You are not logged in. Press here to login.


List volumes - List articles in this issue

Original report

Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: A randomized controlled trial

doi: 10.2340/16501977-1197

Open access


OBJECTIVE: To describe how vestibular rehabilitation influences pain and range of motion among patients with whiplash-associated disorder and dizziness, and to describe whether pain or range of motion correlated with balance performance or self-perceived dizziness handicap.
SUBJECTS: A total of 29 patients, 20 women and 9 men, age range 22–76 years.
METHODS: Patients with whiplash-associated disorder and dizziness were randomized to either intervention (vestibular rehabilitation) or control. Neck pain intensity, cervical range of motion (CROM), balance and self-perceived dizziness handicap were measured at baseline, 6 weeks and 3 months.
RESULTS: There were no differences in neck pain intensity or CROM between the 2 groups either at baseline, 6 weeks or 3 months (p = 0.10–0.89). At baseline, neck pain intensity correlated with CROM (–0.406) and self-perceived dizziness handicap (0.492). CROM correlated with self-perceived dizziness handicap and with 1 balance measure (–0.432). Neck pain intensity did not correlate with balance performance (–0.188–0.049).
CONCLUSION: Neck pain intensity and CROM was not influenced by vestibular rehabilitation. Importantly, the programme did not appear to increase pain or decrease neck motion, as initially thought. Neck pain intensity and CROM correlated with self-perceived dizziness handicap. CROM also correlated with 1 balance measure.


Eva Ekvall Hansson, Liselott Persson, Eva Maj Malmström
Department of Clinical Sciences/Family Medicine, Lund University , SE-205 02 Malmö, Sweden. E-mail:


1. Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sports Phys Ther 2009; 39: 364–377.

2. Hülse M, Hölzl M. [Vestibulospinale Reaktionen bei der zervikogenen Gleichgewichtsstörung.] HNO 2000; 48: 295–301.

3. Treleaven J, Jull G, Lowchoy N. Standing balance in persistent whiplash: a comparison between subjects with and without dizziness. J Rehabil Med 2005; 37: 224–229.

4. Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: Characteristic features and relationship with cervical joint position error. J Rehab Med 2003; 35: 36–43.

5. Cobo EP, Mesquida ME, Fanegas EP, Atanasio EM, Pastor MB, Pont CP, et al. What factors have influence on persistence of neck pain after a whiplash? Spine (Phila Pa 1976) 2010; 35: E338–E343.

6. Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine (Phila Pa 1976) 2011; 36 Suppl 25: S211–S217.

7. Hansson EE, Månsson N-O, Ringsberg K, Håkansson A. Dizziness among patients with whiplash associated disorder – a randomized controlled trial. J Rehabil Med 2006; 38: 387–390.

8. Luxon LM, Davies RA. Handbook of vestibular rehabilitation. London: Whurr Publishers Ltd; 1997.

9. Jacobsson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990; 116: 424–427.

10. Carlsson AM. Assessment of chronic pain. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16: 87–101.

11. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17: 45–56.

12. Balogun JA, Abereoje OK, Olaogun M, O, Obajuluwa VA. Inter- and intratester reliability of measuring neck motions with tape measure and myrin gravity-reference goniometer. JOSPT 1989; 10: 248–253.

13. Malmström E-M, Karlberg M, Melander A, Magnusson M. Zebris Versus Myrin: a comparative study between a three-dimensional ultrasound movement analysis and an inclinometer/compass method. Spine 2003; 28: E433–E40.

14. Ledin T, Kronhed AC, Möller C, Möller M, Ödkvist LM, Olsson B. Effects of balance training in elderly evaluated by clinical tests and dynamic posturography. J Vestib Res 1990/91; 1: 129–138.

15. Briggs R, Gossman M, Birch R, Drews J, Shaddeau S. Balance performance among noninstitutionalized elderly women. Physical Therapy 1989; 69: 748–756.

16. Franchignoni F, Tesio L, Martino MT, Ricupero C. Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging (Milano) 1998; 10: 26–31.

17. Jarnlo G-B, Thorngren K-G. Standing balance in hip fracture patients. Acta Orthop Scand 1991; 62: 427–434.

18. Johansson G, Jarnlo G-B. Balance training in 70-year-old women. Physiother Theory Pract 1991; 7: 121–125.

19. Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990; 116: 424–427.

20. Jarlsäter S, Mattsson E. Test of reliability of the Dizziness Handicap Inventory and The Activities-specific Balance Confidence scale for use in Sweden. Adv Physiother 2003; 5: 137–144.

21. Kronhed AC, Möller M. Effects of physical exercise on bone mass, balance skill and aerobic capacity in women and men with low bone mineral density, after one year of training – a prospective study. Scand J Med Sci Sports 1998; 8 (5 Pt 1): 290–298.

22. Hansson EE, Månsson NO, Håkansson A. Effects of specific rehabilitation for dizziness among patients in primary health care. A randomized controlled trial. Clin Rehabil 2004; 18: 558–565.

23. Bohannon R, Larkin P, Cook A, Gear J, Singer J. Decrease in Timed Balance Test Scores with Aging. Phys Ther 1984; 64: 1067–1070.

24. Altman D. Practical statistics for medical research. 9th edn. New York: Chapman & Hall/CRC; 1991.

25. Unnebrink K, Windeler J. Intention-to-treat: methods for dealing with missing values in clinical trials of progressively deteriorating diseases. Stat Med 2001; 20: 3931–346.

26. Bring A, Soderlund A, Wasteson E, Asenlof P. Daily stressors in patients with acute whiplash associated disorders. Disabil Rehabil 2012; 34: 1783–1789.

27. Di Fabio RP, Emasithi A. Aging and the mechanisms underlying head and postural control during voluntary motion. Phys Ther 1997; 77: 458–475.

28. Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropr Man Therap 2011; 19: 21.

29. Karlberg M, Persson L, Magnusson M. Impaired postural control in patients with cervico-brachial pain. Acta Otolaryngol Suppl. 1995; 520 Pt 2: 440–442.

Related articles

There are no related articles.



Full text



There is no supplementary for this article.

Related articles

Click here to show related articles

Print information

Volume 45, Issue 9

DOI: 10.2340/16501977-1197

Pages: 906-910

View at PubMed