, perform a task, and then turn your head one way and come back and see how well do you land on the centre again. 

That could be again, another tool that we can use to figure out if there is something coming from the neck. And we'll find it in most people is it's never just an either or. You can also have these overlapping things. Like you could have a concussion and you can also have neck symptoms from the impact. For example, if the hockey player into the boards.

So it tends to be you know, we worked through the impairments one by one, and that's kind of how we figure out exactly what contribution is coming from. Just the general system to the neck to the inner ear. So there's lots of treatment options, which is great. But some, you know, manual therapy to the neck, it can be very, very helpful in some cases. 

You know, manual therapy is not just for loosening up joints and loosening up muscles and improving movement. It also gives us a lot of, because these areas are so rich in sensory nerves and you pay a lot of attention to your neck, the neck serves your five senses really, if you think of any treatment delivered there can actually enhance your awareness of the area. So you'll get a temporary improvement sometimes just with one treatment of like a hands-on technique to the neck. 

And, you know, our therapists are experienced in different styles of treatments, but they all seem to work pretty well in this population. The other one, which is really important is there's some exercises that are specifically targeted towards that. There is no one size fits all because you're going to get people with different impairments. 

Some people who have an issue only when they're standing and turning their head. Some people when they're sitting and turning their head. And some people when they turn their body, but their heads stay still. So like think of a swimmer who's swimming and just rotate their torso while their head still basis forward. So you try to kind of target the exercise approach to fit the impairment, instead of just giving this handout sheet that, you know, here you go, this is what you do in case of a headache or dizziness case.

So yeah, it tends to be a bit of a mix of some balance and control of the neck, which is something that a lot of people don't think about, but the neck, like any other joint needs to move well. You need to have good strength around it and you need to have good control around it. 

Mark: And what's the typical course of treatment. I know it's going to obviously be very individual, but what's the more typical timeframe?

Iyad: So initially let's say we would assess if there's any loss of range of motion, we would try to get that going. There's usually a lot of fear based around moving the head. Cause you're kind of worried about triggering an episode of dizziness.

So it tends to be a small exposure program almost. Where we try to kind of get people to practice moving with or without different cues. We would do a neck strengthening program as part of this. But yeah, the sequence of progression tends to be, let's say if you're really low functioning at this point, because it's so symptomatic. We would start very minimal and kind of progress you onto that.

And that could go anywhere from a four week treatment program, to six months, depending on how sensitized everything is and how much is at play here. And how long has it been a play? 

In some cases it could be on the faster side where, you know, they're fairly high functioning and they only get this kind of episode when they're doing something very specific. Like when their other senses are very challenged, like imagine walking on a tight rope and then turning your head, you know, well, that's going to challenge your balance system quite a bit more than if you were just sitting still and turning your head. And the reason is, we have amazing senses in our body that can compensate that.

Like your vision. So often that's just kind of covering a lot of those deficits and you know, your inner ear is so good at that, the vestibular organ. So it'll depend on what's involved. But yeah, it could be anywhere from four weeks to six months. And you know, the idea is you would need reassessment for you to actually figure out what timeline we're looking at because it's never going to be, oh, we know exactly from the first day, how long are you going to be.

 So it's more like we judged the improvements week to week, and then that'll give us a better idea because we have more data to judge how you're going to progress through your treatment. 

Mark: If you having some dizziness, you've had some neck issues of some sort, perhaps. Turning your head is causing you to feel a little bit loopy, perhaps call Insync Physio. You can book online at insyncphysio.com. You can call a North Burnaby location to make your booking as well 604-298-4878 or in Vancouver, 604-566-9716. Get it looked after. The sooner you start, the sooner you're going to be feeling better and a little bit more oriented well in space and time. Thanks Iyad. 

Iyad: Thanks Mark. Appreciate it.