Vertigo is defined as a false sensation of movement of the self or the environment. Vertigo is a sensation and not necessarily a diagnosis as there are multiple underlying pathologies responsible for vertigo [25,26].

Diagnosis

Diagnosis of vertigo relies primarily on the patient’s history and clinical examination. Potential causes of vertigo include both pathological disorders such as vertebro-basilar insufficiency or central nervous system lesions as well as more benign causes such as cervicogenic vertigo or benign paroxysmal positional vertigo [25]. Chiropractors are trained to take a thorough history and perform a neurological examination. If we detect any signs that your condition is more suitable for medical treatment we will recommend a referral to your GP.

Evidence based summary for manual therapy [53]

The highest current standards of scientific evidence suggests that there is moderate quality evidence (on a scale of inconclusive, moderate and high that manual treatment (specifically sustained natural apophyseal glides) is an effective treatment for cervicogenic dizziness, at least in the short term [27].

There is evidence that benign paroxysmal positional vertigo (BPPV) is effectively treated by manual therapy procedures such as the Epley manoeuvre. [Cohen HS, Kimball KT. Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol. 2005;26:1034-1040. von Brevern M, Seelig T, Radtke A, et al. Short-term efficacy of Epley’s manoeuvre: a double-blind randomised trial. J Neurol Neurosurg Psychiatry. 2006;77:980-982. Tanimoto H, Doi K, Katata K, et al. Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal. Neurology. 2005;65:1299-1300.]

Other effective non-invasive physical treatments or patient education [53]

Particle repositioning manoeuvres for benign paroxysmal positional vertigo, vestibular rehabilitation [25,28]

Back-in-Action clinical comment

The balance system relies on information from the position sense of the joints and muscles (particularly of the neck), the vestibular system (inner ear ‘spirit levels’) and the eyes. Information from these areas is integrated in certain brain areas which also need to be working well for healthy balance.

Chiropractors treat dizziness and vertigo using a package of care that may include manual therapies and onward referral where indicated. A thorough functional neurological assessment is highly recommended. Treatment may include functional neurological exercises (vestibular, eye, cerebellum etc.), chiropractic spinal manipulation, cranial work, muscle release techniques, ergonomic advice, relaxation advice, postural advice, acupuncture, breathing techniques, neck exercises, jaw exercises. These disorders may be co-managed medically or with physiotherapists or dental practitioners.

There is evidence to support this approach to patient care [29,30].