TEXT BOOK REVIEW

Chronic Neck Pain and Vertigo:

Is a True Balance Disorder Present?

Pembimbing :
dr. Untung Goenarto ,Sp.S

Oleh :
Ryan Aprilian Putri

G4A013011

BAGIAN SMF ILMU PENYAKIT SARAF

RSUD. PROF. DR. MARGONO SOEKARJO
FAKULTAS KEDOKTERAN DAN ILMU-ILMU KESEHATAN
UNIVERSITAS JENDERAL SOEDIRMAN
2014

BACKGROUND
The mechanisms that control posture are extremely complex and
involve a wide variety of structures: peripheral afferents (i.e.
proprioceptive, exteroceptive, labyrinthine and visual afferents), the
central nervous system (the CNS notably the brain stem,
cerebellum, basal ganglia and the hemispheres) and the effector
muscles
Alterations in one of these components can generate balance
disorders. Degradation of cervical proprioception is often related to
chronic neck pain, which is a frequent reason for consultation in
rheumatology and physical medicine.

Several studies have shown that deterioration of the cervical

spines proprioceptive capacities results in perturbed postural
stability control in chronic neck pain patients . The use of specific
rehabilitation programmes to re-establish cervical proprioception
improves balance in these patients (Yahia et al, 2009) .

Many studies sought to establish whether

chronic neck pain patients suffering from
vertigo and instability have true balance
disorders in a population of chronic neck
pain patients with or without vertigo,
relative to a control group (Grant, 2006)
The study told that the presence of
balance disorders in chronic neck
pain patients caused their episodes
of vertigo and postural instability
(Yahia et al, 2009).

OVERVIEW
NECK PAIN (Roques, 2011).
Neck pain occurs due to
different reasons like poor or
incorrect posture, muscle
strain, ruptured disc, diseases
or disorders of the tissues in
the neck, including whiplash
and neck strain

Neck pain is a common

condition that creates
discomfort in any of the
structures in the neck

From American Pain Foundation,

neck pain is the third most
common type of pain in the
United States. It is estimated that
around 70% of people will
experience this type of pain at
some point in their lives.

Most neck pain lasts for a very

short time either a few hours or
days. On the other hand, if it
continues longer than several
weeks it is considered as chronic.
Chronic conditions may be
indicated by swelling, skin
redness, fever, and headaches.

VERTIGO (Makofsky, 2010)

.

Vertigo is defined an
illusion of movement,
the most common is a
feeling or sensation of a
rotationbody to the
environment or
otherwise, feeling the
environment around us
felt spinning

In etiology,
vertigo may be
caused by
abnormality of
the vestibular
organ, visual or
propioseptive
system

In addition to history,
physical examination and
investigation can be
conducted to determine
diagnosis of this
condition. The
management of vertigo
depends on the duration
and discomfort of the
symptoms and the
underlyting pathology

 BALANCE SYSTEM

Balance results from a

multimodal mechanism
involving :

VISUAL

VESTIBULAR

proprioceptive
receptors

send
information to the
CNS via specialized
afferents.
This information is integrated by CNS structures whose efferent pathways then modulate
muscle tone and trigger the postural adaptations required for the maintenance of posture or
coherent movement. The latter factors must be under control at all times, in order to correct
for and adjust to a new situation. If the various components of the sensory information are
discordant, the subject experiences a sensation of imbalance.

Vertigo- and instability-like postural disorders can be

observed in subjects with chronic neck pain: when
vestibular tests give normal results, one can legitimately
assume that the postural disorders are related to
functional or structural damage to neck proprioceptive
receptors.

In chronic neck pain patients, vertigo and a

sensation of instability are often preceded
or accompanied by headaches related to
upper neck problems.
If the vertigo is not associated with
headaches, it should not be linked with
cervical causes ; in fact, the highest
neuromuscular bundle densities are found
in the small, suboccipital muscles

Taken as a whole, these data

support a neck-related cause for
certain episodes of vertigo, as
Long as the damage is situated in
the upper cervical spine.
This type of vertigo is accompanied by
spinal signs (pain and stiffness) In fact,
the cervical spine plays a decisive role in
posture, in view of its proprioceptive
qualities and its relationship with vision
and the vestibular system (Yahia et ,
2009).

CONCLUSION
a. The mechanisms that control posture are extremely complex and
involve a wide variety of structures.
b. Neck pain is a common condition that creates discomfort in any
of the structures in the neck
c. Vertigo is defined an illusion of movement, the most common is a
feeling or sensation of a rotationbody to the environment or
otherwise, feeling the environment around us felt spinning
d. Many Studies told that the presence of balance disorders in
chronic neck pain patients caused their episodes of vertigo and
postural instability.

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