The Concussive Geode: When Recurrent BPPV Creates Sensory Mismatch
In the aftermath of a concussion, most people expect a linear recovery. However, many find themselves stuck in a frustrating cycle of dizziness and instability that persists long after the initial impact. If you feel like you are floating, constantly off-balance, or overwhelmed in busy environments, the issue may be a persistent mechanical failure within your inner ear and a resulting sensory mismatch in your brain.
The Mechanical Reality: A Fragile Sensor
Deep inside your ear sit the otolith organs—your body’s primary tilt sensors. They contain microscopic crystals called otoconia that sit atop a sensory bed. Their job is to tell your brain exactly where you are in relation to gravity.
During a concussion, the force of the impact can damage this sensory bed. I often use the analogy of a ‘cracked geode’ or a ‘cracked eggshell.’ The sensor's structural integrity is compromised, causing debris particles to intermittently dislodge and fall into the semicircular canals.
This leads to the spinning sensation known as BPPV. In post-concussion cases, this is often not a one-time event. Until the sensor bed stabilizes and debris stops falling off, the system remains unpredictable.
Maladaptive Sensory Strategies
When your inner ears provide inconsistent or ‘noisy’ data, your brain must find a different way to keep you upright. To survive, it often adopts a maladaptive sensory strategy:
Visual Dependency: Your brain starts to ‘up-regulate’ your vision. It begins to over-depend on your eyes for stability. While vision is great for seeing where you are going, it is a poor primary stabilizer.
Surface Dependency: Your brain also becomes hyper-focused on your sense of touch. You might feel the need to touch walls or walk with extreme caution. Your brain has converted the floor into a radar system rather than a silent, trusted stabilizer.
This creates a VVM (Visual Vestibular Mismatch). Your eyes, your feet, and your damaged inner ears are all sending conflicting reports. This mismatch is the root of the ‘off’ feeling that lingers even when you aren’t spinning.
The Path Forward: Disrupting the Mismatch
To support a true recovery, we must retrain how the brain processes this information. This isn’t just about getting used to the dizziness; it’s about changing the strategy your brain uses to stay balanced.
We do this by intentionally inducing visual conflict. Using tools such as optokinetic goggles isn’t intended to simply desensitize you to the movement. Instead, we use visual conflict to create a top-down disruption of your visual system.
When vision is eliminated or impaired, the brain must stop relying on that visual crutch. This disruption facilitates and encourages healthy somatosensory and vestibular integration. Essentially, by taking the eyes ‘offline’ through conflict, we pressure the brain to rely on the otolith organs and trust the body’s sense of touch once again.
What You Can Do
If you are going through this, know that you are not alone. This process coordinates your internal sensors and helps you regain a reliable internal plumb line. Recovery involves:
Strategic Provocation: Performing weight-shifting and stepping exercises in various head positions.
Intentional Conflict: Practicing movements while your vision is disrupted to ‘force’ the inner ear and surface sensors to take the lead.
Consistency: Moving through the discomfort to show your brain that it can—and must—rely on its other stabilizers.
We want to hear from you. If you have been dealing with these symptoms after a head injury, what has your experience been like? How has this sensory mismatch changed your daily life? Tell us more about what you are going through, and let’s discuss how we can help.