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
Alterations
in one of these components can
muscles
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,
Neck 2011).
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 Pain
From American

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.

Neck pain is a
common condition
that creates
discomfort in any
of the structures
in the neck
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.

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

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

Vertigo is defined
an illusion of
movement, the
most common is a
feeling or sensation
of a rotation body
to the environment
or otherwise,
feeling the
environment
around us felt
spinning
(Makofsky, 2010)
.

VERTIGO

 BALANCE SYSTEM

Balance results
from a multimodal
mechanism
involving :

VISUAL

VESTIBULAR

proprioceptive
receptors

send
information to
the CNS.
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

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
rotation body 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.

References

American Chronic Pain Ascociation. 2010. Neuropathic Pain. Available on:

http://www.theacpa.org/conditionDetail.aspx?id=29.
Bablis, Peter. Pollard, Henry. Bonello, Rod Bonello. 2008. Neuro
Emotional Technique for
the treatment of trigger point sensitivity in
chronic neck pain sufferers: A controlled
clinical trial. Chiropractic &
Osteopathy. California USA: , 16:4 doi:10.1186/1746- 1340-16-4
Cooper Grant. 2006. Essential Physical Medicine and Rehabilitation.
Humana Press Inc; New Jersey. hal 249.
Guez M, Hildingsson C, Nilsson M, Toolanen.2002.. The Prevalence of
Neck pain: a
Population-Based Study Northern Sweden, Departement
of Orthopaedics University Hospital, Umea, Sweden.
Guyton A C, Hall J E. 2008. textbook of medical physiology, 11 th
edition. Singapore: Elsevier Pte Ltd and EGC Medical Publisher
Joesoef AA. 2002. Tinjauan umum mengenai vertigo. Dalam: Joesoef AA,
Kusumastuti
K.(eds.). Neurootologi klinis:Vertigo. Kelompok Studi
Vertigo Perdossi. hal.xiii-xxviii.
Lumbantobing SM. 2008. Neurologi Klinik. Pemeriksaan Fisik dan Mental.
FKUI. Hal 50 73.
Makofsky HW, 2010. Spinal Manual Therapy, An Introduction to Soft
Tissue Mobilization,
Spinal Manipulation, Therapeutic and Home

McKenzie R, Kubey C,. 2000. 7 Steps to a Pain-Free Life, How to Rapidly relieve
back and Neck Pain using the
McKenzie Method; Dutton; New York; 2000;
hal 139-145.
McKenzie R, May S. 2006. The Cervical and Thoracic Spine Mechanical Diagnosis
and Therapy Volume One;
Spinal Publications; Raumati Beach; ; hal 75
Rix GD, Bagust J. Cervicocephalic kinesthesic sensibility in patients with chronic,
non traumatic
cervical spine
pain. Arch Phys Med Rehabilitation
2001;82:9119.
Roques CF, Lafont, Sahrmann S. 2011 Movement System Impairment Syndromes
of the Extremities,
Cervical and Thoracic Spines; Elsevier Mosby; USA; hal 1.
Rowbotham, M. C., Petersen, K.L., Davies, P.S., Friedman, E.K., & Fields, H.L.,2000.
Recent Development in The Treatment of Neuropathic Pain. In: Devor, M.,
Rowbotham, M.C., & Wiesenfeld-Hallin, Z. (ed). Proceeding of the 9th World on
Pain. Seattle: IASP Press
Sherwood L. 2010. Human Physiology: The Peripheral Nervous System. 7th ed.
Canada: Brooks/Cole
Tortora GJ, Derrickson BH. 2009. Principles of Anatomy and Physiology: Sensory,
Motor and
Integrative System. 12th ed. Asia:
Willey
Waldman, Steven D. 2001. Pain Management 2nd edition. Amerika: Elsevier
Wreksoatmodjo. 2004. BR. Vertigo : Aspek Neurologi. Tinjauan Kepustakaan.
Cermin Dunia
Kedokteran No.144.. Hal 41 46.
Woolf, C. J., 2004: Pain: Moving from Symptom Control toward Mechanism-Specific
Pharmacologic
Management, Ann Intern Med; 140:441-451

thankyou