Vertigo is one of those strange symptoms that we regularly see at Chirolink. The human body is incredibly complex and vertigo is one of those conditions that have fewer answers. The definition of vertigo is ‘the sensation that either you or the world around you is spinning or moving’. It can be very disconcerting but is often ignored unless it becomes either more constant in someone’s life or if the intensity noticeably increases.
What we most commonly see are milder cases. When someone suddenly moves their head, the world starts spinning but it settles after keeping steady for about 10 seconds. There are even milder cases where it’s brushed off (and shouldn’t be) or there are severe cases that can be debilitating without the correct care. Some people have vertigo that is on and off. Some people have vertigo that is constant in their lives but comes and goes (only occurs with sudden head movements) and some people have vertigo that is constant and unrelenting.
Different conditions create different responses from the body. Short-lived or temporary vertigo is often related to motion sickness, alcohol or medication side effects, migraine headaches, and inner ear infections. Diabetes or low oxygen perfusion (low blood pressure or anemia).
With conditions such as benign paroxysmal positional vertigo (BPPV), it can vary between mild but still present to debilitating. And lastly, with more serious conditions such as an acoustic neuroma or brain injury, symptoms can be severe, but the onset may differ – sudden with an accident and head injury but gradual with a slower-growing neuroma.
Vertigo can vary significantly, and it is our job as Chiropractors to be the detectives of the human body to figure out what is going on. Just recently we had a patient named Tina who presented to our rooms. At 42, working full-time, and a mom of three, she was stressed. She’d been suffering from some intense ‘dizziness’ or vertigo, chronic low-grade headaches, ringing in the ears, and occasional nausea.
It had become consistent for about a month but noted that it had been on and off for about a year. Normally the symptoms would subside if she left it for long enough but this time it wasn’t letting up. On assessment we found that the curve of Tina’s neck had flattened significantly – this tells us that this has been building for many years without her knowing. When this curve gradually flattens the soft tissues and joints around it adapt the best way they can. The muscles at the front and back of the neck are either overstretched or over-contracted and are both under more strain than they can handle. Eventually, they start ‘talking’ to grab our attention as we can see with Tina’s symptoms.
What did we do?
As primary health providers, we performed a full assessment of Tina and we decided on a treatment plan. Tina’s upper back needed a lot of attention. When we describe the increased load on the neck, the upper back experiences just as much. We got the upper back and junction between the neck and the upper back functioning properly. We looked at the neck. We focused attention on very specific muscles through gentle trigger point release and adjusted her cervical spine by specifically releasing all the problematic joints that weren’t moving the way they should.
We ensured the remainder of the body was balanced and cleared any interference.
What could Tina do at home?
Just like homework given when you’re at school, the knowledge given to the body needs to be reinforced to remember it. The goal was to gently re-introduce the normal curve in her neck. Rolling a towel under the neck and laying on the ground at the end of the day made a large change. She had to lift the computer screen that she worked on all day but her cell phone too. Lastly, the difficult but so important care when sitting on the ‘comfy’ couch that was a ‘hunched over’ couch. We also advised Tina to be diligent with taking her vitamin B supplements to ensure that no vitamin deficiency was affecting her symptoms.
What was happening with Tina?
The culprit of Tina’s symptoms was the sternocleidomastoid (SCM) muscle and the first vertebra of the neck (C1). Why? This is a chicken and egg situation. C1 and the SCM are closely related. The SCM is one of the prime neck rotators and most rotation occurs at this vertebra. Therefore, when the SCM spasms, it affects C1 movement. When C1 isn’t moving properly, the SCM spasms. Each of these structures is known to cause all of Tina’s symptoms. Why? It all comes down to nerves. Put simply, most of the neck’s proprioceptors (nerve receptors of body position) are in the joints of the first part of the neck and the SCM muscle holds a large remainder of them. Any abnormal movement in these joints or this muscle confuses these receptors which creates vertigo and poor balance.
What happened next?
After the first session, Tina felt strange. Lighter. No headache (finally) but still some dizziness and ringing in the ears. We persisted with treatment and after regular sessions for a few weeks, her body finally decided to let the symptoms go. She was symptom-free within a month and now regularly comes for her maintenance care as well as diligently does her homework. She knew what she needed to do to not feel the way she had before! By restoring normal movement within the affected joints and muscles, Tina’s symptoms disappeared.
What are some of the other causes of vertigo?
As noted above, vertigo can be caused by motion sickness, alcohol intoxication, migraine headaches, inner ear infections, or poor oxygen perfusion. With each of these, the bout of vertigo is not usually as long-lasting and would be managed differently.
In severe cases, head trauma or a neuroma can be a constant cause of vertigo but these conditions also come with a range of other symptoms and further investigation would be called for by your primary health provider.
An important condition to discuss is BPPV because BPPV is one of the single major causes of vertigo and it is characterized by ‘dizziness’ with sudden head movements. It is caused by the dislodgement of the calcium carbonate particles out of the utricle (a sac deep within the ear) into the semicircular canals (fluid-filled tubes within the inner ear assisting with balance). It can range between mild and manageable to severe and debilitating. The former was more common. This is not a life-threatening condition but affects the quality of life significantly. It is managed with extremely specific vestibular exercises that require consulting a vestibular physical therapist.
The take-home message is that it is not necessary to be living with your vertigo. It is important to get it assessed by the right practitioner to determine the cause and thus find the appropriate treatment. One’s quality of life is not worth neglecting especially when we have the opportunity to improve it right in front of us.