From Whiplash to Wobble: How Neck Injuries Affect Balance and Movement Control

Whiplash-associated disorders (WAD) are often thought of as localized injuries to the neck muscles and ligaments. However, emerging evidence reveals a more complex picture—one where balance, proprioception, and visual disturbances may persist well beyond the acute phase of injury. These lingering symptoms, such as dizziness and unsteadiness, are now better understood through research exploring sensorimotor control deficits that follow cervical spine trauma. This blog synthesizes findings from several high-quality clinical sources, highlighting how manual therapy, exercise, and multidisciplinary interventions—including chiropractic care—can play a role in managing persistent symptoms associated with whiplash.

Sensorimotor Disturbances in Whiplash

Sensorimotor control is a coordinated process involving sensory input (primarily from joints and muscles), central integration, and motor output. In the cervical spine (neck), especially the upper cervical segments, there exists a dense network of mechanoreceptors that interact with visual and vestibular systems to maintain balance, eye-head coordination, and spatial awareness. In other words, the upper neck has a lot of sensors that help your body stay balanced, keep your eyes and head working together, and know where you are in space. These sensors work closely with your eyes and inner ear.

A clinical commentary ⁽¹⁾ emphasizes that disturbances in cervical sensory input—often following whiplash—can lead to significant sensorimotor deficits. These include impaired joint position sense, reduced postural stability, oculomotor dysfunction, and dizziness. These symptoms may not resolve with traditional exercise programs that focus solely on range of motion and strength.

Treleaven et al.’s 12-month follow-up study of patients with persistent whiplash associated disorder (WAD) supports this view. Although participants underwent either neck-specific exercise, neck-specific exercise with a behavioral component, or general physical activity, a large proportion (63%) still reported dizziness at follow-up. The researchers found that limited improvement in neck strength and function was linked to ongoing dizziness. These findings underscore that underlying sensorimotor disturbances—rather than musculoskeletal stiffness alone—may drive long-term dysfunction ^(2).

Reassessing Neck Mobility in Recovery

While early whiplash injuries typically result in reduced neck mobility, these restrictions often resolve over time. A prospective study comparing neck pain and neck mobility in whiplash patients found that cervical range of motion returned to normal within three months. However, those experiencing greater headache and neck pain showed more significant movement restriction in the early stages ⁽³⁾.

This indicates that pain is a limiting factor in neck movement rather than structural impairment. It also suggests that even if neck movement returns to normal, other issues—especially those related to balance and coordination—can remain and may persist and require targeted rehabilitation.

Clinical Case Insights into Sensorimotor Rehabilitation

The relevance of sensorimotor dysfunction is further illustrated through clinical case reports. Treleaven describes four individuals with persistent symptoms following neck trauma. All cases demonstrated varying degrees of proprioceptive impairment, postural instability, and oculomotor dysfunction. Interventions targeting cervical joint position error, balance, and head/eye movement coordination were implemented as part of a broader, multimodal strategy.

These cases demonstrate the importance of tailoring treatment to the individual’s specific deficits. Improvements were observed when sensorimotor retraining was combined with manual therapy, education, and ergonomic adjustments. This approach not only alleviated symptoms but also supported functional recovery in everyday activities.

Chiropractic Manipulation in Addressing Sensorimotor Impairments

Chiropractic manipulation is a form of manual therapy that can positively influence cervical proprioception and neuromuscular control. Although not the focus of all the reviewed studies, its potential role is acknowledged.

Manipulative therapy was found to improve joint position sense and reduce cervicogenic dizziness by restoring normal afferent (sensory) input. In one case report, a patient undergoing both physiotherapy and chiropractic care for upper cervical dysfunction experienced temporary relief from symptoms including eye strain, neck discomfort, and instability. While relief was short-lived, it suggests that spinal manipulation may contribute to symptom modulation ^(5).

Another study^(5). directly assessed the effects of upper thoracic manipulation combined with cervical stability exercises. The combined intervention led to greater improvements in cervical proprioception and pain compared to exercise alone. These results reinforce that manipulation can enhance outcomes, especially when integrated with active rehabilitation.

Interventions for Dizziness and Unsteadiness

Addressing dizziness and balance issues requires more than generic neck exercises. Tailored interventions are necessary to target specific sensorimotor dysfunctions. The sources consistently identify several components essential to effective management:

• Cervical Joint Position Sense Retraining: Exercises that improve the accuracy of head repositioning can recalibrate proprioceptive input.

• Eye-Head Coordination and Gaze Stability: These are critical for individuals with oculomotor disturbances. Training may include smooth pursuit, saccadic eye movements, and visual fixation during head movements.

• Postural Control and Balance Exercises: Implemented in progressively challenging conditions (e.g., different stances, eyes closed), these help restore confidence and reduce fall risk.

• Manual Therapy and Manipulation: These aim to normalize joint function and improve sensory input, potentially reducing dizziness.

• Vestibular Rehabilitation: When vestibular involvement is suspected, targeted vestibular exercises can support recovery.

• Behavioral and Educational Strategies: These address ergonomic factors, activity pacing, and psychological contributors to symptoms.

Case reports emphasize the importance of monitoring symptom response and gradually progressing interventions. A multimodal, patient-centered approach improves the likelihood of meaningful recovery ⁽⁴⁾.

The Role of the Combined Neck and Behavioral Approach

One of the studies ⁽²⁾ explored the efficacy of adding a behavioral component to neck-specific exercises. This combined approach addressed not only physical impairments but also the emotional and functional dimensions of recovery.

Although the behavioral approach did not significantly outperform exercise alone in reducing dizziness, it remains clinically relevant. The Neck Disability Index (NDI), a measure that includes pain, concentration, work ability, and emotional well-being, was a key predictor of long-term outcomes. This supports integrating behavioral strategies into broader rehabilitation models.

Kristjansson and Treleaven also highlighted the importance of addressing adaptive changes across multiple systems. For example, changes in vision or balance (vestibular function) can alter how muscles work and how a person holds their posture, which may worsen or prolong neck problems. Although not always named directly, a behavioural approach is suggested—this includes managing stress, educating patients, and encouraging activity pacing to support recovery. In simpler terms, it’s not just the neck that needs attention—how someone feels, moves, and copes all play a role in getting better ⁽¹⁾.

Case examples further support this integrative model. One patient benefited from ergonomic advice, pain education, and encouragement to resume normal activity levels. Another was referred to psychological services due to persistent distress. These components are consistent with a behavioral framework that complements physical rehabilitation ⁽²⁾.

Chiropractic Care Within the Broader Intervention Spectrum

The reviewed sources suggest that chiropractic care, particularly spinal manipulation, can be an effective adjunct in treating WAD-related sensorimotor disturbances. Its value lies not only in restoring joint mechanics but also in modulating the sensory input critical for proprioceptive integrity.

However, the literature also indicates that chiropractic care may be insufficient on its own in cases involving complex sensorimotor disturbances. Optimal outcomes are more likely when manual therapy is part of a multimodal plan that includes:

• Sensorimotor retraining

• Exercise therapy

• Ergonomic and postural advice

• Behavioral strategies

• Referral to other disciplines where indicated

Upper thoracic and cervical manipulations have been shown to reduce repositioning error and improve functional outcomes. These benefits reinforce the clinical relevance of chiropractic intervention within a structured rehabilitation protocol ⁽⁶⁾.

Conclusion

Whiplash-associated disorders present a multifaceted challenge that extends beyond localized neck pain. Dizziness, balance issues, and oculomotor disturbances are common and often rooted in disrupted cervical afferent input (sensory input). The evidence supports a multimodal, sensorimotor-focused approach that includes exercise, education, and manual therapy.

Chiropractic care, particularly spinal manipulation, has a role to play in addressing sensorimotor deficits—especially when combined with active rehabilitation strategies. The inclusion of behavioral and vestibular elements further enhances outcomes, acknowledging the complex interplay of physical and psychological factors.

Recovery from whiplash-associated disorder(s) is rarely linear, and no single intervention is universally effective. However, a comprehensive, tailored approach that addresses both mechanical and neurological dimensions of dysfunction offers the best path toward long-term recovery.

For more information about rehabilitation for whiplash-associated disorders or to schedule an assessment, contact our clinic today. You can ask to speak to one of our chiropractors or book directly on our website.