Why Neck Pain May Cause You to Fall Over

Neck pain is a common problem for at least 30-50% of the population at some point in their lives.  Neck pain, however, isn’t the only problem that some people may encounter.  Some people suffering from neck pain may also experience the bizarre phenomenon of feeling off balance or even falling over in association with their neck pain.  Why is this?

If you are experiencing these added symptoms (and more – e.g. dizziness, problems with vision etc.), you would quite understandably be concerned that something more sinister might be at play. To rule this out, I highly recommend that you go see your doctor for further tests.  This is especially important if you’ve recently been in any falls, car accidents, suffer from rheumatoid arthritis or any other systemic illness or cancer (to name just a few things that may contribute to structural weakness in the neck area – there are more things that can, but discussing this is not the point of this article).

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Once you have been cleared of anything sinister, the question to ask is, why are you stumbling around, losing your balance or even falling over like a drunk person?

" Schematic of mammalian muscle spindle" by Neuromechanics under Licence in the Public Domain

” Schematic of mammalian muscle spindle” by Neuromechanics under Licence in the Public Domain

There is a structure called a muscle spindle that is a key element in this phenomenon, which is found in an incredibly high density in the upper region of the neck (200 muscle spindles per gram of muscle in this area).  It is also found in other parts of the body, but not in quite the high proportion that it occurs in the upper region of the neck (for example, there are only 16 muscle spindles per gram of muscle in the pincer muscle of the thumb).

The importance and function of the muscle spindle is that it detects changes in the length of the muscle fiber.  This in turn helps the body part associated with those specific muscle spindles, to determine where it’s positioned in space.  It also helps to set the resting tone (the resting degree of muscle contraction) of the muscle concerned as well as playing a protective function for the muscle.  The protective function occurs through the feedback the muscle spindle provides when the muscle is overstretched, resulting in immediate contraction of the muscle to prevent overstretching and injury.

In the upper region of the neck, these muscle spindles play an enormous role in the postural control of your whole body and your overall ability to balance through their function in association with other systems found in the inner ear, eyes and central nervous system.

Something that we as therapists know, is that the whole body follows the head.  In other words, if your head turns right, your body will follow and also lean towards that direction.  Think about when you’re driving the car and you turn to look at something in the road, if you’re not careful, before you know it, your car too has veered off in that direction.   This is all due to these muscle spindles in the upper region of the neck and their complex interaction with your other balance and positioning sensing systems in your inner ear, your eyes and your central nervous system.

I will always remember a knee patient I was rehabilitating years ago following his ACL surgery.  He was absolutely useless at any balance exercise and made very poor progress despite practice.  When I finally made him stand up straight to check his standing posture, I discovered that his resting position for his neck was tilted slightly to one side.  To him, this felt absolutely normal and upright!  Once I had corrected this so that he could sustain a proper upright standing posture, he found any balance exercises a whole lot easier and his rehabilitation, especially the balance and control elements, improved rapidly from there on out.  This again illustrates the importance of these muscle spindles in the upper neck muscles!

So, one of the reasons your neck pain may be causing you to stumble, lose your balance or even fall over, is that you may have some malfunction of these upper neck muscle spindle fibers and their interaction with the associated balance and positioning sensing systems of your inner ear, eyes and central nervous system.

This can be due to a few things:

  1. Damage of the muscle spindles, possibly as a result of a whiplash accident (where overstretching of the muscle may have occurred without your ability to have prevented it).
  2. Inhibition and fatigue of the upper neck muscles and their muscle spindle fibers as a result of your neck pain itself.
  3. Atrophy of the upper neck muscles resulting in less muscle spindles.
  4. Degenerative changes in the upper neck muscles such as fatty deposits in the muscle, or changes in the muscle where muscle tissue becomes a more fibrous tissue with less muscle spindles.
  5. Lastly, the effect of pain can also change the sensitivity setting of the muscle spindle fibers, making them fire more or less easily.  This in turn will change your postural control and balance so that you would over or undershoot a balance related movement.

What can you do about it? Your OMT specialised Physiotherapist has a number of techniques to assist you.  If you click on the link, you can find someone close to you to help.


Guzman J., H. E.-J. (2008). A new conceptual model of neck pain linking onset, course and care: The bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine, 33(4S), S14-S23.

Guzman J., H. S.-J. (2009, February). Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Journal of Manipulative and Physiological Therapeutics, 32(2S), S227-S243.

J. Treleaven. (2008).  Masterclass: Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.  Manual Therapy, 13, 2–11.

D. Falla. (2004).  Masterclass: Unravelling the complexity of muscle impairment in chronic neck pain. Manual Therapy, 9, 125–133.

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