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Dizziness: Misdiagnosed and Mistreated

Dizziness: Misdiagnosed and Mistreated

Dizziness: Misdiagnosed and Mistreated

 

Dizziness is Hard to Diagnose

When people have dizziness as a complaint, it can be one of the most commonly misdiagnosed and mistreated conditions around. The challenge is that dizziness is a symptom that can be associated with lots of different conditions. Here’s a short list of conditions associated with dizziness:

Primary dizziness: Dizziness as a primary disease entity

  • Positional vertigo (BPPV)
  • Meniere’s disease

Secondary dizziness: Dizziness as a result of another problem

  • Stroke
  • Migraine
  • Concussion
  • Tumors
  • Medications

On top of that, dizziness means something different to different people. Does your dizziness feel like spinning? Rocking? Feeling off balance? Light headedness? Sometimes the feeling of dizziness can be hard to describe because you just feel disoriented and lost in space.

All of these factors are important to help a doctor get the right diagnosis.

It means that a doctor has to take a good health history, perform the right bedside tests, and order the appropriate diagnostic testing to find out the cause of your dizziness. Without knowing what’s causing this feeling, then administering the right treatment can be a lucky guess at best, or make you more dizzy at worst.

It’s no wonder that people who have chronic vertigo and other balance issues often see their primary care doctor, neurologist, ENT, physical therapist, acupuncturist, and more looking for answers on how to get their world to stop moving.

Dizziness is Even Harder to Treat

Another challenge with dizziness patients is that medications don’t really do a good job of making the world stop moving. Many patients with chronic dizziness are placed on anti-depressants, anti-anxiety meds, and drugs for nausea. The problem with that is that the patient may not be as nauseated, but their brains are not responding to their environment appropriately.

Dizziness after spinning on a bat is easy to explain, but what if the world is spinning when you're standing still?

Dizziness after spinning on a bat is easy to explain, but what if the world is spinning when you’re standing still?

 Dizziness can also be treated by positional maneuvers like the Epley maneuver and head shaking exercises like gaze stability. Both are extremely effective when they are used appropriately, but can be useless if it’s performed on the wrong patient with the wrong diagnosis.

That’s why it’s so important to know what’s really going on with a patient. Many clinics will take any person with dizziness and just do some of these maneuvers even though the maneuvers may not be appropriate for the patient’s specific condition. In order to help a patient recover, we have to examine them closely to make sure that we have the right information to begin care.

Case Study: 

Recently we had a patient come in with dizziness and had been seeing an ENT for treatment. She was having problems feeling off balance for a while and it was made with head turning sometimes. She wasn’t experiencing a spinning type sensation, but just a sense of feeling out of sorts.

The doctor diagnosed her with benign paroxysmal positional vertigo or BPPV. It’s arguably the most common form of vertigo and is usually easily treated with a positional maneuver called the Epley maneuver. The doctor performed Epley and gave her some alternative maneuvers that she could do at home whenever she felt dizzy.

The problem was that the maneuver wasn’t changing anything. She tried doing the maneuvers for several weeks with no change. When she followed up with the doctor, the doctor told her there wasn’t anything else he could do and that some cases don’t respond.

Fortunately the patient found her way to our office through a referral from one of our patients who got really great results with balance problems

BPPV usually causes a spinning sensation that is really short lived. In many cases, doctors can diagnose BPPV with a test called the Dix-Halpike maneuver. You can look at this test below. If you have BPPV your eyes will start moving making a fast oscillating movement called nystagmus.

It’s this nystagmus when the inner ear moves the eyes that creates a feeling of spinning.

When this patient came in, we did a thorough history and found out that her “vertigo” didn’t have any spinning at all. She just felt disoriented and off balance. We performed the Dix-Halpike test and she had her eyes stayed solid.

So now we knew that she probably didn’t have BPPV, and that’s why the Epley maneuver didn’t work that well for her. It was time to figure out what other anatomy might be causing her problem.

We did a test called the smooth pursuit neck torsion test. It’s a test developed from patients who had dizziness after whiplash. It’s an indicator that the neck might be causing the eyes to move abnormally. You can see that test here below. In patients with neck problems, the eyes will start jumping instead of staying smooth.

Now that we knew the neck could be a problem, we started addressing the neck using the NUCCA procedure for structural correction.

Within 2 visits, the patient’s dizziness was about 80% gone. We have more work to do to help the neck heal, but with some time I think this patient will get back to normal.

Find the Cause, Deliver the Solution

So this isn’t an indictment on another professional. Lots of ENTs keep their focus on infections of the ear, nose, and throat. An ENT with a neurology background would probably have found the same thing and recommended physical therapy or chiropractic care.

The lesson here is that dizziness is complicated, and one treatment won’t solve all forms of dizziness. For any condition, we have to spend time with our patient, listen to their history, examine them thoroughly, and we can find a game plan to help them get back to normal.

Talk to Dr. Chung

 

 

head tilt

Is Head Tilt Driving Your Brain Crazy?

Is Head Tilt Driving Your Brain Crazy?

 

A lot of people are starting to recognize the role that posture plays in overall health. Things like text-neck has made it’s way to major publications like the Washington Post, and the perils of slouching have been written about ad nauseum.

I won’t get into that today, because I think there’s a problem that is a lot more important but gets far less attention. Most doctors will ignore this, but chances are it’s a major contributor to headache, balance disorders, vision problems, and overall brain health.

Today we’re going to break down your head tilt.

Cute for Puppies and Sorority Poses, Bad for Patients with Neurological Issues

First we should clarify a couple of things. When we discuss head tilt, we’re not talking about the tilt that comes on when you intentionally tilt your head for a photo. If you are intentionally creating a momentary head tilt, it’s not a big deal. There’s no such thing as a bad posture if you are willfully and intentionally trying to create a specific shape with your body in gravity.

We only classify postures as negative when your body is doing something that it is not intending. If I ask you to stand up as straight as you can and your head tilts to side, it paints a much different picture of your brain than if I asked you to purposefully hold your head to the side. An inability for you to create a straight upright posture suggests that you have a deficiency in your brain’s ability to control your muscular system. You can read about that in greater detail here:

Why Your Posture Isn’t That Important

So what’s the big deal if your head tilts to the side?

It’s a sign that your brain is perceiving the world around it incorrectly.

If your brain is getting wrong information from your senses, then it can’t produce the right response to the world around it.

It doesn’t sound like a big deal when we’re talking about posture, muscles, and bones, but let’s apply the same idea to some of your other senses:

  • If you have a problem with one of your eyes, how will that affect your ability to catch a baseball?
  • If your ears are hearing a high pitched noise all of the time when everything is quiet, how will that make you feel?
  • If your skin is constantly itching, but you have nothing on your skin that is irritating it, will you keep scratching?

All of these are examples of your brain perceiving the environment incorrectly and they all lead to specific conditions from a lack of depth perception, tinnitus, to neuropathic itch. When left for a long time, these conditions can have a significant impact on your enjoyment of life.

So what are the consequences of a chronic head tilt?

The Physiology of Head Tilt

How your brain decides to hold the head up involves a lot more neurology than most people expect. Generally speaking, we think about head tilts being a result of tight muscles pulling the head out of place. When we use this model, treatments become a matter of rubbing one muscle and stretch another and the head will be straight again.

For better or worse, the way the brain moves the head is WAY more complex than that. Your brain decides where to put your head in space based on the interplay of your inner ear organ, your eyes, and the small muscles of your neck.  Here’s how it works:

Normal Head Tilt Reaction

So this is what happens when the system is working okay. When the system works, you can tilt your head when you choose to, but your brain will bring your head back to the normal upright position after it has achieved its purpose.

We see this system break frequently when someone has injuries like whiplash or concussion. The impact of these injuries disrupts normal function of all three systems. It scrambles the inner ear which distorts your eye movements. It also wreaks havoc on the muscles and ligaments of your neck.

What Happens When Your Head Tilt Breaks?

This is why the biggest problems associated with whiplash and concussion injuries are balance and vision issues. You can’t keep your perception of the world straight if your eyes, ears, and spine are giving you inaccurate information about gravity!

When your head and neck get scrambled by a hit and you disrupt these 3 systems, your body takes on an abnormal head posture which can make the other systems work inappropriately. One of the first things I’ll ask someone during a consultation is to sit up as straight as they can, and I’ll look at where they put their head in space. Very often they look like this:


Abnormal Tilt Reaction

 

 

But let’s be honest here; you don’t really care if you have a head tilt, crooked eyes, and tight muscles if it’s not causing you any pain or discomfort right?

Here’s the thing, your body can compensate like this for a little while. But if you’ve ever had to rely on a back up system before, you probably know that backup systems aren’t ideal and they’re more prone to glitches and failure. Your body is the same way with its own back up systems. They will get you out of a pinch for a short time, but they will eventually fail. Or even worse, you may suffer another injury while you are compensating and have even more damage to the brain.

So as your back up systems start to fail and your eyes and neck aren’t working normally you will start to have problems like:

  • Dizziness
  • Feeling off balance
  • Neck and back pain
  • Headache
  • Nausea

Why? Because if your eyes don’t move well, then it leads to difficulty reading or tracking targets in space. If your neck doesn’t move well, it causes pain and headaches. If you have all three systems saying different things, your brain has no idea how to determine it’s sense of balance.

Your Brain Hates Mismatches

Your brain hates it when its sensory organs give it conflicting information causing sensory mismatches. It hates it more than your significant other hates it when you walk out of the door with a brown belt and black shoes.

Your brain hates sensory mismatches even more than your significant other hates this fashion faux pas

Your brain hates sensory mismatches even more than your significant other hates this fashion faux pas. Image Credit to http://www.houseofmarbury.com/can-wear-black-brown/

All kidding aside, these sensory mismatches are the main trigger for the balance issues that can make people miserable. When you combine that with the fact that the balance system shares connections to your autonomic nervous system, then it gives us an understanding for why balance problems can really wreak havoc on our stress response system.

The abnormal movement of the eyes and head are also likely to create persistent headaches and pain in your joints and muscles from abnormal loading patterns.

When your head tilts, all of your spinal system starts to act screwy

When your head tilts, all of your spinal system starts to act screwy

While the symptoms can be bad enough, the biggest concern is the impact that these maladaptive patterns have on the functioning of the brain as a whole. If you can’t orient your world properly, then the parts of your brain that are responsible for normal function start to degrade while the parts of the brain that are producing these abnormal patterns get stronger. This persistent abnormal head pattern can change the way blood flow and oxygen get to various parts of the brain and lead to further problems with thought, focus, and movement.

If we want to make a real impact on the health of your brain, then we have to allow the brain to stop compensating and get your head on straight again.

Send Dr. Chung a Message

equestrians-and-concussion

Are Equestrians More Resilient to Concussive Injury Than Everyone Else?

equestrians-and-concussion

 

Concussions, Balance, and the Equestrian Advantage

Concussions are a hot topic in professional football, but it’s something that horse lovers have been familiar with for years. A 2014 paper in published in the Sports Health medical journal showed that almost 50% of competitive riders will have experienced a concussion during their life while riding. Surveys have also shown that helmet usage amongst equestrians is extremely low with estimates ranging from 9%-25% of riders opting to ride without head protection.

The sudden deaths of high profile professional football players have made the complications of head trauma a hot button topic in sports and medicine. Concussions are considered a mild traumatic brain injury, but the truth is that a brain injury of any sort is anything BUT mild.

While most people will recover from the effects of a concussion within 7-10 days, approximately 15% of patients will experience symptoms beyond 30 days. When these concussive symptoms persist,  the patient will likely receive a diagnosis of post-concussion syndrome or PCS. The symptoms of PCS include:

  • Headache and migraine
  • Vertigo or loss of balance
  • Brain fog/difficulty with concentration
  • Memory dysfunction
  • Dysautonomia and fatigue

Pro-Riding and Pro-Brains. Not Mutually Exclusive

There are risks to all sports, and as an athlete you have come to accept those risks as part of the game. Additionally, if you have been involved with riding for a while, it’s easy to accept head injuries as an inevitable part of the sport, and the truth is that most people will recover in a week or two.
It’s a common thread with sports doctors to say that sports like riding are too risky for the developing brain. The truth is that concussions shouldn’t be something that scares you from playing your sport. Getting into sports like riding are the most effective ways for people to stay active and fit throughout your life.

I try to teach my riders 2 important concepts:

  1. If you get an injury, make it an injury of performance. Take the right steps to prevent injuries of negligence or careless behavior like not wearing a helmet.
  2. Know what to do after a head injury so that you can ensure maximum brain health and recovery.

 

Taking Care of the Concussed Brain – Performance Over Pathology

When talking about the long-term health consequences of head injury, it’s best NOT to get your stance from places like Will Smith’s recent film, Concussion. The brain illnesses discussed in that movie are pretty rare, and apply to very specific types of athletes.

However, that doesn’t mean that concussion is free of long-term consequences. Studies of athletes with a history of concussion have shown slightly slower cognition and reaction time 30 years later, even if there are no symptoms of head injury. Studies of previous football players have shown that athletes with a history of concussion are more likely to have back and leg injuries after retirement because of the way concussions affect control of your own joints.

Here’s where getting the right treatment after concussion can make all the difference in the world for an equestrian athlete. While most athletes aren’t overly concerned about something abstract like brain health, athletes are VERY interested in anything that can affect their performance on the field or rink.

The Equestrian Advantage

While equestrians are at a higher risk of head injury than most sports, the unique features of equestrian sports may help confer protection from some of the chronic problems associated with concussion.

From a neuroscience perspective, horseback riding requires a tremendous amount of work from the parts of your brain that control balance. Your sense of balance is made up of a delicate interplay between your inner ear (vestibular system), eyes (ocular), and joints (proprioception). Your brain takes information from these 3 systems and paints the image in your mind of where you are in space.

The 3 super systems that maintain your balance

The 3 super systems that maintain your balance

When you ride a horse, your body is constantly bobbing in a way that far exceeds the normal force of walking. Your brain has a magnificent system in place to help keep your vision in focus even though your head is moving all over the place. If this system gets corrupted, then really simple movement makes us feel off balance or dizzy. In other cases, this system also affects our emotional control and cause headaches.

The brain, like any other part of the body gets stronger and adapts the more that you use it and challenge it. Between simple riding, jumping, and dressage, equestrian athletes have to challenge their vestibular system more than almost all people, including many athletes. That means that many equestrians are likely to have a stronger sense of balance than most people, and research is actually starting to demonstrate that1. The effects that horseback riding has on balance or so strong that they are even being suggested for the treatment of balance problems in the elderly2 and in stroke patients3.

No Symptoms No Problems In Concussion Patients

So why is that important for a concussion? Most people associate concussion with your ability to think, but concussions actually have the strongest and most immediate impact on this balance system. When people suffer with concussions, you’ll often see that their ability to stand still and walk is affected even if they don’t have any cognitive symptoms at all. The brain hates when the balance system is broken. Overtime, as balance issues fail to get fixed, it spills over into problems leading to vision disturbances, headaches, and brain fog.

One of the things that I notice in my experience with equestrian patients is that many won’t show signs of head injury in their normal daily activities, due to their strong sense of balance. When your body feels like it has a good sense of balance, some of the cognitive and pain symptoms from a concussion don’t impact you quite as badly. This is a great thing in that a head injury won’t cause an obvious deficiency in your quality of life.

However, many times this is due to a compensation strategy by the brain. When you suffer a concussion, the parts of the brain that control the eyes, cognition, balance, and movement become compromised. When the brain suffers damage to one area, then other areas of the brain will start to work harder to perform the duties of the damaged region. This is driven by a concept called neuroplasticity. This is what allows blind people to have a heightened sense of hearing, or deaf people to have a more focused visual sense.

As a rider, a concussion may damage the regions of the brain that control neck and eye movements, which can be detrimental to your balance. However, your balance system from the inner ear is so strong that it can take over the task of keeping you upright without much of a hitch. Even though you feel good and your balance seems strong, there’s only so long that the brain can manage these compensation strategies before it starts to fail.

Compensated Performance = Suboptimal Performance

 So now we’re going to bring it all back together.

When you suffer a concussion and parts of this comprehensive balance system breaks, many equestrians are fortunate enough to bounce back without prolonged symptomatic consequences because of a well-trained balance system in the brain.

The problem is that our brain is designed to work with contributions from all of our sensory systems. If we partially lose a system like proprioception from the joints and the inner ear system works overtime, then we will gradually lose more and more function from the joint position system. It won’t affect us immediately, but it may start to show up as back pain and knee injuries later on in life. If we lose some of our visual sense, then things like double vision or blurry vision can become long-term consequences.

You can even perform simple tests to see if some of your balance systems are not working well. Something as simple as standing with your eyes closed vs standing with your eyes open helps to see if your inner ear and joint position sense are working. If you start having difficulty concentrating while reading, your ocular system may be compromised.

The good news is that the same plasticity that helps us compensate is what allows us to develop strategies to rehabilitate the brain when we know which system is compromised. A thorough structura and neurological exam can help ensure that your brain does not just survive after a concussion, but to get it back to thriving again.

  1. Kim SH, Lee C, Lee I. Comparison between the effects of horseback riding exercise and trunk stability exercise on the balance of normal adults. Journal of Physical Therapy Science. 2014 Sep; 26(9): 1325-1327
  2. Kang K. Effects of mechanical horseback riding on the balance ability of the elderly. Journal of Physical Therapy Science. 2015 Aug; 27(8): 2499-2500
  3. Kang K. Effects of horseback riding simulator exercise on postural balance of chronic stroke patients. Journal of Phhysical Therapy Science. 2013 Sep; 25(9): 1169-1172.

 

Post-Concussion Syndrome

Case Study: 6 months of Post-Concussion Syndrome

Post-Concussion Syndrome

 

Read Time: [3 minutes]

Post-concussion syndrome has become a big deal with more athletes showing concern about the risks of chronic brain injury. Recovery from a concussion usually takes about 7-10 days for most people but many will have symptoms that last 30 days or more.

Our most recent case had post-concussion syndrome that lasted 6 months prior to visiting our office.

Background

A young woman was a passenger in a car that was struck from the side. The shock of the accident caused her head to whip from side to side and she lost consciousness immediately.

Although many concussions are a result of a direct blow to the head, a concussion can occur through rapid acceleration and deceleration of the head causing the brain to move and collide with the inside of the skull.

Following the concussion, the patient began having daily episodes of migraine headaches. During the migraine attacks, she would also have vertigo that led to a persistent feeling of nausea.

After being discharged from the hospital the patient was seen by an orthopedist and chiropractor. While chiropractic adjustments were helpful, she felt her symptoms come back repeatedly within hours of her treatment. The patient had an appointment with her orthopedist to receive neck injections, but was referred to our office before that to see if correcting her atlas would help.

Assessing the Neck in Concussion

The patient was put through a full examination to evaluate the  neck. In many cases of post-concussion syndrome, the neck has numerous pain-generating tissue that can be responsible for these neurological symptoms. This includes precise x-rays of the top of the neck, evaluation of neck muscle tone, structural positioning, and evaluation of head and neck control.

You can see some images of our head control laser testing below.

img_4266

Laser head positioning system

Testing head control using a maze

Testing head control using a maze

When people suffer a concussion or whiplash injury, it can cause damage to the muscles and allow us to control our head and neck movement. These injuries can lead to headaches, but they also cause problems with our sense of balance.

Once we have some baseline information on their current abilities, we can monitor how they respond and heal from the damage to their neck.

Results:

After her 2nd visit, the patient said that her headaches and nausea were almost completely non-existent.

Imagine that. Going from daily migraines, to no headaches for an entire week. All from a getting the head and neck into a better structural position.

Now that isn’t to say that life is perfect after that. There were certainly some ups and downs along the way. Overall, the patient’s headaches have improved about 80% in frequency and intensity. She has elected to skip getting injections, and is working hard everyday to get stronger.

Here’s the most important element and really the part that matters:

After the head injury, the patient was unable to do the things that made her life fun. She had trouble working out and getting motivated to exercise. Staying focused at work meant having to rely on pain killers. Taking care of a young daughter meant gritting her teeth through pain and nausea instead of being present in the moment.

That’s what all of this is about. It’s not about the pain reduction, it’s about the restoration of normal life!

For more information, you can read this patient’s testimonial below:

I’m a very active mommy that carries around the weight of a 6 year old and owning a salon full time. Work and mommy duties call for my body to be at all times ready and with it. There isn’t time for rest, much less any fatigue or achy-ness. Between playing sports when I was young, actively working out and having the burden of standing on my feet the majority of my work days, my simple adjustments just got me through. I didn’t realize that there could be a cure for my migraines, constant neck stiffness and what seemed to be a much older body that I was trapped in.

I was a back seat passenger in a car crash on New Years, where the car was deemed totaled. There were no major signs of trauma, besides the concussion and black eye I received, however, I knew something was wrong when my pain was continuing to get worse months after the accident. My routine visits to the chiropractor, became tedious weekly visits that just got me through; my pain kept coming back if I didn’t get adjusted that day. I refused to succumb to cortisone shots previously, but felt desperate. Instead of my Chiropractor sending me off the receive the possible relief from an invasive procedure, he referred me to his dear friend Dr. Chung that specializes in post concussion, migraines, fatigue and achy-ness.

Dr Chung was very thorough and did a series of X-rays and tests to see how my whole body was aligned and reviewed my MRI. He explained the symptoms and showed me what was happening to my brain and surrounding inflamed tissues. After one precise adjustment and many months of not being able to be active or myself, I felt 150%. I was scared and apprehensive as to when my pain would return. To my surprise, months later and just a few maintenance NUCCA adjustments, my pain has not returned and I was immediately able to carry on with my workouts, mommy life and my physically involved career. I was even able to hike, travel and do Cross-fit within weeks of being adjusted. My energy and range of motion has returned. I couldn’t be happier for the referral to such a dedicated, intelligent, passionate Doctor of Chiropractic. Thank you so much for your passion to treat your patients and wish you much success.
Jessica S.

Head tilt

Why Does My Head Always Tilt to the Side?

Head tilt

Read Time: [5-7 minutes]

How do I know if someone has an Atlas problem? Can a regular person see it?

Head tilting posture is something we’re used to seeing with curious puppies, but it may be a sign of a problem in the central nervous system. This can be one of the most important signs of poor neurological activity even in the absence of pain or symptoms.

Head tilt

Image from paper in the journal Laterality. Source: http://www3.canisius.edu/~noonan/research/researchreports/human_head_tilt.htm

Poor Head Position = Poor Interpretation of Gravity

Poor head positioning is one of the most important postural findings I look for in a Structural Chiropractic Examination. From a clinical perspective, it’s a lot more important than something like slouching. For the most part, people have the ability to recognize and correct a slouching posture when they want to. When it comes to a persistent head tilt, most people have no idea when it’s happening. It’s also a posture that is related to things like head injury, whiplash, or a balance problem.

When you have a persistent head tilt, you typically don’t know that your head is tilting because in your mind, it’s perfectly straight. This is an underlying indicator that your brain is working inefficienctly.

When you really think about it, posture is primarily your brain’s response to gravity. Whatever your body experesses as a straight posture is how your brain thinks it needs to exist in a gravitational environment. That means that a crooked head position means that the brain is getting bad input, which is leading to poor output.

Garbage in, garbage out

What does garbage out look like to the body? Garbage out expresses itself as Secondary Conditions like:

  • Headaches
  • Facial pain
  • TMJ
  • Vertigo
  • Balance Problems
  • Syncope (Dysautonomia)

All common problems experienced after a concussion or whiplash injury.

Why Head Tilt?

So what does head tilt have to do with concussion, whiplash, and all of these Secondary Conditions?

When your head and neck is exposed to a force, it can affect one of 3 systems in the body that control and regulate your balance and posture.

  1. Visual and Ocular system
  2. Inner ear/vestibular system
  3. Neck/Spine Proprioceptive system

Together these 3 systems integrate into your brain so that your brain knows how to regulate your body in space.

Your vision and movement of your eyes make sure that your head stays level. Your ears tell your brain if your head is moving. Your joints provide information on if your limbs or your spine are moving.

This system works best when all 3 give the same information. If your eyes and muscles say one thing, but your ears say another, then it creates a problem for the brain to process.

The 3 systems that form the Balance Triad

The 3 systems that form the Balance Triad

When you take a blow to the head or neck, then these structures can become damaged and start to malfunction.  We can see this malfunction manifest as a persistent head tilt to the side.

Head tilt may not be the cause of these problems, but it is a clear and obvious sign of a breakdown in this system.

It’s easy to see how a blow to the head can affect the neck because the two structures are connected via the top bone in your neck called the Atlas. In our Wellington office, we handle this problem by re-centering the head on top of the neck again utilizing the NUCCA procedure.

When the head is centered, then it’s almost like a re-boot to the system to make the brain work normally again.

Not All Head Tilts Cause Pain

Notice that not all head tilts cause pain, but head tilt is almost always a sign of a problem in the brain. Lots of people can go through a bad car wreck and not feel any pain immediately. However, the structure of their spine and the function of the brain has changed. This means that a problem can develop over time due to chronic malfunction of the nervous system.

That’s why everyone should get checked for a Atlas Displacement after an injury even if there’s no pain or symptoms present.

Not All Head Tilts Are a Neck Problem

Not every head tilt is related to a problem in the neck, though there is almost always at least some contribution from the neck. As we discussed earlier, there are 3 main systems that dictate your sense of balance.

There are times when I have done my best effort in correcting someone’s neck that a head tilt persists. That’s why it’s important to work with a team of professionals that are capable of addressing this problem.

  • Optometrists/Vision Therapy/Neuro-opthamology – These professionals are trained in addressing the ocular system. It’s a rapidly growing field thanks to our growing knowledge of concussion and how it affects the eyes.
  • Vestibular Therapist / Functional Neurologist – Special types of chiropractors and physical therapists are trained at rehabilitating problems in the inner ear. They use special assessments and exercises to restore normal function of the inner ear.

Remember: No one therapy cures all. An interdisciplinary approach is often the best way to solve many of these complex cases.