Expert: Dr. J. Shawn Leatherman - 7/21/2006

Question
I  am presently  in chiropractic care for pinched or crushed nerves - pain in upper tigh area.  While the pain has now subsided, I have at times difficulty with all of the treatments due to Positional Vertigo, diagnosed earlier this year.  I experience now some return of the vertigo-had 13 adjustments so far, 11 more to go, and have asked for certain procedures, like the head weights and "cracking the neck" to be left out of the treatments.
The neurologist says that chiropractic can take care of sciatica but not vertigo.  The chiropractic doctor says just the opposite.
Your opinion, please,
Thank You.  

Answer
Dear MS. Kennedy,

Both of your doctors are right and both of your doctors are wrong.  Let me explain.

There are different types of vertigo which respond to different types of care. Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Neuronitis Vertigo, and Cervicogenic Vertigo.  To confuse the subject a bit more, there are also additional causes of dizziness (vertigo) such as Meniere's Disease, Labyrinthitis, Perilymphatic Fistula, and Acoustic Neuroma.

Of these above causes, many can be treated with medication to help reduce symptomatology, some are actually caused by viruses and bacteria, and antibiotics will help the latter.  Some actually require a surgical resolution.
Concerning chiropractic, treatment can help with with BPPV, and cervicogenic vertigo, and on limited basis with Meniere's disease.

BPPV:  This condition is believed to be due to degenerative debris(otoconia),floating around in the semicircular canals of the inner ear. There are two main treatment approaches:  habituation exercises and otoconia repositioning maneuvers.  Your chiropractic physician should be familiar with how to perform these proceedures.  Single treatment responses appear to be effective (55% to 70%)for repositioning, but habituation takes time and practice.

Cervicogenic Vertigo:  Usually preceipitated by a previous neck trauma such as a fall, sports injury or whiplash injury. This can be a recent injury or an older one. Chiropractic adjustments to the upper spine are beneficial because of the stimulation of proprioceptive receptors in the cervical spine (neck).  Because of the overlap of vertico symptoms and the difficulty in concrete diagnosis, Meniere's disease may also be helped with chiropractic care.

The most important thing is to get a proper diagnosis of what is the cause of the vertigo symptomatology.  If your Neurologist and Chiropractor cannot determine the cause of the symptoms, it is a guessing game as to what may help.  For instance if you were to have an Acoustic Neuroma, chiropratic care would not be an effective treatment, and neither would medication from your neurologist...you would most likely need surgery, and it would take an MRI for the definitive diagnosis of the problem.

In the mean time, Chiropractic care will not cause the problem to get worse, and you should see some good results within the first two weeks of treatment.  IF not, then you need to look further into the cause as it may be more serious in nature, or it may require medication for resolution.  The bottom line is that you should hold both of your doctors feet to the fire to come up with an approach to find the most likely diagnosis.  This will be the most appropriate way to help your symptomatology.

Good luck Ms. Kennedy.
Respectfully, Dr. J. Shawn Leatherman