Ask the Expert: Dr. Brion Reichler, Neurologist, Answers Your Questions on Gait and Balance Disorders

Q1. I had back surgery three months ago by a decent back surgeon. After the surgery his policy is to “turn over” the case to the hospital and in this case a city hospital. I can’t go back there for real reasons and he won’t talk with me. I have had no rehabilitation yet. My general doctor wants me to have some sort of balance test in a week (following lights or something), why? What does that have to do with my lower back (nerve involvement). I am walking fairly well except for slight occasional pain.

I cannot tell from your description why your doctor wants to test you or what kind of test he has in mind. Pain is a common cause of altered gait, but if you are not having real balance issues, I do not see the utility. Perhaps he found something on examination that you are not aware of. I would inquire about the reason. A good doctor should be able to explain the rationale for any test.

Q2. Can a herniated disc cause balance problems?

A herniated disc can cause imbalance by two main mechanisms. One is weakness of the leg muscles, which could result from compression of the nerve roots (lumbar spine) or spinal cord (cervical or thoracic spine). Another common cause is spinal cord compression (cervical or thoracic spine), resulting in loss of sensation in the legs, especially joint position sense. In fact, imbalance, worse with visual deprivation, is one of the most common presentations of cervical cord compression – often in the absence of any neck symptoms.

Some general questions to ask yourself with balance problems:

– Do your feet feel solidly in contact with the ground, or does it feel as if you are walking on foam or sand?

– Is the imbalance worse in the dark or with your eyes closed (e.g., when washing your face in the shower)?

– Is there any weakness? Can you walk on your toes and heels? Do you trip over your toes?

– Is there any dizziness (i.e., a sense of movement, such as spinning or standing on a rocking boat)?

– Are there associated symptoms of spinal cord disease, such as urinary frequency/urgency, weakness/atrophy of the hands, or jumpiness of the legs?

Q3. I was in a car accident that caused a whiplash. Then I started to have balance problems. Can the two be related?

I am not aware of an association between whiplash and true balance problems. However, if you have developed cervical spinal cord compression as a result, this could be the earliest sign (see question #2). Dizziness is also sometimes reported after whiplash. It is certainly common after head trauma, both in a mild form and as a more severe positional vertigo. The former should be self-limited, while the latter sometimes requires a special non-invasive office procedure. Clearly, it pays to have a formal neurological evaluation.

Q4. I have lupus and sometimes experience symptoms of dizziness and ringing ears. When I try to move I become unbalanced. Is that common?

The vestibular system contributes to balance control by governing the body’s perception of its orientation in space and direction of movement. It consists of the inner ear and its connections to the balance centers of the brain. Vertigo or dizziness can result from disorders of both the brain (such as stroke, multiple sclerosis or trauma) and the inner ear, but more commonly the latter. Ringing in the ears, or tinnitus (which is not always a ringing – sometimes a humming or buzzing) often goes along with inner ear problems. Your symptoms are thus suggestive of an inner ear problem. As to the relationship of these symptoms to your lupus, that is less clear. Lupus patients often complain of a variety of non-specific symptoms of a neurologic nature that may have no correlation on physical examination or MRI – such as headache, dizziness and tingling in the limbs. One study reported a higher prevalence of audiovestibular dysfunction in the lupus population. However, the association remains poorly understood. Causes other than the lupus need to be ruled out, and you should see someone who specializes in dizziness, such as a neurologist or otolaryngologist – or even better, a neurotologist.

Q5. I have rheumatoid arthritis that causes peripheral neuropathy. Sometimes I trip over my toes. How would you treat my problem?

Peripheral neuropathy is not uncommon in patients with rheumatoid arthritis. One study reported a prevalence of almost 40%, most of whom were asymptomatic. This is generally a mild sensory neuropathy, which might be expected to cause numbness or tingling in the feet, and perhaps some related imbalance. The fact that you are tripping over your toes is a bit more worrisome, suggesting the possibility of weakness, which is less common. In addition to neuropathy, one needs to rule out cervical cord compression, which can be severe in the upper spine in RA patients. You must also consider the possibility of a medication-induced neuropathy, as has been suggested with the anti-TNF-alpha agents, such as infliximab, in which case treatment may consist of discontinuing the medication. Aside from this, there is no specific treatment for the neuropathy, other than treatment of the underlying condition. Intravenous immune globulin (IVIg) infusions have proven useful in isolated cases and small series of patients with peripheral neuropathy in association with other autoimmune conditions, but is far from being an established treatment. Consult with your physician for treatment options.

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Dr. Brion Reichler is a Neurologist at Hospital for Special Surgery. His chief clinical interests include neurological complications of spine disease, rheumatological conditions and sports-related injuries. Other interests include headache, dizziness and disorders of balance. He has three Board Certifications, including two in neurophysiology.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. Hello! I have been diagnosed with DDD,3 herniated discs, 3 bulging discs, and my L5-S1 is collapsed, fibromyalgia,MPS, two spinal syrinx’s, (not chairi),occipital neuralgia, and spinal stenosis. My questions are, about a month ago my left arm began to swell all the way to my fingers, any idea what can be causing this? Next my legs are weak, shaky, and will go out on me, and incontinence…..any ideas?

  2. I have herniated discs in my neck and get severe pain when I move my neck in any position. I have balance issues, I feel like I just got off of a host. I don’t get any headaches. It just feels like a vice tightening around my neck. I also have TMJ , I don’t know if that could also cause the imbalance ? I go to the chiropractor and get acupuncture. It helps alittke, but still a lot of pain and tightness in my neck. My neurologist us sending me for an MRI on my neck. If there anything else u could suggest, that may help? Thanks so much. Mary

  3. My name is Robert and I was in a work related accident where I fractured my neck in 10-23-14. Dr Frank Camissa did neck surgery on 6-4-16 I have been suffering with Vertigo and double vision all day everyday since the accident without relief. I have currently exhausted all my resources out here on Long Island. Please lead me in the right direction for proper Diagnosis and Treatment. Thank You so much.

    1. Hi Robert — Thanks for reaching out. In order to help you best, please try reaching out to our Patient Referral Service at 888-720-1982. They will be able to identify if there is an appropriate physician at HSS for you to consider. Best of luck!

  4. I have been riding road bikes for many years but recently I have started getting lower back pain. My bike is properly fitted to my riding style and height, weight and flexibility. Why am I getting lower back pain?

  5. Hi, I’m a rated disability veteran with the VA. I have been fighting the system for about 6 years on my L4/L5 bulging, herniated, and impenged nerve. Recently in the past several months I started having numbness on the tips of my index and thumb of the right hand. Than it started on the left and now it comes and goes with my entire left foot which started with the big toe, and my entire right fingers and thumbs are completely white, numb and ice cold. The VA tells me it is due to my L4/L5 disability and we are working on surgery but I have an outside physician telling me that its impossible to have the hand symptons with an L4/L5 condition and that I have a neck condition as well. I do not know how to address this or if the one can cause it all or if it is two seperate issues. I just know I have both sharp shooting pains down my left leg and also a lot of dull aching pain in my lower back. Can anyone help me?

    1. Hello, thank you for your inquiry. Sorry to hear that you are undergoing such a tremendous amount of pain. It is important to seek additional consultation from another physician so that they can take the appropriate measures to alleviate you pain. If you would like to schedule an appointment at HSS, please contact our Physician Referral Service at 800-796-0482 or request a referral at the following link to ensure that you’re matched with the correct specialist:

  6. Dear Doctor,

    Can you kindly advise me on the below problem about the care to be taken and about medications…

    From my MRI scan, the impressions found are ?

    1) Degenerative discovertebral changes

    2) Posterocentral disc protrusion at L3-L4
    causing thecal sac compression with narrowing of bilateral neural foramina.

    3) Disc extrusion at L4-L5 causing moderate canal compromise leading to compression of cauda equina and bilateral exiting nerve roots.

    4) Diffuse posterior disc bulge at L5-S1 causing thecal sac compression with mild narrowing of bilateral neural foramina.

    5) Disc desiccation seen at L4-L5 as T2 signal loss.

    1. Hi Radha, it would be best for you to seek an in-person consultation with a physician so that they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  7. I had a episode of swirling and couldn’t see out of my right eye, it came with a headache, tingling hand and tongue couldn’t eat. Now I have off and on head pain and dizziness id like to know if it’ll go away

    1. Hi Jessica, thank you for your note. We advise that you consult with your treating physician, who is more familiar with your medical history. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  8. I have questions about 2 MRI reports. The 1st was done in 2006 which reads there is moderate central disc hernia toon at L5-S1 impinging on both neural foramina & the central canal. There is a small left-sided disc buldge at L4-L5. The MRI report from 9/2014 reads Posterior bulging disc at L3-L4 without significant compromise of the cord or canal. Posterior bulging disc at L4-L5 eccentric to the right but it does appear to compromise both lateral nerve roots.
    My questions are does this mean I have another disc damaged compared to the 2006 report? And did the disc herniation at L5-S1 just simply go away? I’ve had a burning sensation & what felt like my feet being crushed about 2mths. Would the lateral nerve roots being compromised cause this?

    1. Hi Jennifer, thank you for reaching out. Dr. Han Jo Kim, Orthopedic Spine Surgeon, says: “Truthfully, it is difficult to say without seeing the images. The radiology reports are helpful, but spine surgeons make decisions based on their own read and the physical exam and clinical presentation.” It is best that you seek consultation with a physician that is familiar with your medical history so that they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  9. I have made a surgery before a month in L5 S1 because there was a degenerative right paracentral disc protrusion compressing the interior epidural fat and right nerve root at S1 level. I thought the pain will disappear completely . During these days I started to feel a pain around my knee in the right leg and a great pain starting from the upper part of my left leg down to the knee and I feel something like an electric shock in the ankle… just to add before the surgery the Lumbar Spine MRI showed?

    Please explain to me what is happening … am I going to have anothervsurge

    1. Hi Ruba, thank you for reaching out. It is best for you to consult in-person with a physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  10. Hi,

    I had cervical disc fashion. The doctor said I was to have two herniated discs fused and have hardware put in. For some reason he only did one. This surgery was on 7/16/2014. I’m still recuperating. I can’t turn my neck to either side yet without pain. Well lately I have been noticing I am loosing my balance. Not dizzy, just feel like I’m going to fall over.I have to grab onto something so as not to fall.Do you think this might have to do with my surgery? I still have pain that goes down my right arm, my thumb and couple fingers go numb. Before this operation, I had a rotator cuff surgery. But when I was still not able to lift my left arm and did all the therapy, and went to pain management had 2 sets of shots in my spine for my neck. I finally was sent to the neck surgeon.he said I only had 2 choices since I underwent everything else. I was to stay in pain the other was neck surgery. So of course I chose surgery. I also still cannot lift my left arm up without pain and my arm shaking. Also before my neck surgery I was sent for a 2nd opinion. He reported I needed the neck surgery. He also stated the MRI from my left shoulder was normal, this was taken before I hat the rotator cuff surgery. Please let me know what you think about my unsteadiness.

    1. Hi JoAnn, thank you for reaching out. It would be best for you to consult with your treating physician so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  11. Hi I had a CT scan that showed enlarged ventricles or a cyst in the brain spinal stenosis bulging discs in the lumbar area I was wondering if I can have trouble walking and with balance because of the bulging discs?

    1. Hi Liliana, thank you for reaching out. Dr. Frank Cammisa, Orthopedic Spine Surgeon, says: ?The bulging discs resulting in lumbar spinal stenosis (narrowing of the spinal canal putting pressure on the nerve roots) can result in difficulties with walking and with balance. However, the presence of enlarged ventricles in the brain can result in what is termed possibly normal pressure hydrocephalus which can also result in difficulties with walking and balance. A consultation and evaluation should be done by a specialist in neurology to determine the etiology of your difficulties with walking and balance.? If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  12. Hi, the last 3 weeks I have been in pain on my left foot ( 2nd toe swollen) where the pain has traveled to my whole side up my leg to breast by my ribs. Everyday I feel numb with pins and needles?
    Went to doctor twice – no luck only received mess for inflammation and recommended me to see foot doctor?
    Took x-ray – no broken bones but swelling was seen.
    What”s cause epilepsy, thyroid or cholesterol medications – side effects?

    1. Hi Christine, thanks for reaching out. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  13. Hi, I”m in high school and about to go into my JR. year in high school and I”m having a problem getting everything together. I”ve been dreaming to become a neurologist since I was 2 years old. I take all honors classes and make really good grades. I just want to know is their anything someone can tell me more about what it takes to become my dream job.

  14. Hi, my question is- can you have dizziness & balance problems with C2 & C3 herniated disc? I notice on my walks if I move to fast or turn head things spin & sometimes go dark for a second. I have a appointment with neurosurgeon on 16th. I’ve already had surgery in 2008 on C3 &C4. Thank you for your input & time.

    1. Hi Pamela, thank you for reaching out. Dr. Han Jo Kim, Orthopedic Surgeon, says: ?It is possible that your symptoms can be coming from the C2 and C3 levels. It might also be worthwhile to rule out the vertigo. Following up with a spine surgeon will be best for addressing your concerns. Be sure to bring detailed imaging to the visit- this will allow for a more thorough evaluation.? It is best for you to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  15. My sister is going through her second bout of PAINFUL sciatica. 2 years ago it lasted almost a year,,,,,,It has returned and she is taking medication and having massages. Results are nil. Last year she even tried acupuncture. The massages seem to eventually alleviate the pain last year. My heart is breaking watching her in constant pain. once again. She says it is actually worse then the prior ‘attack’. What type of Dr. should she be seeing? ,,,,a Neurologist? Could you suggest one at HSS? I appreciate your time and consideration to this matter. Regards, Karen

  16. hi sir My mri says. L4-5 there is a postererior disc/ annular tear and posterior shallow disk bulge slightly contacting theanterior surface of thethecal sac and junctiuon of the proximal left L5 nerve root. both my feet in lots of pain, right upper in side leg ,even the palms of my hand,tingling. 3 moths al my doc has given me is hydrocodone 325mg. please what kind of doctor am I need to see. pills are not helping to fix me ? thank you again for your time

    1. Hi Robert, thank you for reaching out. It is recommended that you see a physiatrist so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  17. Have scolosis taken me to many epidural injections lumbar and neck…how may is too many? Now heading it to HSS neurologist–as losing balance, a bit of tingling. What will a neurologist tell me that ur injection folks have not? What do u do that is different? Done carpal tunnel with no findings…have a consultation, but pls hope to walk out with a plan to tackle? –.been a long few months back and forth at HSS as not easy getting appointments…thank you.

  18. i have suffered from vertigo an spinal inflammation an headaches an vision an gait problems for 12 yrs. i am post menapausal , an i have severe sleep deprivation from menapausal symptoms night sweats ect. but i was diagnosed with somatoform . not somatization disorder . this is a mental problem . dont drs. understand hormones yet. i am having a hard time due to severe sensitivities to medications an hormone therapy. why do drs. call this a mental disorder. . i have same symptoms for 12 yrs. i know sleep deprivation can cause multiple symptoms. there is 40 known menapausal symptoms not all the same time .can u answer this an get back to me on your thoughts. thanks…….i am so stressed with this .

    1. Hi Karen, thank you for your comment. If you would like to see a physician at HSS, please contact our Physician Referral Services at 877-606-1555.

      1. still experiencing the same symptoms as in 2013 . it never ends. inflammation in spine same stuff off balance, will this ever end. post menopause 3 yrs now .

  19. I””ve got tinnitus and it has been really upsetting me over the last few weeks, I lie awake at night, I””m irritable and keep getting angry with my kids. I found a online group which has a couple of useful tips.

  20. my mom has suffering (SCI) or granlouma or milgnency because she is bed ridden and cant able to walk and move properly her legs due to spinal cord compression, in M.R.I they showed that D4 is totally collapse due to unknown reason, they suggested C.T Guided biopsy but this procedure has been failed due to lots of risk factors, now they started A.T.T so that granlouma can cure, all the investigation are not showing milgenency and tuberculosis, but something is here kindly give me suggestion what to do? i want u to give me advice to cure without surgery. thanks regards Babar Ali from Pakistan

  21. Hello and thank you. I hope you can help me. My name is Stephen and I am concerned about my wife Victoria.

    In January 2012, my wife fell walking up a stairs and fractured her right fifth metacarpal – nondisplaced. She also landed on her back and neck. She went to the hospital, got a splint and some percocet. A couple of weeks later she felt numbness in both hands, with her right hand still feeling weird (from the pain, I guess). Her orthopaedic doctor who changed the splint initially said it was just hormones. The numbness in both hands continued. We went to a number of other doctors, surgeons and a neurologist shortly after.

    The neurologists report states the following:
    Electromyography Impression:
    Subacute bilateral cervical radiculopathies affecting the left C6 root as well as the bilateral posterior root innervated paraspinals. No active denervating potentials are demonstrated.
    IMPRESSION from 112012 Trauma
    1. .Cervical strain with referred sensory loss to the bilateral hands

    The MRI report states the following:
    – Posterior disk bulges. C5-C6 (2 mm) and C6-C7 (1-2 mm) levels.

    Except for saying cervical strain and radiculopathies, the neurologist does not say why the numbness is there. The neurologist said that he would not recommend any procedures as there is no pain.
    One spine surgeon (nationally recognized) states that the dermatones do not match up as the numbness should travel down the arms as well as the hands. He said the two disk bulges would not be enough to cover the whole of the hands (C8 bulge would also be needed apparently). He said he would not perform any surgeries or procedures.
    Another spine surgeon said he would try an epidural injection in an attempt to reduce the numbness (it didn’t sound convincing).
    Another doctor has put forward the idea that it is due to Conversion Disorder.
    A hand specialist has confirmed no carpal tunnel syndrome is present.

    The questions I have are these:
    1. Are the bulges enough to cause numbness in both hands?
    2. If the damage to the nervous system is as stated, is it possible that the numbness could start only from the wrists down on both hands, with no symptoms up the arms?
    3. If the bulges are “released” by an epidural injection is there a possibility the nerves can be repaired, and the sensation come back?
    5. What are your thoughts on the potential cause(s)?

    Thank you very much for your time. I appreciate the time and any help you can give.


  22. Hi in recent years I feel like balance disorder, feel like dizzy and blurred vision, sometime loss sense, doctor told this is because of anxiety disorder(GAD),

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