By Dr. Corey Finan
If you suffer from any form of Vertigo, you understand that it can be very debilitating. From head or room spins after standing, to not being able to find your balance while walking, to nausea when turning your head. Many people suffer from Benign Paroxysmal Positional Vertigo, which is a fairly self-limited condition which leads to dizziness, sometimes drop-attacks, and general unsettled feeling.
Vertigo can last for days, weeks, or even years in some situations. It can come on out of the blue, or be the result of neck or head trauma. Many people suffer for different reasons, but all share one thing in common, and that is the need for it to resolve.
The Inner Ear Connection to Vertigo
If you’re suffering from Vertigo, a simple google search will take you to a number of sites that discuss BPPV. Most if not all of them will talk about the inner ear connection to Vertigo. Inside your ear there is a mechanism that your brain uses to determine rotational motion of your head. The way your brain senses motion (rotational motion) is by using a system comprised of a gel, some hair cells, and tiny crystals called otoliths. The mechanism is basically set up so that there is a chamber in your inner ear that is filled with a liquid gel. Hair cells (which are cells that have hair-like projections sticking up out of the gel) are submerged in this gel. Floating on the gel are the otoliths. As you turn your head, the otoliths move and when they bump into the hairs, a signal is sent to your brain telling it you are moving a certain direction. If this information is consistent with the information your eyes are telling your brain in regards to the direction your head is moving, all is well. However, if through head trauma, or other mechanisms crystals that are found elsewhere in the inner ear happen to migrate into the semicircular canals where the hair cell mechanism is, they can cause problems but triggering the hair cells more than should happen. When this happens, your brain gets a signal from your inner ear that your head is moving faster than it is, while your eyes tell your brain that your head is moving at the speed it is. When this happens, your brain becomes confused by the two differing signals, and dizziness (or Vertigo) results.
The Neck and Vertebrae’s Connection to Vertigo
There is another more common form of Vertigo that has to do with your neck and the vertebrae that make up your neck. In this situation, a similar mechanism is at work. Each vertebra in your neck have receptors in their joints known as proprioceptors. These receptors basically telly your brain how the joint is moving in space. So if you turn to the left, the proprioceptors are triggered appropriately and tell your brain that joint is moving to the left. The same situation can arise where your eyes are telling your brain you are looking straight ahead, but the proprioceptors in the upper neck joints are telling your brain that they (and therefore your head) are turned one way or the other. So, just like before, when your brain gets conflicting information, it becomes confused, and vertigo results. This is a more common mechanism for vertigo, because it can result from head trauma again, or simply by tension in the muscles that attach to the joints in your upper neck getting tight, and pulling a vertebra slightly out of alignment, causing the proprioceptors to misrepresent their position in space. It is much more common than the migration of crystals from one area of the inner ear to another (a mechanism that researchers still can’t explain how it happens).
What is the treatment?
Treatment for both kinds of Vertigo is possible. Vertigo caused by the inner ear failure can be addressed by one of two manual therapies, that being the Epley Maneuver, and the Dix-Hallpike Test. Both therapies are aimed at creating a situation that allows the crystals to migrate back to where they came from.
The Dix-Hallpike Test
The Dix-Hallpike test starts with the patient in a seated position, with their head in neutral position. The head is extended, and they are lowered down onto the table in to a face up position, with their head in extension. The practitioner will then turn their head 45 degrees to one side, and the other, looking at the eyes for nystagmus (twitching of the eyes), the patient will note if one side or the other made their vertigo worse. This will help determine which side the problem is coming from.
The Epley Maneuver
Once that is determined, treatment using the Epley Maneuver can be directed at the problem side. To perform the Epley Maneuver, the patient begins by sitting with the legs fully straightened, and the head rotated 45 degrees in the same direction that gave the positive Dix–Hallpike test. Next the patient is quickly and passively forced down backwards by the practitioner into a face up position with the head held approximately in a 30-degree neck extension and still rotated to the same. The eyes are examined for nystagmus again. The patient remains here for up to 1–2 minutes. The patient’s head is then rotated all the way to 45 degrees in the opposite direction so that the opposite ear faces the floor, all while maintaining the 30-degree neck extension. Again the eyes are examined for nystagmus, and the patient remains in this position for up to 1–2 minutes. Following that, the patient rolls onto their shoulder, keeping their head and neck fixed in the position they are in. They rotate their head another 90 degrees in the direction that they are facing. The patient is now looking downwards at a 45-degree angle. The patient remains in this position for the next 1-2 minutes, the eyes are checked for nystagmus again. Once this is complete, the patient will swing their knees up so that they can start to slowly come back up to a sitting position while maintaining the 45 degree head rotation. The patient remains seated for 30 seconds. Once the treatment is done, the patient must keep the head upright for the next 48 hours, which can be difficult. This means no looking down, etc. It is the hardest part of the treatment, but also the most important. The Epley Maneuver can be a one-time treatment, or may take several sessions to remove all signs of vertigo.
Treating Vertigo Related to the Neck
The second form of vertigo requires a much more straight forward treatment plan. It involves releasing muscle tension in the upper neck using Active Release Techniques to stretch out the tightened muscles, home self-stretching aimed at the neck muscles as well, and finally moving the stuck vertebra back into proper place with Chiropractic Adjustments. Once the vertebra is properly seated and moving correctly, the symptoms will disappear. This can take 1 to several treatments to resolve completely.
It is important to note that vertigo can come back in either situation, so it is important to realize that this may not be a one-time situation. Regular monthly or maintenance care aimed at keeping the upper neck stretched out and functioning properly can help mitigate vertigo that is caused by the upper neck scenario. Unfortunately if your vertigo is coming from the inner ear, there really is no way to be proactive against it coming back.
For more information, or if you suffer from Vertigo, please contact Active Sports Therapy to book your assessment and treatment today. The sooner you get it treated, the sooner you can get back to your normal life.