English
Yet again, we have another research studying linking Benign Proxysmal Positional Vertigo (BPPV) to the health of your cervical spine, aka your neck. As incredible as this sounds considering that so many people go from specialist to specialist, have so many brain CT and MRI scans that surely the problem must be with the crystals of the inner ear. And yet, for people who continue to suffer the effects of BPPV (which is a LARGE amount), there must be something else going on.
But wait! What about the Epley Manoeuvre? Isn’t that for BPPV because it helps to reposition the crystals in the inner ear which are responsible for balance, dizziness and vertigo? Well … I don’t believe so. You see, the Epley Manouevre is about 50% effective for helping people with BPPV, which is fantastic! (More on the other 50% later in this article that the Epley Manoeuvre doesn’t quite seem to help). However, I do not believe that it works the way that other specialists think it does. What I see is a person who is moving their neck through a full range of motion, and by doing so, releasing tiny points of restriction that are affecting the balance and sensory nerves in the neck that are actually responsible for coordination.
My reasoning is simple: we are told that BPPV is because of crystals in the inner ear … but have you actually seen these crystals malpositioned? Moreover, has anyone ever remarked about these crystals on your MRI scans? The reason that no one has is that you cannot see the crystals of the inner ear on an MRI. They are too small! So, the idea is certainly plausible that BPPV is caused by a problem with crystals in the inner ear … but it is also plausible that something else entirely different is going on. And what more and more research is showing us that it is your neck that might make all the difference.
Is it Meniere’s Disease, BPPV, Vestibular Neuritis … or none-of-the-above?
A paper came out in 2021 talking about the marked similarities of Meniere’s Disease, BPPV, Vestibular Neuritis and cervicogenic vertigo. What the researchers proposed is that these are not actually different disease processes at all, but that they are different manifestations of the same thing that shows up in slightly different ways in different people. In other words, it isn’t the diagnosis of the vertigo condition that matters most. It is the common underlying thing that is causing it.
What the researchers also described was how an absolutely massive percent of people diagnosed with either Meniere’s Disease or BPPV or Vestibular Neuritis actually had underlying issues with their neck that was also causing neck pain, headaches, and shoulder problems (including posture asymmetry and a low shoulder). The researchers then went on to propose something that I and many other specific upper cervical chiropractors have been saying for many, many years: the structure and alignment of the joints in your neck have a massive role in dizziness, vertigo and thus may be an essential and powerful solution to helping people with Meniere’s Disease, BPPV, Vestibular neuritis or any number of other balance-related disorders when all the other treatments (perhaps with the exception of the Epley Manoeuvre) are focused on treating the effects.
How is your neck (cervical spine) involved with dizziness and BPPV?
In brief, the balance centres of your brain receive information from three primary sources:
- Your inner ear
- Your eyes
- The joints of your cervical spine.
The joints in your neck contain a vast array of sensory receptors known as proprioceptors that are involved with the internal body and position sense, which is essential for maintaining normal muscle tone and in an upright posture. Proprioceptors are especially dense in the muscles of your upper neck at the base of the skull called the suboccipital muscles. These suboccipital muscles are involved in maintaining the balance of your head. Indeed, there is far more that goes on in balance and equilibrium than that, but these are the three primary sources of information. So for any person experiencing BPPV or other balance-related disorder, it is essential to get tested not just for a brain MRI of your inner ear, but it is also important to get your eyes and your neck tested.
The other part of the neck side-of the-story that is terribly important for people with BPPV is the influence of the top vertebrae of the neck on blood flow to, from and within your skull. The top vertebra in your neck is called the C1 or atlas bone. The second vertebra in your neck is called the C2 or axis bone. These vertebrae provide about 50% of the total movement of your entire neck. They are also involved in protecting your brainstem, which is the master control centre for every function in your entire body.
These vertebrae also transmit what is known as the vertebral arteries and veins that supply blood to your brainstem and balance centres. When the atlas and axis have been found to be misaligned - i.e., not broken or dislocated - that they can affect the normal circulation of brain fluids. Now, this isn’t necessarily the type of injury that will kill you (because these almost always show up on MRI). What we are talking about are 1-2mm injuries that affect blood flow by only a few percentage points, but that added up over a long period of time can ultimately contribute towards a sense of dizziness or vertigo.
A study in 2022 found that people suffering BPPV also experience significant decreases in their total neck range of motion. Remember what we literally just said: 50% of your total neck movement comes from your atlas and axis. You might be able to imagine that if these vertebrae have ever been knocked or jarred from their normal position that they will affect how well your neck is able to move. So when it comes to BPPV, I repeat, the health of your neck is of critical importance!
Atlas Treatment and BPPV
If you have suffered BPPV for a while, including if you have tried the Epley Manoeuvre, you may be wondering two things: 1) why didn’t it work for you, and 2) why hasn’t anyone said that there are any problems with your neck on an x-ray, CT or MRI scan? The first question, I believe has to do with how much and how tightly locked out of position the vertebrae in your neck could be. Think of it like trying to open a jar. Some jars open without issues. Others nearly take a crowbar to open. Levels of friction are different in different circumstances. When it comes to atlas-axis misalignment, I believe it is similar. For some people, all that is needed to un-jam the vertebrae in their neck is basically to hang upside-down and do a few mobilisations and stretches. This is why physiotherapy is often so effective for people with BPPV.
However, when things are stuck - just, stuck - gravity alone won’t solve the problem, in which case these people frequently need what is known as an upper cervical specific correction performed by a unique type of chiropractor who focuses on that area of the spine. Note: this can be done precisely without needing to twist or crack the neck, so don’t worry about that.
As for why your problems don’t necessarily show up on an MRI or CT report, part of the reason is that most specialists aren’t looking there. However, the other reason is that MRIs and CTs are taken from stock 90-degree angles to the planes of your body. However, your body is a three-dimensional structure with oblique angles that are different in every single person. Your architecture is unique, and so unless these individual differences are taken into account, there is no way that you will be able to detect the significant 1-2mm misalignments that are present until they become 5-7mm misalignments, which of course are far more severe and will need way more than an upper cervical chiropractor to help.
This is why so many upper cervical chiropractors who use the Blair Technique are often able to find these types of problems and help people with BPPV even if they have been to all the other doctors and specialists. We are looking at the problem differently so that we might be able to come up with a different type of solution to help you get to the cause of the problem and not just treat the effects.
Upper Cervical Chiropractic and BPPV Treatment in Brisbane
The Blair Technique is an independent approach to healthcare, developed and researched in the USA that focuses on the alignment of the atlas and axis vertebrae (similar to the NUCCA or Atlas Orthogonal techniques) as they relate to a variety of neurological conditions including BPPV. The way that the Blair procedure begins is with a detailed health history, a focused physical and neurological exam, and also a series of precise diagnostic images in order to determine the exact location, direction and degree of misalignment in your neck that could be connected with BPPV.
From here, a Blair Upper Cervical chiropractor will recommend a personalised course of care in order to restore the normal alignment and motion through your neck without twisting or cracking - ultimately to take the pressure of the nerves, restore the normal flow and function of your body so that you can have a much better chance of getting back to enjoying the quality of life that you desire most. We hope that we have found value in this article and that it may give you hope that there are other options out there to help you.
At Atlas Health, we are the leading upper cervical chiropractic healthcare centre in Australia. Located in North Lakes (north Brisbane), our practice works with people across the country experiencing a variety of conditions including BPPV. We take an independent, detailed and personalised approach to help people so that you can have the best chance of success with the least amount of intervention possible.
If you would like to schedule a consultation to find out if the Blair Technique and Upper Cervical Care may be right for you, call us at 07 3188 9329 or click the Contact Us link on this page, and one of our staff will be happy to arrange things for you. We look forward to hearing from you.
References
Armstrong BS, McNair PJ, Williams M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clin Biomech (Bristol, Avon). 2005 Aug;20(7):675-84. https://www.ncbi.nlm.nih.gov/pubmed/15963617
Attanasio G, Califano L, Bruno A, et al. Chronic cerebrospinal venous insufficiency and menière's disease: Interventional versus medical therapy. Laryngoscope. 2019 Nov 11. doi: 10.1002/lary.28389. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31710712
Burcon MT. Health Outcomes Following Cervical Specific Protocol in 300 Patients with Meniere’s Followed Over Six Years. Journal of Upper Cervical Chiropractic Research ~ June 2, 2016, ~ Pages 13-23. https://www.vertebralsubluxationresearch.com/2016/06/02/health-outcomes-following-cervical-specific-protocol-in-300-patients-with-menieres-followed-over-six-years/
Damadian RV, Chu D. The possible role of cranio-cervical trauma and abnormal CSF hydrodynamics in the genesis of multiple sclerosis. Physiol Chem Phys Med NMR. 2011;41:1-17.
Flanagan MF. The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurology Research International, 2015; Article ID 794829: http://dx.doi.org/10.1155/2015/794829.
Jain S, Jungade S, Ranjan A, Singh P, Panicker A, Singh C, Bhalerao P. Revisiting "Meniere's Disease" as "Cervicogenic Endolymphatic Hydrops" and Other Vestibular and Cervicogenic Vertigo as "Spectrum of Same Disease": A Novel Concept. Indian J Otolaryngol Head Neck Surg. 2021 Jun;73(2):174-179. doi: 10.1007/s12070-020-01974-y. Epub 2020 Jul 22. PMID: 34150592; PMCID: PMC8163930. https://pubmed.ncbi.nlm.nih.gov/34150592/
Rosa S, Baird JW. The craniocervical junction: observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66 (DOI:10.1159/000365470).
Teng CC, Chai H, Lai DM, Wang SF. Cervicocephalic kinesthetic sensibility in young and middle-aged adults with or without a history of mild neck pain. Man Ther. 2007 Feb;12(1):22-8. Epub 2006 Jun 14. https://www.ncbi.nlm.nih.gov/pubmed/16777468
Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016 Dec;16(12):1598-1630. doi: 10.1016/j.spinee.2015.08.024. Epub 2015 Dec 17. https://www.ncbi.nlm.nih.gov/pubmed/26707074
Yang L, Chen J, Yang C, et al. Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study. World Neurosurg. 2018 Nov;119:e686-e693. doi: 10.1016/j.wneu.2018.07.243. Epub 2018 Aug 6. https://www.ncbi.nlm.nih.gov/pubmed/30092465
Micarelli A, Viziano A, Granito I, et al. Onset and resolution failure of recurrent benign paroxysmal positional vertigo: the role of cervical range of motion [published online ahead of print, 2022 Jan 29]. Eur Arch Otorhinolaryngol. 2022;10.1007/s00405-021-07226-1. doi:10.1007/s00405-021-07226-1. https://pubmed.ncbi.nlm.nih.gov/35091829/
Leave a comment