Traumatic Brain Injuries and Posture: Why Balance Changes, What Abnormal Posturing Means, and How Integrative Chiropractic Care Can Help

 

Key takeaways

• Mild TBIs can cause lasting changes in balance and postural control by disrupting the visual, vestibular (inner ear), and proprioceptive (body position) systems. (Brain Injury Canada, n.d.; BIAA, n.d.) Brain Injury Canada+1

• Severe TBIs may trigger abnormal posturing—decorticate (arms flexed, legs extended) or decerebrate (arms and legs extended)—a medical emergency. (Cleveland Clinic, 2023; Mount Sinai, n.d.; UF Health, n.d.) UF Health+3Cleveland Clinic+3Mount Sinai Health System+3

• Neck and upper-back (cervical) injuries often accompany TBIs, contributing to headaches, dizziness, and poor alignment; treating the cervical spine can improve symptoms. (Morin et al., 2016; King et al., 2019; Coffeng et al., 2020) PMC+2PMC+2

• Integrative chiropractic care, including spinal adjustments, soft-tissue therapy, graded vestibular-ocular drills, and movement retraining, can support recovery when coordinated with medical care. (Mucha et al., 2014; HML Functional Care, n.d.; Dr. Jimenez, 2025) PMC+2HML Functional Care+2

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How TBIs change posture—mild to severe

Mild TBI: subtle but stubborn balance problems

After a concussion (mild TBI), many people look “normal” but still feel unsteady, dizzy, or off-balance, especially with fast turns, busy visuals (like a grocery aisle), or sports. These issues arise because the brain must blend information from vision, the vestibular system (inner ears), and proprioception (joint/skin feedback). A concussion can disrupt one or more of these inputs or the brain networks that integrate them, producing postural-control deficits that can persist for weeks to months—and in some, longer. (Brain Injury Canada, n.d.; Buckley et al., 2016; Sosnoff et al., 2011) Brain Injury Canada+2PMC+2

Common signs include:

• Swaying with eyes closed or on foam, tandem stance difficulty

• Head turns or busy environments can cause dizziness

• Headaches or neck pain after screen time or reading

Research shows that postural control remains altered after concussion, and quiet-stance and walking measures can detect lingering impairment. (Buckley et al., 2016; Sosnoff et al., 2011) PMC+1

Severe TBI: abnormal posturing is an emergency

With severe brain injury, the brain’s control centers can be so disrupted that the body assumes rigid, involuntary positions:

• Decorticate posturing: arms flexed toward the chest, legs extended and rigid.

• Decerebrate posturing: all limbs extended, often more serious.

Either posture in an unconscious, unresponsive person demands immediate emergency care. (Cleveland Clinic, 2023; Mount Sinai, n.d.; UF Health, n.d.; Flint Rehab, n.d.) Flint Rehab+4Cleveland Clinic+4Mount Sinai Health System+4

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Why posture suffers after TBI: the three-system model (plus the neck)

Your body stays upright by fusing signals from:

1. Eyes (vision) for orientation,

2. The vestibular system for head movement and spatial awareness, and

3. Proprioception from skin, muscles, and joints.

A mild TBI can disrupt any of these inputs or the brain networks that integrate them, leading to gait instability, sway, and poor dynamic posture—especially in dual-task situations (such as walking and thinking) or those involving visually complex environments. (Brain Injury Canada, n.d.; BIAA, n.d.) Brain Injury Canada+1

The often-missed link: the cervical spine

Many concussions include whiplash-type forces. Injury to the upper cervical spine can cause neck pain, cervicogenic headaches, dizziness, and impaired head-on-body awareness—all of which degrade balance. Studies show cervical musculoskeletal and sensorimotor impairments can persist after concussion, even when other symptoms fade. Early acute neck pain predicts more persistent post-concussion complaints. (Morin et al., 2016; Coffeng et al., 2020; Galea et al., 2022; Treleaven, 1994) PubMed+3PMC+3BioMed Central+3

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Abnormal posturing (decorticate vs decerebrate): what to know

• Decorticate: arms flexed, wrists/fingers flexed, legs extended, toes pointed—often indicates damage affecting the cerebral cortex, thalamus, or upper midbrain. (Cleveland Clinic, 2023) Cleveland Clinic

• Decerebrate: arms and legs extended, wrists pronated, jaw clenched—often suggests damage lower in the brainstem and may signal a more serious injury. (Mount Sinai, n.d.; UF Health, n.d.) Mount Sinai Health System+1

• Action step: If someone is unconscious and exhibits either of these postures, call emergency services immediately. (Cleveland Clinic, 2023; Mount Sinai, n.d.; UF Health, n.d.) UF Health+3Cleveland Clinic+3Mount Sinai Health System+3

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Symptoms that connect TBI, posture, and the neck

• Headaches that worsen with upright time or screen use

• Dizziness, lightheadedness, motion sensitivity

• Neck pain, stiffness, “heavy head”

• Visual strain, difficulty focusing, or reading intolerance

• Unsteady gait, knee/hip “drift,” poor single-leg balance

These symptoms often reflect a combined brain–vestibular–cervical problem. Recognizing all three speeds of recovery. (Morin et al., 2016; King et al., 2019; Brain Injury Canada, n.d.) PMC+2PMC+2

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How clinicians evaluate posture after TBI (simplest → most advanced)

Screening & bedside tests (simple, office-based)

• Symptom checklists and history (headache, dizziness, neck pain, visual strain).

• Orthostatic vitals, ocular range of motion, Romberg, tandem stance, and single-leg stance.

• BESS / M-BESS (Balance Error Scoring System): quick static balance scoring; inexpensive and often used post-concussion. (Bell et al., 2011; Atrium Health BESS manual; NCAA BESS manual) PMC+2Atrium Health+2

• VOMS (Vestibular/Ocular Motor Screening): checks smooth pursuits, saccades, convergence, VOR, visual motion sensitivity; sensitive to concussion-related vestibular/oculomotor issues. (Mucha et al., 2014; Health.mil, 2020) PMC+1

Functional measures (moderate)

• Gait analysis (tandem gait, head turns while walking, dual-task walking).

• Instrumented balance (wearables/accelerometers) and computerized posturography for sway profiles. (BESS literature overview) Archives PMR

Specialized vestibular/ocular testing (advanced)

• Videonystagmography (VNG), video head-impulse testing (vHIT), caloric testing, dynamic visual acuity, optokinetic stimulation—to map vestibular deficits driving postural problems. (VOMS literature and military guidance, as part of comprehensive vestibular work-ups) PMC+1

Imaging & neurodiagnostics (as indicated)

• CT (acute bleeding or skull fracture suspicion);

• MRI (structural injury); advanced MRI (e.g., DTI) for white-matter changes in select cases;

• Cervical imaging is performed when red flags or focal deficits suggest the presence of neck pathology. (Clinical standards implied across concussion guidelines; see Buckley et al., 2016, for lingering deficits prompting further work-up.) PMC

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Chiropractic integrative care: a coordinated plan for posture and brain–neck recovery

Important: Chiropractic care is not a replacement for emergency medicine or needed neurological care. It can play a supportive role in a coordinated, interdisciplinary plan, especially in mild TBI or the post-acute phase, when serious issues have been ruled out and the goals are focused on posture, balance, and symptom relief. (Mucha et al., 2014; Brain Injury Canada, n.d.) PMC+1

Core elements

1. Thorough triage and safety screen

   • Rule out red flags (worsening neuro signs, severe headache, repeated vomiting, new weakness, abnormal posturing). Coordinate imaging or neuro referrals when indicated. (Cleveland Clinic; Mount Sinai; UF Health) UF Health+3Cleveland Clinic+3Mount Sinai Health System+3

2. Cervical spine care for alignment and sensorimotor control

   • Gentle, targeted spinal adjustments or mobilization (as appropriate), plus soft-tissue therapy to reduce nociceptive drive and restore segmental motion.

   • Cervical proprioceptive retraining: laser-pointer head-repositioning drills, deep neck flexor endurance, scapular control. These methods aim to improve head–neck awareness, alleviate headaches and dizziness, and stabilize posture. Evidence supports persistent cervical sensorimotor deficits after mTBI that benefit from focused care. (Morin et al., 2016; Galea et al., 2022) PMC+1

3. Vestibular/ocular rehabilitation and graded exposure

   • Based on VOMS and functional testing: smooth pursuit and saccade drills, vestibulo-ocular reflex (VOR x1/x2), gaze stability, convergence training, and visual motion sensitivity desensitization. These aim to reduce dizziness and improve gaze–posture coupling. (Mucha et al., 2014; Health.mil, 2020) PMC+1

4. Movement therapy for dynamic posture

   • Progressive balance (narrow base, foam, head turns), gait with head motion, core/hip/ankle control, and dual-task drills to restore real-world postural control. (Ustinova et al., 2014; Brain Injury Canada, n.d.) ResearchGate+1

5. Lifestyle & recovery support

   • Sleep, hydration, graded activity, and nutrition to lower neuro-inflammation and support healing. (Pinnacle Health Chiro, n.d.; HML Functional Care, n.d.) pinnaclehealthchiro.com+1

Potential mechanisms for improvement

• Reducing painful cervical input can decrease sensory conflict, thereby lowering dizziness/headaches, and allowing for better multisensory integration for improved posture. (Morin et al., 2016; Coffeng et al., 2020) PMC+1

• Restoring segmental mobility and proprioception may help recalibrate head–neck–eye coordination, which is critical for balance. (Galea et al., 2022; Treleaven, 1994) PubMed+1

• Graded vestibular/ocular drills improve gaze stability, reducing symptom provocation during movement and enabling safer posture control. (Mucha et al., 2014) PMC

Note: Some clinics and authors also propose that improved spinal mechanics may enhance blood flow and cerebrospinal fluid dynamics; these ideas are hypothesized in clinical blogs and require more high-quality research. They can be considered as adjunct concepts alongside established vestibular/cervical rehabilitation. (Northwest Florida Physicians Group, n.d.) northwestfloridaphysiciansgroup.com

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Dr. Alexander Jimenez’s dual-scope perspective (DC, APRN, FNP-BC)

In El Paso, Dr. Alexander Jimenez practices a dual-scope, integrative model that combines family practice nurse practitioner training with chiropractic care. His published materials emphasize:

• Gentle spinal and postural care to reduce nervous-system load,

• Targeted movement retraining for balance and gait,

• Vestibular/ocular drills when indicated,

• Team-based care with imaging and referrals for red flags. (Jimenez, 2025; Jimenez, 2025b) El Paso, TX Doctor Of Chiropractic+1

His pages also highlight how dynamic posture relies on good alignment and coordinated sensorimotor control, which is especially relevant after TBI. (Jimenez, 2025c) El Paso, TX Doctor Of Chiropractic
Professional background and credentials appear on LinkedIn and clinic pages. (Jimenez, 2025d; A4M profile) LinkedIn+1

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A practical, step-by-step recovery roadmap

Step 1 — Medical safety first

• Worsening neuro signs, abnormal posturing, severe headache, repeated vomiting, new weakness, or seizures → urgent emergency care. (Cleveland Clinic; Mount Sinai; UF Health) Cleveland Clinic+2Mount Sinai Health System+2

Step 2 — Comprehensive evaluation

• History: injury details, neck symptoms, triggers.

• Screen: BESS/M-BESS, VOMS, tandem gait, head-turn walking. (Bell et al., 2011; Mucha et al., 2014) PMC+1

• Neck exam: joint motion, deep neck flexor endurance, sensorimotor tests. (Galea et al., 2022) PubMed

Step 3 — Build your plan (typical clinic approach)

• Cervical care (gentle mobilization/adjustments as appropriate), soft-tissue work.

• Vestibular/ocular rehab (gaze stability, pursuits, saccades, convergence).

• Movement retraining (balance progressions, dual-task walking, core/hip/ankle control).

• Education (activity pacing, sleep, nutrition). (Mucha et al., 2014; Ustinova et al., 2014; Jimenez, 2025b) PMC+2ResearchGate+2

Step 4 — Progress with metrics

• Track BESS/M-BESS, VOMS symptom scores, tandem gait time, head-turn walking tolerance, return-to-work/sport milestones. (Bell et al., 2011; Mucha et al., 2014) PMC+1

Step 5 — Maintain

• Keep posture drills, neck proprioception, and periodic tune-ups to prevent relapse—especially if you work at a desk or drive long hours. (Jimenez, 2025c) El Paso, TX Doctor Of Chiropractic

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FAQs

Q: Can posture improve even months after a concussion?
A: Often yes. Studies show lingering deficits in postural control can be identified and treated with targeted rehab. (Buckley et al., 2016; Sosnoff et al., 2011) PMC+1

Q: Why do screens or grocery stores make dizziness worse?
A: Busy visuals challenge visual–vestibular integration; after concussion, the brain may over-rely on vision and under-use other systems, upsetting posture. Graded visual motion exposure and VOR training help. (Mucha et al., 2014; Health.mil, 2020) PMC+1

Q: Is chiropractic safe after TBI?
A: With proper screening, gentle, individually tailored care—including mobilization or adjustments as appropriate, soft-tissue work, and vestibular/ocular and movement therapies—can complement medical management. Red flags require medical referral. (Mucha et al., 2014; Jimenez, 2025b) PMC+1

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References

• Bell, D. R., Guskiewicz, K. M., Clark, M. A., & Padua, D. A. (2011). Systematic review of the Balance Error Scoring System (BESS). Journal of Athletic Training. https://pmc.ncbi.nlm.nih.gov/articles/PMC3445164/ PMC

• Brain Injury Association of America. (n.d.). Factors associated with sitting and standing balance. https://biausa.org/professionals/research/tbi-model-systems/factors-associated-with-sitting-and-standing-balance Brain Injury Association of America

• Brain Injury Canada. (n.d.). Mobility. https://braininjurycanada.ca/en/effects-brain-injury/physical/mobility/ Brain Injury Canada

• Buckley, T. A., et al. (2016). Postural control deficits identify lingering post-concussion impairments. Clinical Journal of Sport Medicine (summary). https://pmc.ncbi.nlm.nih.gov/articles/PMC6191989/ PMC

• Cleveland Clinic. (2023). Decorticate posturing. https://my.clevelandclinic.org/health/symptoms/24969-decorticate-posturing Cleveland Clinic

• Coffeng, S. M., et al. (2020). Patients with mild traumatic brain injury and acute neck pain… BMC Neurology. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-01887-x BioMed Central

• Flint Rehab. (n.d.). Posturing after brain injury explained: Decerebrate vs decorticate. https://www.flintrehab.com/posturing-brain-injury/ Flint Rehab

• Galea, O., et al. (2022). Cervical musculoskeletal and sensorimotor impairments post-mTBI. Musculoskeletal Science and Practice. https://pubmed.ncbi.nlm.nih.gov/34847469/ PubMed

• Health.mil. (2020). Vestibular/Ocular Motor Screening (VOMS). https://health.mil/Reference-Center/Publications/2020/07/31/Vestibular-Ocular-Motor-Screening-VOMS Health.mil

• HML Functional Care. (n.d.). How chiropractic neurology supports brain healing. https://hmlfunctionalcare.com/how-chiropractic-neurology-supports-brain-healing/ HML Functional Care

• Jimenez, A. (2025a). Traumatic brain injury: Understanding the long-term effects. https://dralexjimenez.com/traumatic-brain-injury-understanding-the-long-term-effects/ El Paso, TX Doctor Of Chiropractic

• Jimenez, A. (2025b). Finding hidden TBI symptoms: Signs you might miss. https://dralexjimenez.com/finding-hidden-tbi-symptoms-signs-you-might-miss/ El Paso, TX Doctor Of Chiropractic

• Jimenez, A. (2025c). Dynamic posture for real life: Move better, hurt less. https://dralexjimenez.com/dynamic-posture-for-real-life-move-better-hurt-less/ El Paso, TX Doctor Of Chiropractic

• Jimenez, A. (LinkedIn profile). (n.d.). https://www.linkedin.com/in/dralexjimenez LinkedIn

• King, J. A., et al. (2019). Frequency of primary neck pain in mTBI. PM&R. https://pmc.ncbi.nlm.nih.gov/articles/PMC6930963/ PMC

• Morin, M., et al. (2016). Cervical spine involvement in mild traumatic brain injury. The Open Neurology Journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC4977400/ PMC

• Mount Sinai. (n.d.). Decorticate posture information. https://www.mountsinai.org/health-library/symptoms/decorticate-posture Mount Sinai Health System

• Mount Sinai. (n.d.). Decerebrate posture information. https://www.mountsinai.org/health-library/symptoms/decerebrate-posture Mount Sinai Health System

• Mucha, A., Collins, M. W., et al. (2014). A brief Vestibular/Ocular Motor Screening (VOMS) assessment… American Journal of Sports Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC4209316/ PMC

• Northwest Florida Physicians Group. (n.d.). Using chiropractic care to treat traumatic brain injuries. https://northwestfloridaphysiciansgroup.com/using-chiropractic-care-to-treat-traumatic-brain-injuries/ northwestfloridaphysiciansgroup.com

• Pinnacle Health Chiropractic. (n.d.). Six ways chiropractic care supports healing after TBI. https://www.pinnaclehealthchiro.com/blog/six-ways-chiropractic-care-supports-healing-after-tbi pinnaclehealthchiro.com

• Sosnoff, J. J., et al. (2011). Previous mTBI and postural-control deficits. Journal of Athletic Training (review on PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC3017494/ PMC

• UF Health. (n.d.). Decerebrate posture. https://ufhealth.org/conditions-and-treatments/decerebrate-posture UF Health

• Ustinova, K. I., et al. (2014). Physical therapy for correcting postural and coordination deficits in mild-to-moderate TBI. Physiotherapy Theory and Practice (ResearchGate abstract). https://www.researchgate.net/publication/264429455_Physical_therapy_for_correcting_postural_and_coordination_deficits_in_patients_with_mild-to-moderate_traumatic_brain_injury ResearchGate

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General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed to practice. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and to identify relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.

We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. To discuss the subject matter above further, please contact Dr. Alex Jimenez or us at 915-50-0900.

Dr. Alex Jimenez, DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

Email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*