Vertigo in Hamilton
Vertigo is a very disabling complaint that we see often as Chiropractors in Hamilton. Often times patients will be accompanied with a family member to the office because of how severely disabling the condition can be. The patients will often say that they are “dizzy”. Dizziness is a word that describes many things, including vertigo.
Dizziness can mean:
- the patient is in a “fog”
- the patient feels unbalanced or “out of sorts”
- the world is spinning
Vertigo is when the world is spinning when you are not!
What causes vertigo?
Vertigo can be caused by many different things:
- Problems in the neck
- Problems in the ear, nose, or throat
- Problems in the brain or spinal cord
- Problems with the heart or blood vessels
The Chiropractic approach addresses the neck component and how it connects to the spinal cord and spinal nerves. The word we use in Chiropractic to describe this physiological phenomena is vertebral subluxation.
How does the neck cause vertigo?
There are four hypotheses explaining cervical vertigo (how the neck creates the disabling condition) that are mentioned in this research paper on the Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Short snippets are mentioned below from the article. I will try to summarize the concepts for the reader in brackets:
1. Proprioceptive Cervical Vertigo:
(Your neck is causing your problem when in different positions because of injuries to the neck. Manual therapies such as Chirorpactic are suggested to address the neck component of vertigo )
- Whiplash injuries often cause cervical proprioception disorders, leading to cervical vertigo
- Manual therapy is recommended for treatment of proprioceptive cervical vertigo
- Manual therapy is effective for cervical vertigo
2. Barre-Lieou Syndrome (Sympathetic Dysfunction)
(The neck is irritating the sensors along the spine which are very important for the body to determine where it is in space and to coordinate body functions. The resulting experience is a feeling of spinning as well as other uncomfortable and disabling symptoms. Manual therapies such as Chiropractic are suggested to address the imbalance the neck is creating amongst the body’s sensors.)
- It is a sympathetic nervous system dysfunction
- The sympathetic plexus surrounding the vertebral arteries could be stimulated by cervical degenerative disease and this stimulation could contribute to reflexive vasoconstriction of the vertebrobasilar system
- Clinical symptoms include vertigo, tinnitus, headache, blurred vision, dialated pupils, nausea vomiting, etc.
- Effective treatment includes manual therapy and/or physical therapy. Fusion surgery may be required
3. Rotational Vertebral Artery vertigo (Bow Hunter Syndrome)
(When the neck is turned in these patients the blood flow to the brain is decreased leading to this dizzy and spinning feeling. These cases can improve with conservative treatments such as Chiropractic care but can also require spine surgery. Fortunately, these cases are rare.)
- Occlusion or insufficiency of the vertebral artery during neck rotation resulting in decreaded blood flow through the posterior inferior cerebellar artery, causing vertebrobasilar insufficiency and vertigo
- May respond to conservative treatment, but cervical decompression and/or cervical spine fusion may be required
- Rotational vertebral artery vertigo is rare
4. Migraine-associated Cervicogenic Vertigo
(Migraine sufferers can unfortunately experience this same problem as part of their migraines. There is no proven treatment according to this research paper but conservative efforts such as Chiropractic care are suggested as the primary approach.)
- Typically these patients suffer from cervical pain and stiffness, migraine, and vertigo.
- The association between migraine and vertigo has been well documented in the literature.
- There is no proven treatment, conservative efforts should be the primary approach.
Vertigo in the elderly
According to this same paper mentioned above, 65% of dizziness in the elderly is attributed to cervical spondylosis (the neck). Cervical spondylosis is when the joints in the neck are “degenerating” or “becoming arthritic”. Fortunately, the joints in the neck can still be “taught” to move better in spite of the arthritis, unlike the “old dog who can’t learn new tricks”.
How does the neck create vertigo?
The neck creates this problem because your brain relies on information from your neck to determine where your spine and skull are. If this information is wrong or “jumbled”, then the brain has a very difficult time navigating the world, resulting in vertigo. Here are some excerpts regarding vertigo and the neck:
“Proprioceptive input from the neck helps the coordination of the eye, hand, and body posture as well as spatial orientation.”
“Patients with whiplash injuries always have postural control impairment.”
“Patients with cervical vertigo usually have pain in the back of the neck and occipital region, sometimes accompanied by stiffness of the neck.”
“Cervical vertigo is often increased with neck movements or neck pain and decreased with interventions that relieve neck pain.”
Should I see a Chiropractor if I am suffering from Vertigo?
A thorough Chiropractic examine will help you determine if your neck is contributing to your problem. Chiropractors refer to bones in the neck interfering with the nerves as a subluxation. If your Chiropractor determines that the neck is involved in your case, a series of Chiropractic care will be suggested which can help you get your world “level” again.
Here to help in Hamilton at Westdale Chiropractic Clinic – Dr. Callum Peever
Want to read more associated with this topic?
Check out this other blog from Dr. Peever on Meniere’s Disease. Where he discusses recent research on how 300 Chiropractic patients who were suffering with the vertigo and hearing loss symptoms associated with Meniere’s disease improved with the help of Chiropractic care.
BPPV and Chiropractic
The following research study discusses a case in which a lady suffering from Benign Paroxysmal Positional Vertigo was helped through Chiropractic care. Some of my favourite excerpts from the article are listed below along with my comments. To learn more, read the article or connect to me in Hamilton. – Dr. Callum Peever
“The following case study features the favorable outcome of a female patient who presented to her chiropractor with Benign Paroxysmal Positional Vertigo.”
-At our Chiropractic office in Hamilton we see people suffering with these problems often. These symptoms are too worrisome and severe for the patient to ignore and they have often seen other specialists with no success first. Much focus is spent on the ear canals, which is helpful, but often times the neck component of the problem has not been assessed. That is where the Chiropractor comes into play. It is important that all aspects of the problem are addressed in order to encourage the body to regain its balance again.
What is BPPV?
“Benign Paroxysmal Positional Vertigo is a spinning sensation perceived with changes of head position and movement.”
What is this patients experience with this dizzying problem?
“The patient began re-experiencing BPPV and again sought treatment form her general practitioner and an otolaryngologist (ENT). She was prescribed medication but refused to take it since she was nursing her 1-year-old child. The Epley maneuver was also performed and while the severity subsided, the vertigo remained. She then scheduled an appointment with her chiropractor.”
“The patient was driven to her first few appointments, as she was so dizzy she was unable to drive. Cervical radiographs (X-Rays) were also taken. Osteoarthritis was present at the levels of C4, C5 and C6 with evidence of minor osteophytosis in its early stage. She lacked a cervical lordosis, instead displaying a straightened neck with anterior head carriage. Static and motion palpitation revealed several spastic, hypo-mobile and tender segments throughout the patient’s spine. The patient’s posture demonstrated right head tilt with left head rotation.”
-The Chiropractic exam focuses on how the bones, joints, and nerves in the neck are functioning together. If these important structures in the spine are not functioning properly, they can greatly impact a person’s balance. (Interestingly, these structures in the upper neck can even impact the pressure/fullness in the ears, as well as nerve functioning in the ears.) Posture, structure, function, and reflexes are assessed through touch, observation, movement patterns and X-Rays.
“Intervention and outcomes for this patient with BPPV The patient was examined for vertebral subluxation and adjusted 13 times in a three-month period. The segments adjusted varied per visit, based on subluxation indicators found each visit. The doctor utilized mostly Diversified adjusting techniques, including side posture, drop table, prone thoracic adjustments, and supine cervical sets.”
“By her third visit, the patient was experiencing fewer vertigo episodes. Her neck and mid back pain had also decreased in severity. She was able to drive by her fourth visit, noting she had fewer dizzy moments but the vertigo was much better. On her 14th visit, she presented with no complaints.”
“Most BPPV is primary, or idiopathic, but secondary BPPV may be due to head trauma, inner ear disease, migraine headaches and much more.”
-It is very common for a person experiencing this problem to have had an injury to their head in the past. Not only can this “shake up” the ear canals but it can also “shake up” the neck! Interestingly, in a study of patients with a similar problem, the head injury from a car accident was on average 15 years before they experienced issues of dizziness!
How is the Diagnosis of BPPV made?
A diagnosis of BPPV is made medically by observing the characteristic nystagmus (shaking of the eye ball) following a position maneuver with the patient. Posterior canal BPPV, the most common type, is diagnosed via the Dix-Hallpike maneuver.
-There are many differing forms of why vertigo could be happening. This is some of the clinical information that identifies that the problem is due to positioning of the head or neck, as well as that it is changing.
Treatment for BPPV
“Drugs and surgeries come with side effects and are therefore used sparingly or not at all to reduce the risk of increasing falls and discomfort [in patients suffering with Benign Paroxysmal Positional Vertigo.]
“There are essentially two classifications of treatment for BPPV: canalith repositioning maneuvers (CRMs) and medication. BPPV often remits within 6 months without intervention, however, its symptoms can greatly interfere with daily living and patients often seek treatment….Repositioning maneuvers attempt to guide the debris floating in the endolymph-filled canals back into the utricle… The Epley and Semont maneuvers are the most commonly utilized CRMs.”
-These repositioning maneuvers can be done in the Chiropractic office or at home once you learn them. If you are curious about them there are many videos of them online, or you can ask your chiropractor.
Chiropractic & BPPV
The patient in this case presented to her chiropractor after a failed Epley maneuver attempt by her ENT and her decision not to take the prescribed medication. In the literature several papers showcase chiropractic care and its effectiveness in the management of vertigo.
The author of this research article discusses how a Chiropractic adjustment can impact BPPV. She does this by connecting the subluxation theories to how the subluxation of the neck can manipulate a vertigo experience:
One model of subluxation theory, the Subluxation Degeneration Model, suggests there are neurological consequences with degeneration of the spine. Pioneers in the study of vertigo, Dix and Hallpike, found cervical x-ray findings at the fifth and sixth vertebrae to be common among vertigo sufferers. (The bones in the neck stop working well due to arthritis and they begin to interfere with the nerve signals going to the brain creating an imbalance in the person at a very important part of the spine).
Another dysfunction resulting from subluxation, described in the Dysafferentation Model, may serve to further the connection between vertebral subluxation and the BPPV. Due to the amount of receptors along the joints in the spine, especially the upper neck, any dysfunction can result in a confusing balancing experience for the brain – with vertigo being the experience or aggravated.
Conclusion of the research study “It is therefore suggested that those suffering with vertigo seek chiropractic care before resolving to medication or surgery, as chiropractic adjustments address the cause of neurological dysfunction, rather than masking symptoms.”