VERTIGO, BALANCE AND CHIROPRACTIC
 
   

Vertigo, Balance and Chiropractic

This section was compiled by Frank M. Painter, D.C.
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  Frankp@chiro.org

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Chiropractic and Vertigo
 
   

The Role of Chiropractic Care in the Treatment of Dizziness or
Balance Disorders: Analysis of National Health Interview Survey Data

J Evid Based Complementary Altern Med. 2016 (Apr);   21 (2):   138–142

The odds ratio for perceiving being helped by a chiropractor was 4.36 (95% CI, 1.17-16.31) for respondents aged 65 years or older; 9.5 (95% CI, 7.92-11.40) for respondents reporting head or neck trauma; and 13.78 (95% CI, 5.59-33.99) for those reporting neurological or muscular conditions as the cause of their balance or dizziness.

Is There a Role for Neck Manipulation in Elderly Falls Prevention?
An Overview

J Can Chiropr Assoc. 2015 (Mar);   59 (1):   53–63 ~ FULL TEXT

We conclude that chiropractors may have a role in falls prevention strategies in the subpopulation of the elderly that suffer from mechanical neck pain or dysfunction and non-specific dizziness. However, this role remains to be rigorously studied and properly defined.

Chiropractic Management of Benign Paroxysmal Positional Vertigo
Using the Epley Maneuver:   A Case Series

J Manipulative Physiol Ther. 2013 (Feb);   36 (2):   119–126 ~ FULL TEXT

The patients underwent one or more canalith repositioning procedures (Epley maneuver). Scores in each of the categories decreased from the initial to 6-day assessment and then again at the 30-day assessment. The effects of the treatment on the Short Form 12 scores showed changes between the initial assessment and 30 days posttreatment.   The patients in this case series demonstrated reduction in symptoms with chiropractic management.

Comparison of Outcomes in Neck Pain Patients With and Without
Dizziness Undergoing Chiropractic Treatment: A Prospective Cohort
Study With 6 month Follow-up

Chiropractic & Manual Therapies 2013 (Jan 7);   21:   3 ~ FULL TEXT

Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.

Cervical Vertigo:
Myths, Facts, and Scientific Evidence

Neurologia. 2012 Sep 13. [Epub ahead of print]

Cervical vertigo has been a controversial entity for many years. Completing a clinical-pathophysiological assessment to explain the symptoms in a particular case proves to be the most reasonable bedside strategy, regardless of the name assigned to the disease in the end. At present, no complementary studies have demonstrated that the variant known as cervicogenic proprioceptive vertigo is an independent entity, and measuring its true impact is difficult. Once potentially severe causes of the symptoms have been ruled out, the most appropriate strategy seems to be use of manipulative and vestibular physical therapy.

Manual Therapy With and Without Vestibular Rehabilitation for
Cervicogenic Dizziness:   A Systematic Review

Chiropractic & Manual Therapies 2011 (Sep 18);   19:   21 ~ FULL TEXT

There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended.

Chiropractic Management of a 40-year-old Female
Patient With Mιniθre Disease

Journal of Chiropractic Medicine 2010 (Mar);   9 (1):   22–27 ~ FULL TEXT

Treatment included primarily high-velocity, low-amplitude spinal manipulation to the upper cervical and thoracic spine, along with soft-tissue trigger-point therapy, and stretching exercises. Within 2 weeks of treatment, the patient's tinnitus had resolved; and all other symptoms (including vertigo) were improved. The patient's headaches, neck pain, and vertigo were subsequently resolved within 3 months of treatment. The patient experienced only 2 minor episodes of self-resolving "light-headedness" over that time. After 2½ years of follow-up, any occasional episodes of mild aural fullness and/or light-headedness are either self-resolving or relieved with cervical spinal manipulation and soft-tissue treatment.

Improvement in Ataxia, Dizziness, & Visual Disturbance,
in a Child with Vertebral Subluxations Undergoing
Chiropractic Care:   A Case Study

J. Pediatric, Maternal & Family Health 2010;   2:   89–94

The patient is an 11-year-old female who had a one month history of dizziness, fuzzy vision, and inability to stand or walk unassisted. MRI revealed an anatomical variant in which the patient’s cerebellar tonsils protruded 2mm into the foramen magnum, and there was compression of the pituitary gland by cerebral spinal fluid (CSF). The patient was no longer able to attend school, or perform normal daily activities of an eleven year-old. Physical exam findings indicated the presence of vertebral subluxation at the atlas and occiput. Specific manual and drop table assisted adjustments were performed, primarily in the upper cervical region, based on evidence of subluxation. The patient responded well to care with complete resolution of cerebellar symptoms.

Observation of Curative Effect on Fixed-point Spin Reduction
of Spinal Manipulation Therapy for Cervical Vertigo

Zhongguo Gu Shang. 2010 (Feb);   23 (2):   99–101

Fixed-point spin reduction of spinal manipulation therapy for cervical vertigo can accurately correct single or multiple vertebral body displacement, restore normal spinal position, reduce the oppression and stimulus of the vertebral artery, release ischemia of vestibular labyrinth, and eliminate the symptoms of vertigo.

Effects of Chiropractic Care on Dizziness, Neck Pain, and Balance:
A Single-group, Preexperimental, Feasibility Study

Journal of Chiropractic Medicine 2009 (Dec);   8 (4):   156–164 ~ FULL TEXT

This feasibility study was conducted to further the development of a line of investigation into the potential effects of spinal manipulation/manual therapy on cervicogenic dizziness, balance, and neck pain in adults.

Chiropractic Care for Nonmusculoskeletal Conditions: A Systematic
Review With Implications For Whole Systems Research

J Altern Complement Med. 2007 (Jun);   13 (5):   491–512 ~ FULL TEXT

(1) Adverse effects should be routinely reported. For the few studies that did report, adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe.   (2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic.   Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia.

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 ~ FULL TEXT

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.

Manual Therapy Treatment of Cervicogenic Dizziness:
A Systematic Review

Man Ther. 2005 (Feb);   10 (1):   4–13

Dizziness is a common and often disabling disorder. In some people the cause of their dizziness is pathology or dysfunction of upper cervical vertebral segments that can be treated with manual therapy. The aim of the present study was to systematically review the literature on the manual therapy treatment of patients with cervicogenic dizziness, by identifying and evaluating both randomized controlled trials (RCTs) and non-RCTs (controlled clinical trials and non-controlled studies).

Vertigo, Tinnitus, and Hearing Loss
in the Geriatric Patient

J Manipulative Physiol Ther. 2000 (Jun);   23 (5):   352–362 ~ FULL TEXT

The patient received upper cervical-specific chiropractic care. Paraspinal bilateral skin temperature differential analysis was used to determine when an upper cervical adjustment was to be administered. Radiographic analysis was used to determine the specific characteristics of the misalignment in the upper cervical spine. Through the course of care, the patient's symptoms were alleviated, structural and functional improvements were evident through radiographic examination, and audiologic function improved.

Cervical Vertigo After Hair Shampoo Treatment at a Hairdressing Salon:
A Case Report

Spine 2000 (Mar 1);   25 (5):   632–634

The authors suggest that the hyperextended neck position during hair shampoo treatment in a beauty parlor may be a risk factor for back lifting or cerebellum vascular insufficiency. Public education should lead to avoidance of this position during hair shampoo treatment at hair dressing salons.

A Combined Approach for the Treatment of Cervical Vertigo
J Manipulative Physiol Ther. 2000 (Feb);   23 (2):   96–100

Chronic, nontraumatic, cervical and shoulder-girdle dysfunction was an important causal and perpetuating factor of cervical vertigo in the population studied, and a consistent improvement was observed with the use of a conservative treatment protocol involving multiple modalities for patients with cervical vertigo. Further controlled studies are needed to access its validity.

Clinical Study on Manipulative Treatment of Derangement
of the Atlantoaxial Joint

J Tradit Chin Med 1999 (Dec);   19 (4):   273–278

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.

Vertigo in Patients With Cervical Spine Dysfunction
Eur Spine J 1998;   7 (1):   55–58

60% of the patients examined were assessed with upper cervical dysfunction, and 77.4% of them responded favorably to spinal manipulation.

Therapy of Functional Disorders of the Craniovertebral Joints
in Vestibular Diseases

Laryngorhinootologie 1992 (May);   71 (5):   246–250

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.

 
   

Chiropractic and Balance or Proprioception
 
   

Effectiveness of Chiropractic Care to Improve Sensorimotor Function
Associated With Falls Risk in Older People:
A Randomized Controlled Trial

J Manipulative Physiol Ther. 2016 (Apr 2) [Epub]

Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26-212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%-24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°-0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF-36 physical component of quality of life (2.4; 95% CI, 0.04-4.8; P = .04) compared with control.

The Role of Chiropractic Care in the Treatment of Dizziness or
Balance Disorders: Analysis of National Health Interview Survey Data

J Evid Based Complementary Altern Med. 2015 (Sep 11)

The key findings in this study were that improvements were observed in the chiropractic group in joint position sense error, sound-induced flash illusion, and CSRT compared with the control group. Between-group differences were also observed in the physical component of health-related quality of life, with the chiropractic group improving compared with the control group between the 4- and 12-week assessments.

Is There a Role for Neck Manipulation in Elderly Falls Prevention?
An Overview

J Can Chiropr Assoc. 2015 (Mar);   59 (1):   53–63 ~ FULL TEXT

We conclude that chiropractors may have a role in falls prevention strategies in the subpopulation of the elderly that suffer from mechanical neck pain or dysfunction and non-specific dizziness. However, this role remains to be rigorously studied and properly defined.

The Effects of Manual Therapy on Balance and Falls:
A Systematic Review

J Manipulative Physiol Ther. 2012 (Mar);   35 (3):   227–234 ~ FULL TEXT

A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.

Geriatric Chiropractic Care as a Health Promotion and
Disease Prevention Initiative:
Focus on Fall Prevention

Topics in Integrative Health Care 2010 (Dec 30);   1 (2) ~ FULL TEXT

The chiropractic profession is well positioned to align itself with the principles of health promotion and disease prevention championed by the World Health Organization. As a means to explain how chiropractic practice models and the WHO position statements can converge, this article will use the example of fall prevention. This article will discuss the epidemiology, risk factors, patient assessment tools and preventive strategies of falls prevention for older patients.

Chiropractic Care for Older Adults: Effects on Balance,
Dizziness, and Chronic Pain

J Manipulative Physiol Ther. 2009 (Jul);   32 (6):   431–437 ~ FULL TEXT

Falls are an important public health concern, making major contributions to death, disability, and health care costs in older adults. [1] Because of the importance of fall prevention to the well-being of the aging population, as well the extremely high health care costs associated with falls, the evidence base on this topic is growing exponentially. At least 16 controlled studies have been done examining the contribution of various risk factors to falls. [2] Lower-extremity weakness, balance, and gait deficits are the top risk factors. [2] Interventions that target these have been shown to reduce risk of falls.

Pilot Study of the Effect of a Limited and Extended Course
of Chiropractic Care on Balance, Chronic Pain,
and Dizziness in Older Adults

J Manipulative Physiol Ther. 2009 (Jul);   32 (6):   438–447 ~ FULL TEXT

Falls are one of the chief public health concerns for older adults, being the leading cause of nonfatal injury and comprising two thirds of all unintentional injury deaths in this population. [1] Direct medical costs of falls are estimated to be $6 to $8 billion per year. [2] Not only is the number of older adults increasing, but also the fall death rates have increased significantly from 1988 to 2000 for both men and women. [3]

Feasibility Study of Short-term Effects of Chiropractic
Manipulation on Older Adults With Impaired Balance

J Chiropr Med. 2007 (Dec);   6 (4):   121–131 ~ FULL TEXT

Falls are the leading cause of nonfatal injury in older adults and account for two thirds of all unintentional injury deaths in this population. [1] Direct medical costs of falls have been estimated at $6 billion to $8 billion per year. [2] Furthermore, fall death rates have increased significantly from 1988 to 2000 for both men and women. [3]

Assessment of Balance and Risk for Falls in a Sample
of Community-dwelling Adults Aged 65 and Older

Chiropractic & Osteopathy 2006 (Jan 27);   14:   3 ~ FULL TEXT

A total of 101 participants enrolled in the study. Advertising in the local senior newspaper was the most effective method of recruitment (46%). The majority of our participants were white (86%) females (67%). About one third (32%) of participants had a baseline BBS score below 46, the cut-off point for predicting risk of falling. A mean improvement in BBS scores of 1.7 points was observed on the second visit. For the subgroup with baseline scores below 46, the mean change was 4.5 points, but the group mean remained below 46 (42.5).

Effects of Acupuncture, Cervical Manipulation and NSAID therapy
on Dizziness and Impaired Head Repositioning of Suspected
Cervical Origin: A Pilot Study

Man Ther 2000 (Aug);   5 (3):   151–157

The effects of different forms of therapy-and none-on dizziness and neck pain were compared, using a 100 mm visual analogue scale (VAS). Active head relocation by subjects with dizziness was significantly less precise than in the control group. Manipulation was the only treatment to diminish the duration of dizziness/vertigo complaints during the past 7 days and increased the cervical range of motion. Both acupuncture and manipulation reduced dizziness/vertigo on the VAS scale and had positive effects on active head repositioning.

Cervicocephalic Kinesthetic Sensibility, Active Range of
Cervical Motion, and Oculomotor Function in Patients with
Whiplash Injury

Arch Phys Med Rehabil 1998 (Sep);   79 (9):   1089–1094

Active head repositioning was significantly less precise in the whiplash subjects than in the control group. Failures in oculomotor functions were observed in 62% of subjects. Significant correlations occurred between smooth pursuit tests and active cervical range of motion. The results suggest that restricted cervical movements and changes in the quality of proprioceptive information from the cervical spine region affect voluntary eye movements. A flexion/extension injury to the neck may result in dysfunction of the proprioceptive system. Oculomotor dysfunction after neck trauma might be related to cervical afferent input disturbances.

The Effects of Spinal Manipulation on Cervical Kinesthesia
in Patients With Chronic Neck Pain: A Pilot Study

J Manipulative Physiol Ther 1997 (Feb);   20 (2):   80–85

Subjects receiving manipulation demonstrated a mean reduction in visual analogue scores of 44%, along with a 41% improvement in mean scores for the head repositioning skill. In comparison, a 9% mean reduction in visual analogue scores and a 12% improvement in head repositioning scores was observed for the stretching group. The difference in the outcomes of the head repositioning skill scores was significant (p < or = .05).

Therapy of Functional Disorders of the Craniovertebral Joints
in Vestibular Diseases

Laryngorhinootologie 1992 (May);   71 (5):   246–250

In our opinion chiropractic treatment is mandatory for the therapy of patients with vestibular affections and functional disorders of the craniovertebral joints.

Chiropractic Effects on Athletic Ability
Chiropractic: The J Chiro Res and Clin Invest 1991;   6 (4):   84–87

In this study, chiropractic researchers gave chiropractic adjustments to an experimental group, while the control group was simply monitored. Reaction time was measured before the season began and at six weeks. In the control group, the improvement in reaction time at the six-week check-up was less than 1 percent. On the other hand, the experimental group's reaction time was 18 percent faster.

Single-Leg Balance
Charles Masarsky, DC

Even if your practice is not involved in any formal program to rehabilitate balance and proprioception, it is still worthwhile to inform your patients of the interaction between subluxation and balance. The following patient education article is designed to be useful regardless of whether or not you are deeply involved in rehabilitation. Please feel free to use it for bulletin-board display, front-desk handouts, lay lectures or tableside talks.


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