Does Exercise Make you Dizzy? Here’s Why

One of the biggest complaints in people with dizziness is that they can’t exercise because exercise makes their symptoms worse. This is a particularly difficult problem in athletes who have suffered a concussion because the dizziness upon activity is preventing them from getting back to their sport.

When people have problems with dizziness on exercise, it can usually be attributed to a couple of problems.

  1. Deficient vestibulo-ocular response (VOR)
  2. Autonomic Dysfunction

Let’s break these issues down.

Deficient VOR

The vestibulo-ocular response is one of your body’s primary and important reflexes. It’s based out of an organ in your inner ear called the vestibular apparatus; the part of your ear that is really important for balance. When you turn your head, your inner ear sends a message to your eyes to move the eyes in the opposite direction.

Image result for VOR testing
The Vestibulo-ocular response in action

This reflex is fast. Really really fast. When your vestibular system is working, this reflex occurs in about 6 milliseconds.

Just for comparison, it takes your eyes 100 milliseconds to respond to something you see. That means your eyes are almost 20x more responsive to movement of your head than to vision.

Why do you need this reflex? Mainly to keep your eyes on target whenever your head moves. We don’t think about it at all because this reflex works really well, but whenever we move, our heads are bobbing all over the place.

Image result for slow motion walking head gif
Our heads move way more than we think about when we run and our eyes have to match that movement.

When this reflex is working well, your head can be moving quickly, but you still have an ability to read and focus while on the move. It doesn’t even feel like your head is bouncing around. It’s a critical neurological circuit passed on by our evolutionary ancestors that relied on hunting to survive.

When this reflex doesn’t work, our eyes move too slowly which makes it feel like the world is moving around you too quickly which can in turn produce a feeling of dizziness.

How do we know this is true? Because this is exactly what many people experience after a head injury or if they have lost the function of their inner ear from something like an infection.

But you don’t need a concussion or an infection for your VOR to become less efficient. The only thing that needs to happen is that the nerves coming from the inner ear to the brain stem start firing too little, or sometimes too much than is necessary.

Image result for vestibular nerve
The inner ear sends messages to the brainstem through a specialized nerve called the vestibulocochlear nerve. When this nerve fires too little or sometimes too much, it can affect your body’s VOR.

Autonomic Dysfunction

Another reason that someone may feel dizzy while exercising is from a problem causing blood flow issues in the brain. Blood flow in the brain is a very tightly regulated system that is maintained by blood pressure, pulse rate, and the opening and closing of key arteries. Your body is set up to prioritize maintaining a steady stream of blood and oxygen in the brain.

The brain and the nervous system control this response through a branch of the nervous system called the autonomic nervous system. The autonomic nervous system is basically the branch that controls all of your automatic bodily activities like heart rate, digestion, blood pressure, etc. Some people can have problems with this system and develop a subset of conditions called dysautonomia.

You can read more about dysautonomia and the autonomic nervous system here.

While people who get dizzy with exercise might not have a diagnosable form of dysautonomia, some of the physiology that is occurring may be similar. With dysautonomia, many patients may feel light-headed and dizzy just from going from sitting to standing. This is because the brain doesn’t have good control of the heart and blood vessels resulting in decreased blood flow to the brain or an abnormal compensation to prevent it.

Different types of dysautonomia showing various breakdown of communication between the brain and cardiovascular system.
Source http://annals.org/aim/fullarticle/715764/dysautonomias-clinical-disorders-autonomic-nervous-system

One of the hallmark issues in sports concussion is exercise intolerance. It’s been thought that this is a result of large changes in cerebral blood flow after a head injury because the brain is struggling to regulate the opening and closing of the arteries feeding it blood. 

Exercise itself makes the brain work harder which demands increased blood flow to meet the demand. However, the brain is not adequately prepared to increase blood flow leading to an energy deficit.

When the brain is experiencing an energy deficit, the areas that are hit hardest by the deficiency are likely to produce symptoms because of a failure in adequately feeding those neurons oxygen.

Treat the Patient, Not the Symptom

Just to be clear, these aren’t the only reasons that you can get dizzy when you exercise. These are just the more common things that I’ve seen in my practice when people feel mostly fine in normal circumstances, but as soon as exercise begins the dizziness starts.

When it comes to dizziness, people like to take a one-size fits all approach by throwing a variety of maneuvers or remedies to try to fix the symptom. You may get lucky sometimes by doing an Epley maneuver for someone because they just happen to have positional vertigo, but that same maneuver may be useless for someone with an autonomic imbalance.

Fortunately, people with a pattern of dizziness that looks like an insufficient VOR or an insufficient autonomic nervous system are things that seem to respond well to our combination of craniocervical correction and functional neurological rehabilitation.

As with most problems, it comes down to identifying the nature of YOUR pattern of dizziness, then developing the right strategy that suits the patient, not the illness.

The Neurology of a Max Effort Lift

One of the keys to successfully completing a maximum effort lift is to not think so much, and just pull and push with all of your might. On the surface it seems really simple. Get this heavy object from point A to point B in a straight line, but all of the moving pieces that are involved in doing a very complex compound movement is actually pretty astounding.

When people are taught about the neurology of contracting a muscle, it’s usually in the form of a diagram like the one you see below:

Classic diagram for how the brain moves a muscle.

Right side of the brain sends a signal down the spinal cord and tells a muscle on the left to contract.

The truth is way more complicated that than. Honestly, when you want to contract just one muscle, your brain is unconsciously doing all of these calculations to figure out all the other things that need to happen for you to contract that muscle and not fall flat on your face.

You can check out my breakdown of this majestic system in my instagram story at this link: Instagram Story

Why Do We Do Balance Tests After an Atlas Correction?

One of the main components of every examination we do with new patients is a video balance test. You can see what that looks like in the video below:

It’s true that our office works with a lot of people who come in with dizziness or balance complaints, but we do this exam on people even if their complaint is low back pain, neck pain, or any other problem you can think of. Why does a chiropractor need to measure the balance of someone with back and neck pain?

The reason is that balance is a really important indicator for the function of your entire nervous system. Large chunks of your brain and spinal cord are devoted to neurons that help to keep you standing all day. When your brain is struggling, balance is one of the key functions that starts to go badly first. At it’s most extreme, you can see balance deteriorate in brain injuries and illnesses like concussion, Parkinson’s Disease, Multiple Sclerosis, and Alzheimer’s Disease.

Balance and the Nervous System

Our state of balance is the net result of multiple senses providing information to the brain. We take standing and walking for granted because it’s so automatic but it takes a ton of brain power to make standing upright work!

  • While you’re standing your foot and ankle muscles are constantly providing feedback to the brain about the angle of your ankles so you can tell if you’re standing on a flat surface or at an angle.
  • At the same time, your eyes and ears are sending messages to the brain about the location of your head. Is it moving? Is it standing still? Are you tilting? The location of your head will change the amount of muscle tension that you need to keep in your spine.
  • Meanwhile, your spine is constantly manipulating the tension in the dozens of of muscles connected to your vertebrae to help find the right balance of standing up straight and maintaining comfort.
  • All of the messages from these areas are being sent to the brain stem and the cerebellum for interpretation. Within fractions of a second, your brain is doing calculations and sending messages back to your muscles to make small little changes and adjustments as needed.

While all of this happening subconsciously, the higher level brain centers are busy with things like talking, listening, thinking about what’s for dinner, or any other thing that may be on your mind. Your brain separates these unconscious processes so you can do multiple things at once.

By measuring your balance, we can figure out what part of your nervous system may be dysfunctional. 

The 3 super systems that maintain your balance

Balance is Linked to….

The systems that come together to form your sense of balance are your vestibular, visual, and proprioceptive systems. All of these systems send signals and stimulate the brain to take action in it’s internal and external environment.

Disruptions to this system doesn’t necessarily mean that you will feel dizzy and off balance. Your body is really good at compensating when you lose one of those senses. How does your body compensate for a loss of some of your balance receptors?

By changing the posture of your body.

As your body makes these postural changes, then you may start to feel tightness in some of your back muscles in some areas more than others. It may lead to a lower hip on one side and a tilted head on another side. 

Disruptions in these systems may also contribute to problems outside the spine. The neurological connections between the vestibular system and proprioceptive systems are also related to things like your heart rate, digestive tract, and control of blood pressure.

The best part about this is that balance can change really quickly. Even within a single atlas correction.

We Measure Everything

So why do we measure balance? Because we want to measure every meaningful datapoint that may contribute to getting our patients a successful outcome.

We can and do measure someone’s pain and symptoms, but pain and symptoms is not always a good indicator of someone’s level of improvement.

You can feel a lot better after an adjustment but your balance measurements are still far from optimal. If a patient stops working when they feel better, they are leaving a lot of improvements on the table that may contribute to a long term outcome.

On the flip side, someone’s balance and posture may improve relatively quickly, but their body still experiences pain. In some of these cases their body may need more time for nerve, muscle, and other tissues to heal.

That’s why we measure everything to get a complete picture. If we only relied on one metric, we may miss the whole picture.


Chiari Symptoms, Cerebral Spinal Fluid, and the Atlas

Arnold-Chiari malformation is a condition in which portions of the brain (the brain stem or cerebellum) descend below the skull and into the spinal canal. You can see an image of a normal brain MRI and a classic Chiari malformation shown below.

Comparison of a normal appearance MRI vs one that has a herniated cerebellar tonsil characteristic of Chiari malformation

The estimated prevalence for Chiari is about 1 in 1000 people. The good news is that this issue doesn’t cause a problem in most people. Many times people will show a Chiari while getting an MRI for a problem like neck pain, and the Chiari is just an incidental finding.

When a Chiari is causing problems, it can cause non-specific symptoms like:

  • Headache
  • Balance problems
  • Drop attacks
  • Dizziness and Dyscoordination
  • Ringing in the ears
  • Muscle weakness
  • Neck pain
  • Scoliosis

Many patients are born with this brain abnormality, but things like spinal taps and head/neck trauma have been shown to cause cerebral spinal fluid abnormalities that cause the brain to descend into the spinal canal. 

Identifying the Problematic Chiari

Because Chiari symptoms are non-specific in nature and because so many Chiaris are asymptomatic, you can’t diagnose someone’s problem by symptoms or imaging alone. So how do you know if Chiari is causing your problem?

A 2007 study published in the journal Radiology showed that a cerebrospinal fluid flow study can help differentiate symptomatic vs asymptomatic patients. In this study, patients with symptomatic chiari will show blockages in cerebrospinal fluid in the area of the herniated brain tissue. You can see a video example below:

A part of your brain called the choroid plexus is constantly producing cerebrospinal fluid from circulating blood flow. In cases of chiari, the pressure from cerebral spinal fluid pushes against the skull and the brain. Since the skull is solid after childhood, the pressure from the fluid is going to compress the brainstem and cerebellum leading to the symptoms we discussed before.

Prolonged pressure from cerebrospinal fluid can force it’s way into the spinal cord creating a lesion in the spinal cord called a syrinx. These syrinxes can cause pain and loss of sensation into the arms and legs in some cases. In other cases, they are not symptomatic at all.

Image result for syringomyelia and chiari
Chiari + spinal cord syrinx

In the case that someone has chiari, syringomyelia, and chiari type symptoms, a surgical procedure to expand or remove parts of the skull and the protective covering of the brain can be done to alleviate this pressure.

Can Chiari symptoms be addressed conservatively?

This can be a tough question to answer for a few reasons.

Chiari is not symptomatic in a lot of people, and the symptoms of chiari are symptoms that commonly arise in a variety of pain and balance disorders. It’s hard to tell if a treatment actually addressed the consequences of chiari or by another reason.

Additionally, traditional chiropractic high-velocity manipulation is considered a contraindication to chiari malformations. The rationale for this is that a forceful maneuver to the neck may worsen or exacerbate the pressure to the brain stem. There’s no real data to support this, and there are even a few case studies showing no harmful effects. Plus, considering how many patients likely have an asymptomatic chiari and get chiropractic, it seems unlikely that someone with a small chiari would be an absolute contraindication.

But let’s just assume that high-velocity low-amplitude manipulation is problematic. Is there room for a low-force procedure to help?

Some of the work done by Dr. Scott Rosa using upright MRI suggests that a low-force upper cervical technique is more than just safe, but it may help patients with symptomatic chiari.

Craniocervical alignment and Spinal Fluid

There’s a theory that traumatic injuries to the neck like those seen in whiplash can cause susceptible patients with shallow skull bases to have their cerebellum protrude into the foramen magnum.

Michael Flanagan wrote about this concept and how the top of the neck called the craniocervical junction could be a potential choke point for the normal flow of cerebrospinal fluid in the brain. 

Not only can a chiari cause this blockage in spinal fluid, but misalignments in the top of the neck can create this blockage and potentially create the environment to cause or worsen a chiari after trauma. You can see a cool pre and post adjustment video from one of Dr. Rosa’s patients below.

Pre and post cerebrospinal fluid changes after upper cervical alignment

Not only has Dr. Rosa noted changes in cerebrospinal fluid movement, he has also recorded changes in the size of a chiari by using MRI scans after an adjustment. It’s actually pretty amazing to see!

Chiari Might Be More Implicated in Pain and Illness Than We Thought

Thanks to new methods of neuroimaging, scientists are able to see the how spinal fluid impacts brain motion with some startling visibility. The video you below shows how each heart beat creates a pulsing motion of cerebrospinal fluid in the brain of a patient with chiari.

New imaging technique showing the how CSF motion can move the brain

A study using this technique showed alterations in normal brain biomechanics related to changes in how the chiari affects cerebrospinal fluid pressure. The study was only done on one patient, but more work is being done to investigate this phenomenon.

There is also evidence that upright imaging may show that more patients have a chiari than anticipated in patients in whiplash.

Historically, non-specific nature of chiari symptoms have been reason to dismiss it as an entity that can cause pain and illness, but from the experience of many craniocervical chiropractors, there may be more people with this problem that can get relief from a gentle approach to the upper neck.

New Research Shows Concussion + Neck Injury = Longer Recovery

If you’re a reader of our blog, then you’re aware of our stance that an injury strong enough to concuss is strong enough to also injure the neck. You can read some of our thoughts on this subject here:

2 Reasons Why Your Concussion Symptoms Aren’t Going Away

Head Injury, Chronic Dizziness, Concentration Problems, and the Atlas – A Case Study

What a 10 mph car accident does to the neck

You can find a lot more by using the search tool on the website, but that should get you started.

 After years of research, we now know that injuries to the neck can mimic symptoms seen in concussion. This is a big reason why patients with chronic whiplash look really similar to patients with post-concussion syndrome when you’re just looking at symptoms alone [source]. However, many clinicians have suspected that when patients have both a neck injury and a brain injury, that it can take longer for the patient to recover and return to sport.

A study published in the Journal of Head Trauma Rehabilitation is helping to shed light on this concept. THe study looked at patients in a multidisciplinary pediatric concussion clinic with sports related concussion. A total of 246 patients were included and were assessed for neck pain, headache, dizziness, and abnormal cervical spine exam findings. Out of the 246 patients with concussion, 80 met the criteria for a neck injury.

When reviewing the data, the authors found that patients with a neck injury took an average of 28.5 days to make a clinical recovery compared to 17 days for the patients who only showed physiologic brain injury alone. Patients with neck injury were also almost 4 times more likely to experience delayed recovery (longer than 4 weeks) from their symptoms.

So just to summarize, if you have a neck injury + concussion:

  • It will take on average 10 days longer to make a clinical recovery than a concussion alone
  • You are 4 times more likely to have symptoms beyond 30 days than a concussion alone

So you might be saying….well…maybe some of these neck injuries were really serious ones. Like the ones you might see where people have to wear a neck brace and get carted off the field. Obviously people with severe neck and spinal cord injuries can drastically skew the number of days it takes for people to recover and some may not recover at all.

The authors actually accounted for these types of injuries. One patient had a compression fracture and 5 patients had spinal cord injury or cord neuropraxia. All of these patients were taken out of the data analysis. So that leaves us with patients with a neck injury, but an injury that compromises the spinal cord.

Protect the Neck

The role of the neck has become a growing area of research in the field of head trauma. One study looking at the relationship between neck strength and risk for concussion showed that for every pound of increase in neck strength, there was a 5% reduction in risk of concussion. Another study shows a rehabilitation program that includes treating the neck in patients with post-concussion symptoms can accelerate a patients return to normal activity.

The neck is a neurologically important and inherently mobile area that can be prone to injury. When it is injured, people with a combination of brain and neck injuries may have higher levels of sensitivity than patients with more routine neck pain. That means that people who suffer concussions and neck injuries may benefit from more precise and gentle care than approaches that take a more aggressive style of treatment.

 

Podcast Archives: Heart Rate Variability and Human Performance with Dr. Mike Nelson

 

Dr. Mike Nelson is a human performance expert and faculty member for the Carrick Institute. In this episode Mike discusses some of the hidden ways an athlete can get more from their bodies by modifying their training to match the demands of the brain and nervous system. We also get into the concept of metabolic flexibility. A great listen for anyone that is involved in training athletes or are aspiring athletes themselves.

Podcast Archives – Looking Beyond the Brain in Concussion with Dr. John Leddy

Podcast Archives – Episode 23b – 2015

Looking Beyond the Brain in Concussion with Dr. John Leddy

University of Buffalo Concussion Management Clinic

With the high school, NCAA, and NFL seasons right around the corner, I decided that we re-visit my favorite topic; concussions. This week we have a 2-episode special on concussions featuring one of the most sought after clinician experts in the country, and a fast growing name in the research of post-concussion syndrome. Dr. John Leddy is a concussion researcher with a sports medicine background out of the University of Buffalo. He’ll be talking about future considerations in concussion management that goes beyond treating the brain and making sure that we protect the neck.

Podcast Archive – Pro-Brain and Pro-Sports with Dr. Tad Seifert

Heal Yourself Radio Archives – Episode 23a- 2015

Pro-Brains and Pro-Sports with Headache and Concussion Expert Dr. Tad Seifert

Show Notes:

With the high school, NCAA, and NFL seasons right around the corner, I decided that we re-visit my favorite topic; concussions. This week we have a 2-episode special on concussions featuring one of the most sought after clinician experts in the country, and a fast growing name in the research of post-concussion syndrome. Episode 23a features Dr. Tad Seifert an expert in neurology and sports medicine. He’s combined his passion for sports and the brain to be a leader in the field of sports concussion. He’ll talk about his experience and what the evidence says about head injuries, and what you can do to better help prepare your athlete for their sports season.

What are the risk factors for poor outcomes after a concussion?

When patients suffer a concussion, the vast majority of patients will have symptoms for 10 days or less. About 10-15% of concussed patients will develop persistent symptoms and be diagnosed with post-concussion syndrome.

Thanks to an explosion in concussion research in the last 20 years, we know a lot more about these head injuries than we have in the past. While we don’t know the exact physical reasons why some people are more likely to suffer from post-concussion syndrome, we do know some specific risk factors for people developing persistent symptoms.

Here’s a short but important list of factors that may make a young athlete more susceptible to chronic concussion symptoms:

  1. Patients with a history of migraine headache
  2. Patients with a history bipolar or anxiety disorder
  3. Patients with a family history of bipolar or anxiety disorder
  4. Patients with a previous concussion

There’s a few interesting things to take away from this:

  • Having a history of migraine likely means that your nervous system will be more vulnerable to the headache and nausea experienced with concussion symptoms. It may also signal that you have a sensitivity in your neck to issues that may stimulate the headache process and can be worsened by head trauma.
  • The first is that mental health seems to be a major player in the future expression of post-concussive symptoms like headache and dizziness. It shows us the power that mental health can have on physical health problems.
  • There’s no association with the severity of the concussion or losing consciousness. While a more severe hit to the head or getting knocked out seem like they would predict worse recovery, the data suggests that it doesn’t play a significant role in the development of persistent symptoms.
  • A lot of people get their physical symptoms treated for post concussion symptoms by a variety of providers, but a lot of people ignore their psychological and cognitive treatments. Having someone that can help manage their anxiety appropriately and use cognitive behavioral interventions can help many patients benefit from their physical symptoms.

Don’t Forget: Health Is A 3 Legged Stool

It’s easy to think about health in terms of physical ailments, but your overall well being is dependent on physical, mental, and emotional health. There’s a reason why people with depression and anxiety have worse outcomes for every physical ailment that exists. If you have a poor mental and emotional outlook, your brain simply doesn’t mobilize it’s repairing and recuperative resources as effectively.

In the world of concussion we often talk about getting the right care for concussions linking it to cervical spine problems, vestibular problems, or brain problems. What we sometimes forget is that some of our susceptibility to illness is related to our belief in the fragility or resilience of our bodies. Let’s restore faith in the strength of our bodies and make ourselves more robust healing machines.

Cracking the Code on Lightheaded Dizziness

When people say that they feel dizzy, most people, even healthcare providers usually think that you’re talking about the room spinning sensation of vertigo. However, there are thousands of people around the country describe themselves as having dizziness but don’t have the characteristic sensation of vertigo. Many patients may describe their dizziness as a rocking, swaying, floating, or disoriented feeling. More than anything, people with dizziness have a feeling of being out of sorts if it’s not specifically related to vertigo.

In this article, we are going to breakdown a specific and very common feeling that people associate with dizziness. We are going to talk about lightheaded dizziness.

Orthostatic Intolerance – a blood flow issue

Most people have had a feeling of light headedness at some point in their life. It’s most commonly felt when people go from laying down to standing too quickly. Your head feels funny and you might feel your vision get dark for a moment. After a few seconds, the feeling passes and you probably won’t even think twice about it.

This sensation of feeling light headed on standing is called orthostatic hypotension or orthostatic intolerance.These are terms used to describe the fact that when you change positions, your blood pressure didn’t meet the brain’s demand for blood in that moment in time.

Your brain is a greedy organ when it comes to blood flow. Although it only makes up about 2-3% of the body’s total mass, the brain hogs about 20% of the body’s blood flow. Your blood pressure is not just a marker for the health of your heart, but the purpose of a tightly regulated blood pressure is to make sure that your brain is getting that 20% blood flow at all times. 

While people generally think of their heart as the main controller of blood pressure, it is actually your nervous system that keeps it tightly regulated. It’s so regulated, that in the moments right before you stand (when the idea of standing was just a thought), your brain is sending messages to your muscles and arteries to tighten up so it can keep your blood pressure constant when you are changing postures.

Pretty neat right?

While most people can have moments of lightheadedness like this from time to time, it usually goes away on its own. However, some people feel this sensation on a regular basis. It’s been estimated that anywhere between 4% young adults and 30% of older adults experience orthostatic intolerance. About 42% of people with a complaint of dizziness have a complaint of light headed dizziness related to standing. [Source]

Whether you feel like you’re  spinning, rocking, or light headed, a persistent feeling of dizziness can lead to feelings of anxiety and depression because of the impact on your daily life activities. Orthostatic hypotension is also associated with increased incidence of cardiovascular events and overall mortality, especially in the aging population where feinting and dizziness can lead to falls

Why Does Orthostatic Intolerance Happen?

So far, research has shown that the light headed feeling from orthostatic intolerance is a blood flow issue in the brain. We also know that the autonomic nervous system is a major role player in this problem as many patients with this form of dizziness will have abnormal findings on head upright table tilt testing as well as abnormal blood pressure findings when using a valsava maneuver. [Source]

For many of these cases, there is a problem in the regulation of the sympathetic or parasympathetic nervous system. This gets further complicated by the fact that people who experience orthostatic hypotension may have the same symptoms, but the neurological mechanism that is causing the symptoms are different. [Source]. In general terms, the sympathetic nervous system may have problems constricting your arteries on standing, or the parasympathetic system may have difficulties in regulating your cardiac output. That’s why many patients with orthostatic issues may get evidence-based treatment for the condition.

How Is It Treated?

This part is difficult, because unless you’re in an area that does specialized autonomic laboratories, many people don’t even know this condition exists. Many people get misdiagnosed with vertigo. Many others will just have their condition brushed off.

If you’re lucky enough to have someone that understands orthostatic issues, then you will likely be managed with a regiment of blood pressure medication and IV’s to help keep your blood pressure from tanking. This gets complicated if a patient has HYPERtension when they lie down which is obviously problematic to give therapies that will non-specifically increase your blood pressure.

A Neurological Approach

While many doctors are concerned with blood pressure numbers in of themselves, from a chiropractic perspective we ask why the body is having an abnormal autonomic response to changes in posture. This is particularly important when we are thinking about the head.

When the head and neck shift, it can disrupt normal proprioception into the brainstem and have wide ranging effects of the autonomic nervous system. Excessive twisting or rotation of the Atlas vertebrae may also affect the jugular vein and how blood flow returns to the heart leading to problems with the vagus nerve and cardiac output.

We have also seen patients with dysautonomia have small disturbances in the function of their vestibular system. In some cases patients with orthostatic hypotension can experience vertigo, but in many cases it simply makes head and eye movement far less efficient.

When we put this all together, we have found that a cervical-vestibular approach has the potential to create important improvements in the autonomic nervous system which can help patients overcome their poor relationship with gravity.

Tell us about your dizziness