Vertigo and osteopathy

Sight informs the central nervous system about our position in space in relation to visual cues in the environment...

The vestibule is located in the inner ear and is made up of canals filled with a liquid (the endolymph) in which crystals (otoliths) are found. The movement of these crystals in the fluid informs the nervous system about the position of the head (flexion, extension, rotation and tilt) as well as the accelerations and decelerations it undergoes.

Finally, the proprioceptive system is made up of multiple sensors distributed throughout the body (the proprioceptors) whose purpose is to constantly inform the central nervous system of the body's position in space. It is for example what allows us to know instinctively how our legs are positioned under a chair when we are sitting, without having to check visually. It is particularly the alteration of this system following an ankle sprain that will make us more vulnerable to a new episode.

A vertigo or a sensation of vertigo is triggered when two of these systems send different or contradictory information to the central nervous system. For example, if the vestibule does not function correctly, when the neck is rotated to make a turn, it will not send the right information, while the eyes will perceive this movement. The brain will then not know which information to trust, which is what triggers the vertigo that can go from a slight dizziness to a loss of consciousness.

Medically, a distinction is made between "lesional" vertigo, which is the consequence of a failure of the "measuring" organ (sight, vestibule, proprioception) and/or the "interpreting" organ (brain and cerebellum), and "symptomatic" vertigo, which is the consequence of an anomaly or an underlying pathology (for example, vertigo related to high blood pressure). In the case of "symptomatic" vertigo, their resolution will necessarily be linked to the definitive treatment or control of the anomaly that causes them (e.g. treatment of hypertension).

There are nevertheless a certain number of cases in which osteopathy can be effective, mainly in the so-called "positional" vertigo linked to a vestibular problem or in the deficits of the proprioceptive system (even if these generally cause other symptoms than vertigo). The most frequent are benign paroxysmal positional vertigo and Meniere's disease.

It is by far the most frequent and fortunately the least complicated to treat in general. It is an abnormality of the crystals in the inner ear which, instead of moving with the movements of the head, remain attached to the wall of the inner ear canals, thus no longer informing the brain effectively. The result is dizzy spells that are specifically triggered by a (usually rapid) movement of the head and can last from a few seconds to one minute. Diagnosis and treatment is done by a spectacular and effective maneuver called the "Head Shaking Test" or "Otolith detachment maneuver", normally performed by an ENT specialist or a physical therapist. In this context, it is often interesting to consult your osteopath in order to regain a good cervical mobility and to get rid of the apprehension to the movement which often persists in the patients having suffered from this type of vertigo.

Meniere's disease (or Meniere's syndrome) is a consequence of too much fluid present in the canals of the inner ear which prevents sounds from being perceived correctly and scrambles the balance signals sent to the brain. Thus, during an attack of vertigo, contradictory information reaches the brain, as if the body were both stopped and moving.

It is characterized by recurrent attacks of dizziness that are accompanied by whistling and ringing in the ears (tinnitus) and reduced hearing. Most often, only one ear is affected when the disease occurs.

It is a chronic disease. The frequency of attacks is highly variable and unpredictable. Most people have a few attacks per year, but some have several per week. Between attacks, periods of remission can last several months or even years. There is currently no cure for Meniere's disease, but the symptoms can be effectively relieved in most cases.

Meniere's disease most often appears around the age of 40 to 60, although cases have been described in children. It affects slightly more women than men. In Europe and North America, the prevalence varies from 1 in 1,000 to 1 in 10,000, depending on the study.

In this context, the role of your osteopath is important to try to limit as much as possible the occurrence of attacks by working on the mobility of the "head and neck", but also by making sure that all the liquid drainage channels of the head are as free as possible to limit the risk of clogging the channels located upstream. For example, by working on different muscles of the neck and the base of the skull, whose excessive contraction can have an influence on the vascular system, in the same way that the flow of a garden hose can be limited by a fold along its path.

In all cases, the onset of vertigo is a source of deep fatigue and is very often accompanied by stress or significant anxiety, which should not be neglected in the treatment of vertigo, and for which osteopathy is fully indicated. However, episodes of vertigo are very often linked to important tensions in the neck region and the base of the skull which can cause sensations of dizziness or temporary loss of balance for which your osteopath has very effective techniques. Your osteopath will also be able to redirect you to another practitioner for a multidisciplinary treatment or the realization of complementary exams. This can be done before or in addition to the treatment at the practice, so don't hesitate to ask!

Damien Fabre
Osteopath D.O
2 rue Alexis de Tocqueville
78000 Versailles