• Andrew Synnott

Can Your Chiropractor Help Your Dizziness?


Can your chiropractor help with dizziness?


Vertigo is the sensation that the environment is spinning around relative to oneself (objective vertigo) or vice versa (subjective vertigo). The term is sometimes used erroneously to mean any form of dizziness. True vertigo is described as a rotary sensation of the patient or surroundings, and is often of vestibular origin. Vertigo may result from diseases of the inner ear or disturbances of the vestibular centers or pathways in the central nervous system (e.g., Meniere disease, arteriosclerosis of cerebral vessels, brain lesion, head injury, motion sickness, or large and rapid variations in barometric pressure)[1]. Depending on the underlying cause/condition, it may be associated with nausea and vomiting, or accompanied by other symptoms and signs (e.g., headaches and visual symptoms).


Most causes of vertigo are peripheral and non-life-threatening. However, those few central causes (vascular and neoplastic) are emergencies that should not be overlooked.


Most Common Types of Peripheral Vertigo

Your chiropractor or health care provider can help by firstly taking a history and physical examination. Do not trust a therapist or any doctor who says they can cure your dizziness with their treatment modality (whether it be drug or manual therapy) without performing an exam to see the true cause. Chiropractors play a pivotal role in treating peripheral causes of vertigo as often times once serious causes of vertigo are ruled out patients are left with pharmacological options and are told that the vertigo will subside. However, symptoms can last for months to years and be debilitating. Chiropractors can offer many treatment options and offer continual monitoring to help you get over our vertigo. Some of the most common peripheral causes and treatments are as follows;


Benign Paroxysmal Positional Vertigo (BPPV): This is a common type of vertigo that is caused by an inner ear condition where small crystals called otoliths are free to float around the inner ear. This causes the sensation of dizziness and nausea. If episodes are brought on by certain head positions and last less than one minute then BPPV is likely. There are also positioning tests and movements that a health care practitioner can use to both diagnosis and treat the condition [2].


Meniere’s disease: if episodes of vertigo are accompanied by a feeling of fullness in the ear, tinnitus, and hearing loss than Meniere’s disease is likely. The cause unknown and is most likely caused by increase of pressure from decreased endolymph absorption in the ear. 1st line treatments includes low salt diet, diuretics, medications and vestibular rehabilitation [3].



Cervical involvement: Oftentimes the neck and cervical spine is involved or coexists with patients that suffer from vertigo. This is most likely due to the neurological link between the head and neck. Both trauma such as whiplash or degeneration in the neck can cause changes in balance and proprioception. In this case manual therapy can be applied to the neck muscles and spine to help restore range of motion, decrease spasm, improve pain, and help proprioception [4].


Central Causes of Vertigo


Central causes are rarer than peripheral causes however, are more serious. Where many peripheral causes respond well to dietary changes, elimination of triggers, rehabilitation, positioning maneuvers, and medications to help symptoms. Central causes are usually caused by vascular lesions, neoplasms, or existing neurological condition. Although both central and peripheral causes have some overlapping symptoms such as dizziness and nausea central causes are usually accompanied with neurological deficits such as difficulty standing or walking. Also, as cranial nerve deficits (i.e., difficulty swallowing, facial drooping). Due to the seriousness of the conditions MRI and CT scans are often performed when patients have severe vertigo to rule out the possibility of a central cause especially when patients have risk factors such as diabetes, high blood pressure, smoking, and cardiovascular disease [5].


Chiropractor’s role in treatment


Once the cause of vertigo is determined there are many treatments that chiropractors can offer to help. BPPV responds extremely well to positioning maneuvers that chiropractors are trained in. Also, manual therapy, and rehabilitation, exercise, and lifestyle changes can help restore balance and visual deficits.


Chiropractors are also trained in examinations to detect red flags so they refer to the individual to ensure the best treatment for the patient. Often times when the more serious causes of vertigo a chiropractor will identify this and make sure the patient gets the proper referral for further examination.


References

1. Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010;82:361-368.

2. Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 Sep 30;169(7):681-93.

3. Glasscock ME, Gulya AJ, Pensak ML, et al. Medical and surgical management of Meniere's disease. Am J Otol. 1984;5:536-542.

4. Hain TC. Cervicogenic causes of vertigo: Current Opinion in Neurology. 2015 Feb;28(1):69–73.

5. Baloh RW. Differentiating between peripheral and central causes of vertigo. Otolaryngol Head Neck Surg. 1998;119:55-59.

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