Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma.

STUDY DESIGN Synthesis and application of research. OBJECTIVE To provide a framework to consider the role of signs and symptoms of postural control disturbance in the transition to chronicity after a whiplash trauma. SUMMARY OF BACKGROUND DATA Dizziness is one of the most frequent complaints in those with persistent pain after a whiplash trauma and is often associated with postural control disturbances. METHODS Focus paper to review the causes, management, onset, and relationships of such signs and symptoms after a whiplash trauma to explore the role they may have in the transition to chronicity. RESULTS Contemporary literature suggests these signs and symptoms are often, but not always, aligned with those with significant neck pain and disability and have been related to a poorer prognosis. There are obvious links between the cervical proprioceptors and the musculoskeletal system, but links to the autonomic nervous, vestibular, and visual systems and influence on pain modulation are important. Postural control may have potential to alter other systems and affect pain and should be considered as one of the processes that might influence the transition to chronicity after a whiplash trauma. Future research should monitor the effect that addressing abnormal cervical afferent input has on not just dizziness and postural control but other symptoms such as altered pain processing and psychological distress. CONCLUSION The causes of transition into chronicity after a whiplash trauma are present early and appear to be multifactorial. Pain sensitivity and psychosocial distress have recently been considered but postural deficits and the symptom of dizziness also appear to have a role.It is recommended that future research address these issues to further the understanding of the transition to chronicity after a whiplash trauma.