Balance Problems and Osteopathy

Your balance is maintained by the co-ordination by the brain of information from the eyes, ears (vestibular system), and of muscles and joints throughout the body (proprioception), especially the neck. Parts of the brain then direct certain muscles to contract and relax to help us keep stable. Disturbance to any part of the balance system leads to symptoms such as dizziness (a sensation of feeling unsteady) and vertigo (where the world seems to spin around you).

Causes of dizziness

Rm5 ST

These range from changes in blood pressure

(from a faint caused by an emotional reaction, to extremely high blood pressure) to much more serious circulatory or neurological problems. Anaemia, low blood sugar or various drugs may also cause dizziness. These are best dealt with by medical treatment of the underlying cause. Dizziness, however, is also sometimes caused when there are mechanical problems in the neck, particularly the upper neck area, and osteopathic treatment  of such problems at Lincoln Osteopaths can often relieve these symptoms.

Inner ear problems

There are a number of problems that affect the inner ear, or more specifically the vestibular system. (The inner ear also contains the cochlear, which is involved in hearing.) This normally monitors what position the head is in, in relation to gravity, and also how fast we are moving. Any disturbance to one ear causes extreme confusion to the brain, co-ordinating all the information regarding balance, frequently leading to vertigo, and in the extreme the sufferer can barely rise from lying down without feeling very unstable and sometimes nauseous, or even vomits as a result. More common causes of vestibular problems include benign positional vertigo, Meniere’s disease and vestibular neuritis (an inflammation or irritation of the nerve).

Benign Paroxysmal Positional Vertigo (BPPV)

This is believed to result from displacement of calcium carbonate crystals from their normal position in the ear into the adjacent canals where fluid movement occurs and is monitored by nerves along the canals. The crystals disrupt fluid movement causing confusion in the information then transmitted to the brain. This can be treated successfully by the Epley manoeuvre. Symptoms of vertigo usually occur after moving to lie on one side, or when turning the head,  ie dizziness occurs turning onto for example the right side, but not when turning onto the left. This also helps identify which is the disturbed ear (in this case the right ear). They occur for a brief period of up to 30 seconds following these movements, but settle down once the balance system gets used to the new position. Changing position then provokes the symptoms again.

Treatment for Benign Paroxysmal Positional Vertigo (BPPV) at Lincoln Osteopaths – Epley Manoeuvre

Patients with benign paroxysmal positional vertigo are being seen more frequent at Lincoln Osteopaths as word of mouth spreads. Helping patients with the Epley manoeuvre is very simple but very effective in relieving symptoms. If the diagnosis is correct, we rarely need to see people more than a couple of times and often symptoms are 80-90% better after the first treatment.

EpleyThe Epley manoeuvre was developed over 25 years ago. It involves a series of head positions that slowly guide the calcium carbonate crystals back to their appropriate position within the affected ear, usually resulting in a rapid reduction in symptoms. Frequently only one to three sessions are required, and improvement should occur after each occasion. During the manoeuvre dizziness or even vertigo may be caused temporarily. Indeed, this is a sign that the manoeuvre is appropriate, but the dizziness settles down while the various positions are maintained. Most people will feel less dizzy after the first series of manoeuvres.


Meniere’s disease

This is a more persistent disorder that involves some deterioration of the balance system. However, in between episodes, some improvement in balance control can be achieved by specific exercises that carefully challenge balance co-ordination (vestibular rehabilitation exercises). We can give advice about these.

Vestibular neuritis

This is believed to be the result of viral infection of one vestibular nerve (there are 2 vestibular nerves, one to each inner ear.). Medical treatment to help the infection is important in the early stages, but as the nerve starts to recover vestibular rehabilitation exercises are helpful in speeding the return to normal balance and activity.