Chiropractic is uniquely positioned to treat people with vertigo problems. One of the most important Medical Doctors in the field of vertigo said “It is important to stress that a cervical factor may be present in all forms of vertigo and dizziness … in no field is manipulation more effective than in the treatment of disturbances of equilibrium“[1]. Chiropractors examine and treat necks with a variety of techniques including manipulation and techniques aimed at the muscles, ligaments, tendons and fascia of the area.
Types
There are a few types of vertigo
- benign paroxysmal positional vertigo – the most common, typically short (30-40 second) attacks
- central vertigo – the cause is coming from problems in the cetral nervous system rather than the inner ear. Acoustic neuromas and Multiple Sclerosis are two of the more common reasons
- migrainous vertigo – vertigo as a symptom or related to migraines
- Postural & Cervical Vertigo – related to head positions and movement
Tests
There are a few orthopaedic tests that can help in the diagnosis and treatment of Vertigo.
- Hautant’s test
- Barany maneuver/Dix–Hallpike
- Rotating stool test
Treatments
Given the connection between vertigo and the bones of the neck (and cranium and jaw) manipulation when appropriate can produce remarkable results. The McTimoney Chiropractic Technique and Activator Chiropractic techniques both have specific techniques for dealing with vertigo. Alongside this there is trigger point and soft tissue work that can sometimes also make a difference. The effects can also have dramatic impact on Tinnitus.
As well as the Chiropractic treatments there are a couple of manoeuvres that if my patients haven’t already tried and they are appropriate, I like to incorporate into my treatments. They are the Epley manoeuvre(also known as canalith repositioning procedure) that uses gravity to move the calcium build up- there is a you tube video of someone demonstrating it here.
The semont maneuver is another similar exercise although the evidence is not as good regarding resolving vertigo and as such I rarely perform it.
Chiropractic Research
Sixty Patients With Chronic Vertigo Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation: A Retrospective Analysis
Two diagnostic tests, paraspinal digital infrared imaging and laser-aligned radiography, were performed according to IUCCA protocol. These tests objectively identify trauma-induced upper cervical subluxations (misalignments of the upper cervical spine from the neural canal) and resulting neuropathophysiology. Upper cervical subluxations were found in all 60 cases. All 60 patients responded to IUCCA upper cervical care within one to six months of treatment. Forty-eight patients were symptom-free following treatment and twelve cases were improved in that the severity and/or frequency of vertigo episodes were reduced.
Therapy of Functional Disorders of the Craniovertebral Joints in Vestibular Diseases
Cervicogenic vertigo is caused by functional disorders of the craniovertebral joints. The therapeutic effect of chiropractic treatment in 28 patients with vertigo and purely functional disorders of the upper cervical spine or with a combination of functional disorders of the upper cervical spine and the labyrinth was evaluated. In our opinion chiropractic treatment is mandatory for the therapy of patients with vestibular affections and functional disorders of the craniovertebral joints.
Upper Cervical Protocol to Reduce Vertebral Subluxation in Ten Subjects with Menieres: A Case Series
The objective of this case series was to review the management outcome of upper-cervical protocol on ten patients diagnosed with Menieres disease. Prior to the onset of symptoms all ten cases suffered neck traumas, most from automobile accidents, resulting in undiagnosed whiplash injuries.
Chiropractic care for the reduction of subluxation was undertaken. Custom x-rays and analysis of the upper cervical vertebrae were used to determine chiropractic listings of subluxation. Thermographs of the cervical spine were utilized using a DTG-25 instrument. A Toggle adjustment was used to reduce the subluxation. The condition of Menieres, which is poorly understood, responded favorably to chiropractic care using an upper cervical approach to reduce a specific subluxation complex.
Conclusion: It is possible that the true cause of Menieres disease is not only endolymphatic hydrops as theorized, but that vertebral subluxation plays a role. Further study is recommended.
Clinical Study on Manipulative Treatment of Derangement of the Atlantoaxial Joint
The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis. The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.
Chiropractic Care of a Patient with Temporomandibular Disorder and Atlas Subluxation
A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist. High-velocity, low-amplitude adjustments were applied to findings of atlas subluxation. The patient’s symptoms improved and eventually resolved after 9 visits.
Vertigo, Tinnitus, and Hearing Loss in the Geriatric Patient
A 75-year-old woman with a longstanding history of vertigo, tinnitus, and hearing loss experienced an intensified progression of these symptoms 5 weeks before seeking chiropractic care. The patient received upper cervical-specific chiropractic care. Through the course of care, the patient’s symptoms were alleviated, structural and functional improvements were evident through radiographic examination, and audiologic function improved. The clinical progress documented in this report suggests that upper cervical manipulation may benefit patients who have tinnitus and hearing loss.
Notes
There are other sources of vertigo that whilst are much rarer are also worth considering. An example is an Iron deficiency that affects one in four people and has in its large list of affects Dizziness and Tinnitus. Because of the different causes of Vertigo and the complexity of tracking down the cause I would strongly recommend consulting a professional for a diagnosis and a treatment plan rather than consulting with Dr Google.