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 is no shortage of videos on YouTube 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 it on a large swing that we went on in Ecuador that flew over the city of Banos, supported by 100-foot metal ropes; 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 forth. In other words, he had his doubts about Epley’s effectiveness and was unaware that posture played a part in vertigo, something chiropractors encounter frequently. The Mayo Clinic describes the theory in their web site, which can be reached at 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 anyone understanding why. The Epley maneuver may relieve the condition, or it may not. It can also exacerbate the condition, as my wife found out accidentally. Is there more to vertigo than crystals that move and affect balance? Is there more to the body’s mechanical imbalances chiropractors see daily that affect the inner ear balance mechanisms, including the crystals that are theorized to be causing the condition? Vertigo is often a postural problem involving the whole body. As a chiropractor practicing for over 40 years, I have had hundreds of patients with vertigo come in for neck and back problems. 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, according to my otolaryngologist, Pei Lin, MD. 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. When was the last time your doctor considered postural adaptations in diagnosing and recommending methods to solve vertigo? Did the doctor look at you first, ask the right questions about previous neck, back, knee, and even foot issues that are valuable clues in diagnosing postural issues that may cause vertigo over time? Since they do not teach postural evaluation and consideration as part of the causation of BPPV as part of medical education, medical providers do not consider it. Chiropractors, on the other hand, always consider movement, posture, and gait as a reason for pain in the back, neck, shoulder, knees, and more. They also see patients with BPPV improve when patients move and function better. Medically, doctors consider labyrinthitis and Meniere’s disease, which are assumed to happen from trauma or aging. Is it possible these symptoms and history-based conditions are merely a diagnosis looking for a treatment without understanding the cause of the condition? There is so much that is misunderstood about BPPV in the world of healthcare. 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 flow to the brain. This is often present in older patients; however, many of them are on polypharmacy (more than one medication), 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 standing. A significant drop in blood pressure helps diagnose this. Patients rarely have postural hypotension. Most doctors fail at solving 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 because of how they are trained to understand posture and movement while using methods that are proven safe to treat these conditions. 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 dizziness. During our history and evaluation, patients with BPPV often lean to one side due to asymmetrical tightness, causing their head to lean to the side as well. This offsets the occiput which is the base of the skull, 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 during the initial part of your evaluation, rather than only considering the symptoms and jumping to conclusions based on a symptom of vertigo. 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 to help level and unlevel the pelvis. Exercises can reeducate poor gait and postural habits, improving many chronic physical problems you may be living with now. Each patient has a different reason for developing 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 and improving pelvic balance, which reduces upper body tension in the neck, reduces vertigo in many of our patients. Some patients do require the Epley maneuver, so consider both posture and the possibility of crystal involvement when postural improvements alone do not resolve the condition. The patient with BPPV may have a concurrent back issue, sciatic problem, or 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. This is why healthcare by a committee of doctors often fails, as nobody is really considering the whole patient. The chiropractic primary care approach has the doctor looking at and guiding the patient through care on each visit. Simple is better. Customizing exercises based on the patient’s unique needs vs. protocols based on a prescription for therapy is far more effective. You are not a protocol. Resolving the cause of BPPV, through chiropractic care, often resolves many of the chronic problems people have thought of as normal. 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 are good for our brain, which adapts positively over time and results in fewer falls and fewer back problems as we age. This also reduces the risk of bad knees, hips, and other joints 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 the 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.