The vestibular system includes the parts of the inner ear and brain that process the sensory information involved in controlling balance and eye movements. Acute trauma, disease and degeneration (of special note is the upper cervical spine) that damages these areas may result in vestibular disorders.
"It affects my mood and memory. I can't do things I used to enjoy doing."
One recent large epidemiological study estimates that as many as 35% of adults aged 40 or older in the United States, have experienced some form of vestibular dysfunction (1). Chiropractic has been shown to be an effective alternative to the management of these conditions (11,12,13,14).
When vertigo or disequilibrium is caused by dysfunction in the cervical spine or labyrinythine apparatus, it is most often treatable in the chiropractic setting. Optimum function of the cervical spine is essential to the recovery from these disorders regardless of the cause. Lewit (8) showed that patients with Meneire's syndrome can be effectively treated with adjustments, demonstrating that 79 percent of 21 cases showed an "excellent" outcome. Fitz-Ritson (9) showed that patients with post-tramatic vertigo of cervical origin treated with chiropractic manipulative, myofascial and rehabilitative procedures experienced a 90 percent success rate (10).
Although there are many root causes of vestibular disorders, the primary variations that we most frequently see in our office include the following:
Benign Paroxysmal Positional Vertigo (BPPV)
Dizziness from BPPV accounts for approximately 20% of cases and although it may be present in children, it is typically found in older adults. The symptoms of dizziness, lightheadedness, imbalance and nausea are typically brought on by rotational movements such as rolling out of bed, or change in the position of the head with respect to gravity. BPPV is thought to be caused by crystals (otoliths, otoconia) that collect within the inner ear in areas they are not supposed to be.
The most common cause of BPPV is head injury (2,6), but it does not need to be a direct head trauma (ie. whiplash). In this case, head trauma usually does not occur without some form of neck trauma and the evaluation of the cervical spine is a very important aspect of the overall management.
People with cervicogenic dizziness tend to complain of dizziness that is worse during head movements or after maintaining one head position for a long time. The dizziness may or may not be associated with neck pain and may be accompanied by a headache. Often the dizziness will decrease if the neck pain decreases. The symptoms of dizziness usually last minutes to hours (3,4).
This type of dizziness is usually associated with a history of neck or head trauma and the majority of people improve only with the resolution of the neck problem (5,6,7,8,9).
Thought to be a disorder of the inner ear and often a disease of exclusion, Ménière’s often presents with a fullness and ringing in the ear, called tinnitus, usually preceeding short bouts of dizziness. Some individuals have short, isolated bouts of dizziness while others have several attacks over several days (15). The exact cause of Ménière’s disease is still unknown, although the leading theory is that it is a result of a buildup of fluid in the inner ear, called the labyrinth (but what is the root cause of this buildup?).
According to the NIH, 6 out of 10 people get better either on their own, or can "control" their vertigo with diet, drugs or other devices. Chiropractic has been shown to be successful in the management of Ménière’s disease (13,16).
If you or someone you now suffers from balance problems, we would be happy to do an evaluation to determine if it is the type of problem that we deal with.
1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balances and vestibular function in US adults. Arch Intern Med. 2009; 169(10): 938-944
2. The Mayo Clinic (July 2010). Benign Paroxysmal Positional Vertigo. Accessed from http://www.mayoclinic.com/health/vertigo/DS00534/DSECTION=causes
3. Furman JM, Cass SP. Balance Disorders: A Case-Study Approach. Philadelphia: F.A. Davis, 1996.
4. Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther 2000; 30:755-766.
5. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–58.
6. Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain 1994;58:283–307.
7. de Jong PTVM, et al. Ataxia and nystagmus induced by injection of local anesthetics in the neck. Ann Neurol 1977; 1:240-246.
8. Lewit K. Disturbed balance due to lesions of the cranio-cervical junction. J Orthop Med 1998; 3:58-61.
9. Fitz-Ritson D. Assessment of cervicogenic vertigo. J Manipulative Physiol Ther 1991; 14(3):193-198.
10. Norre ME. Neurophysiology of vertigo with special reference to cervical vertigo: A review. Medica Physica 1986; 9:183-194.
11. Reidar P et al., 2011. Manual Therapy With and Without Vestibular Rehabilitation for Cervicogenic Dizziness: A Systematic Review Chiropractic and Manual Therapies. Chiropractic and Manual Therapies 2011 (Sept 18).
12. Emary, Peter. Chiropractic Management of a 40-year-old Female Patient With Ménière Disease. J Chiropr Med. 2010 (Mar); 9 (1):22–27.
13. Jones, M., Salminen B. Meniere’s Disease Symptomatology Resolution with Specific Upper Cervical Care. J. Upper Cervical Chiropractic Research Mar 2012: 31-39
14. Elster E. Sixty Patients With Chronic Vertigo Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation: A Retrospective Analysis. Journal of Vertebral Subluxation Research 2006 (Nov 8); 1–9
15. Saeed S.R. Fortnightly review. Diagnosis and treatment of Ménière's disease. BMJ. 1998;316:368–372.
16. Emary, P. Chiropractic management of a 40-year-old female patient with Ménière disease. J Chiropr Med. 2010 March; 9(1):22-27.