Vertigo is the unsettling sensation of spinning, swaying, or tilting, where you or your surroundings feel as if they are constantly moving, even when you are still. This feeling is a profound disturbance in your sense of balance, not general lightheadedness. Since vertigo is a symptom of an underlying condition, treatment depends on identifying the source. Chiropractic care can be a beneficial management option, but only for specific types of vertigo originating outside the central nervous system. This approach aims to restore normal function to the systems that regulate balance and spatial orientation.
Understanding the Causes of Vertigo That Respond to Treatment
Vertigo is broadly classified into two major categories: peripheral and central. Peripheral vertigo originates from a dysfunction in the inner ear or the vestibular nerve, which sends balance signals to the brain. Central vertigo, which is less common, stems from a problem within the brainstem or cerebellum, the parts of the brain that process those signals.
The two primary types of peripheral vertigo that may respond well to manual therapy are Benign Paroxysmal Positional Vertigo (BPPV) and Cervicogenic Vertigo. BPPV is caused by tiny calcium carbonate crystals, called otoconia, that become dislodged from their normal position in the inner ear and migrate into the semicircular canals. Cervicogenic Vertigo arises from mechanical issues, such as stiffness or misalignment, in the joints and muscles of the neck.
Chiropractic Management of Positional Vertigo (BPPV)
BPPV is the most frequent cause of peripheral vertigo and responds well to specific, non-surgical interventions. The disorder occurs when displaced otoconia crystals travel into the fluid-filled semicircular canals. There, they inappropriately trigger nerve endings when the head moves, creating the intense, brief spinning sensation associated with BPPV.
Chiropractors who treat BPPV utilize specialized techniques known as Canalith Repositioning Procedures (CRPs). The most well-known is the Epley maneuver, a series of controlled head and body movements performed by the practitioner. The maneuver uses gravity to physically guide the displaced otoconia out of the semicircular canals and back into the utricle, where they belong.
The success rate for the Epley maneuver is high; studies show a single intervention can lead to symptom remission in a significant percentage of patients. Many chiropractors receive training in these maneuvers, making them a common part of their practice. Resolving BPPV typically involves this precise, evidence-based positional technique rather than traditional spinal adjustments.
Addressing Vertigo Linked to Neck Dysfunction
Cervicogenic Vertigo is a form of dizziness originating from the neck (cervical spine) and is often accompanied by neck pain or stiffness. The upper cervical spine, particularly the joints and muscles near the base of the skull (C1–C3), is densely populated with proprioceptors. These specialized nerve endings send information about head and neck position to the brain’s balance centers.
When neck joints or soft tissues are restricted or irritated, the proprioceptors send abnormal signals to the brain. This conflicting input, or sensory mismatch, with information from the eyes and inner ear, can confuse the brain and result in unsteadiness or dizziness. Unlike BPPV, cervicogenic vertigo is more often described as light-headedness or a generalized imbalance.
Chiropractic management focuses on restoring normal mobility and reducing muscle tension in the neck. Techniques may include spinal manipulation (adjustments) to improve joint function and mobilization to increase range of motion. Additionally, soft tissue therapy, such as myofascial release, is often used to address muscle hypertonicity, aiming to normalize the proprioceptive signals traveling from the neck to the brain.
When Chiropractic Care Is Not Appropriate
While chiropractic care is effective for specific types of peripheral vertigo, it is not the appropriate first step for all causes of dizziness. Symptoms suggesting central vertigo or a more serious neurological issue are considered red flags and require immediate medical attention. These symptoms indicate a potential problem in the brain, such as a stroke or other vascular event.
A patient should seek emergency care if vertigo is accompanied by:
- Sudden, severe headache
- Double vision
- Slurred speech
- Weakness or numbness in the limbs
- Severe imbalance that makes standing or walking impossible
- Loss of consciousness
If a full medical workup rules out central causes, and the diagnosis remains uncertain, a referral to a specialist, such as an Ear, Nose, and Throat (ENT) doctor or a neurologist, may be necessary to identify conditions like Meniere’s disease or vestibular migraine.