One day you wake up and the room is spinning so much and you are nauseated by the experience. You notice that turning your head one way makes the dizziness worse and less the other way. Does the dizziness go away on its own? Where did this come from? Which specialist should you see first? What is Benign Paroxysmal Positional Vertigo (BPPV)? Benign Paroxysmal Positional Vertigo according to wikipedia is “Benign paroxysmal positional vertigo (BPPV), sometimes called “top shelf vertigo“, is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head. This can occur with turning in bed or changing position. Each episode of vertigo typically lasts less than one minute. Nausea is commonly associated. BPPV is one of the most common causes of vertigo.” Read more below Benign paroxysmal positional vertigo While this is the classical definition of the condition, the mechanism in the inner ear that prevents vertigo has to level the head to work properly. There are no shortage of videos on you tube showing how to perform the Epley Maneuver which is thought to move crystals that have moved out of place in the inner ear back in place. When my wife had vertigo she blamed on a large swing that we went on in Equator that went over the city of Banos from 100 feet up, the problem would come and go at will. One time, the symptoms were so bad she requested I take her to our EENT doctor who agreed with my assessment that the crystal idea is theoretical. He explained that the Epley maneuver works if the crystal moves right or left but not back and fourth. In other words, he had his doubts. The Mayo clinic describes the theory in their web site which can be reached in the link below. Mayo Clinic Q and A: Dizziness Caused by Inner Ear Crystals The medical world sees this as strictly an inner ear problem which is echoed from source to source, yet, so many patients are left with chronic vertigo that comes and goes without understanding why. The Epley maneuver may relieve the condition or it may not. It can also exacerbate the condition. Is there more to vertigo than crystals that move and affect balance or is there more to the imbalances that affect the inner ear balance mechanisms Vertigo is often a postural problem involving the whole body. As a chiropractor practicing over 40 years, I have had hundreds of patients with vertigo come in for a neck and a back problem. Improving how they moved often improved the vertigo significantly in most patients. Medical specialists look at the problem symptomatically and attempt to reduce the symptoms medically however the medications have side effects and rarely do much to help. It seems to be sensible to use the Epley maneuver however, when the body is causing the neck to tilt to one side, unless we correct the postural issue, vertigo can become chronic. There is also the consideration for labyrinthitis and Meniere’s disease, which is assumed to happen from trauma or aging. One other source is postural hypotension which happens if the adrenal glands do not cause the blood vessels to constrict fast enough, which reduces blood temporarily to the brain. This is often present in older patients however many of them are on a number of medications including blood pressure and statistically, most falls in the elderly are medication related. Ruling out postural hypotension is done by taking the blood pressure sitting and then right as they stand. I significant drop in blood pressure helps diagnose this. Patients rarely have postural hypotension. Most doctors fail with the condition because they never consider posture, body style, body mechanics and attempt to treat the symptoms while failing to solve the problem. Your chiropractor may offer a better option by being holistic. Why visit the chiropractor for vertigo? Most patients with vertigo visit for back pain, neck problems, shoulder issues and other symptoms after the problems have become chronic. The vertigo often shows up when they get up from the table. After they are treated, a common side effect of their muscle work and spinal adjustment is less dizziness. Many patients after having their back problems or neck issues resolved, also notice they feel better getting up and no longer have the dizziness. During our history and evaluation, patients with BPPV are often leaning to one side, due to asymmetrical tightness causing their head to lean to the side as well. This offsets the occiput, the base of the skull resulting in an unlevel head and the symptoms of vertigo. Correct this and most patients will have relief usually within the following 24 hours. Postural problems can have multiple sources and your chiropractor who does primary care for the musculoskeletal system can see the malfunction in your posture as we look at the patient, rather than only the symptoms. Solve the mechanics from the ground up and most patients resolve their vertigo, including those chronic cases. Is the Epley maneuver helpful? Sometimes as in the case of my wife. We finally resolved the problems using a combination of chiropractic methods of muscle work, manipulation and foot orthotics help to level and unlevel pelvis. Each patient has a different reason behind why they developed vertigo. From the chiropractic perspective, improving how you walk, body symmetry and poor adaptations that affect the tension on the neck may be the reason most people develop vertigo. In our experience, correcting posture, improve pelvic balance which reduces upper body tension into the neck reduces vertigo in many of our patients. Some patients do require Epley maneuver which can help but crystal displacement as a cause of BPPV can be helped with the Epley Maneuver. Considering both is most helpful. Seeing the entire patient in front of you is better medical care, since most doctors dwell on the symptoms, yet, the patient with their postural adaptations is often overlooked in the process. Chiropractors are holistic and look at the entire patient. The patient with vertigo may have a concurrent back issue, sciatic problem, foot problem such as plantar fasciitis and may even have historically poor balance. We must consider all of this as research is now showing us that balance affects us neurologically and perhaps, vertigo is a side effect. Resolving the problem which may actually be a gait issue from the ground up may resolve the vertigo, the back problem, the shoulder problem and more. More often than not, this is a common outcome in chiropractic offices. Improving the way you function and move may be the answer to many chronic problems that are worsening as we age. We are also learning that better balance and gait is good for our brain which adapts positively over time and results in fewer falls and fewer back problems as we age. NPPV may be a symptom of poor mechanical function. Seeing a chiropractor first may be your best choice. If the doctor believes that patient requires medical attention, they will send them to the appropriate provider. The good news is that chiropractic primary care approaches to the musculoskeletal system are safe, effective and improve the quality of your life. Need help today? Book online or call one of our offices today.