Do you suffer from chronic dizziness? When I was practicing conventional family medicine over 25 years ago, chronic dizziness was one of the complaints that most family doctors hated to deal with. The practitioner knew that he/she could not help them and knew that referring them to a neurologist or otolaryngologist rarely helped.
What are the causes of dizziness? Dizziness is an imprecise term. Here are the most common categories of conditions that might make a patient say they feel dizzy.
Cardiovascular causes: when the person has a drop in the blood supply to the head due to either episodic low blood pressure or heart rhythm problems, the person will feel “dizzy” but when carefully asked, it is more of a “lightheadedness or feeling faint” sensation. They do not have spinning or balance symptoms.
Dizziness due to an abnormal vestibular system. The vestibular system comprises of fluid filled labyrinth canals in the ear that detects both position and motion of the head. If these are injured, inflamed, or if the nerve that supplies these canals are inflamed or injured the individual will experience vertigo. This is typically a violent sense of motion and spinning. This type of dizziness is called vertigo. It is extremely unpleasant. When the nerve is involved there often is ringing and hearing loss additionally associated with the condition. True vertigo has visible physical eye signs (a rapid jerking eye movement called nystagmus). The diagnosis is straight forward by mainstream doctors. There are “vestibular” tests done by ENT doctors, but they are merely confirmatory. The symptoms of true vertigo are quite distinctive. A CT or MRI can rule out physical lesions such as tumors or infarcts to that region.
Dizziness due to disequilibrium. Patients describe a sense of being off-balance, swaying sensation, sea sickness type symptoms. To understand dizziness caused by disequilibrium, one must have some basic understanding of what gives us a sense of balance and equilibrium.
For the mind and body to feel a normal sense of equilibrium, one must have three components of our body system working in coordination and harmony.
- We must have adequate vision. Our vision gives us information as to where our bodies are in relation to our external environment.
- Our inner ear vestibular system must work properly. The vestibular system comprises of fluid filled semi-circular canals. When the head/body moves into a different orientation the resulting fluid motion is detected and the brain can sense where our head is in space. E.g., when we tilt our heads, the fluid level tilts, and our brain can detect that we have tilted our head even when we have our eyes closed.
- We must have accurate proprioception. We have proprioceptor sensory nerves located on all our muscle/tendon, that give information about the length of each muscle in our body. For example, when we tilt our head to the left, our brain senses that our neck muscles on the right are longer and stretched and our neck muscles on the left are shortened and contracted.
To feel in balance all three components must give appropriate and congruent information and our brain must integrate thatinformation to tell us exactly where our body is in space.
When the information is incongruent, we feel disequilibrium and dizzy.
For example,
- When we are below deck in a rocky ship at sea. The boat is rocking, our vision shows no real movement of the walls, our proprioceptors show no rocking or tilting of the neck, but our vestibular system senses rocking. That mismatch makes us dizzy and sick.
- When we watch a video shot with a shaky handheld camera. Our vision senses marked shaking, but our bodies are not shaking so both the vestibular system tells us we are not shaking, and the proprioceptors tell us that there is no shaking. This mismatch of information makes us dizzy and sick.
- When we have injured our proprioceptors in our neck due to trauma, such as an auto accident, the proprioceptors can give wrong information. That is why, trauma to the neck following an auto accident can result in chronic disequilibrium/dizziness. Unfortunately, you do not have to have a history of trauma do have problems in the neck.
By far the most common cause of disequilibrium is due to incongruent proprioceptive information going to the brain. This type of dizziness is due to an abnormal muscle, tendon, ligament, proprioceptive nerve dysfunction (the myofascial).
Disequilibrium, however, is poorly diagnosed and managed by mainstream medicine. This is because the diagnosis and treatment of chronic neck myofascial dysfunction is poorly taught in medical school. Many patients and physicians do not realize that many cases of dizziness due to disequilibrium are problems with the proprioceptors in the neck.
Typically, the average neurologist or ENT doctor rarely ever examines the neck for clues because they were not trained to do so. I know this because every patient with dizziness that I have ever treated tells me the neurologist and ENT never physically palpated their p neck. I have also taught medical students for over 30 years and know that they are barely taught how to manage myofascial problems in their four years of schooling.
When carefully examined, most patients with disequilibrium have abnormal findings in the neck.
Chiropractors, Osteopaths, physical therapists, massage therapists, body work experts, acupuncturists, prolotherapists, neural therapists and other alternative therapists generally have more practical knowledge regarding managing symptoms related to the functional management of the musculoskeletal system than allopathic conventional medicine.
Unfortunately, all these alternative practitioners can only manage a portion of the causes of myofascial dysfunction and tend to be biased towards their own area of training and knowledge. The chiropractor will want to mobilize joints and vertebrae, the osteopath might use muscle energy technique or Jones strain counter strain, the physical therapist might use proprioceptive neuromuscular facilitation, heat, ultrasound, passive stretching, the massage therapist might use deep tissue massage, the prolotherapist will try to inject the ligaments and tendons, and the neural therapist might inject abnormal scars.
At the Chung Institute we are familiar with almost all the different myofascial diagnostic and treatment techniques and know which combination will most likely restore the proprioceptive system in the myofascial in the shortest number of visits. We have successfully treated numerous patients over the past 25 years with chronic dizziness due to disequilibrium by correcting their neck issues.
Information for physicians: that might want to learn how to manage dizzy patients.
Here are some key suggestions:
Define by history taking what type of dizziness the person is likely to have:
Cardiovascular: if sounds like lightheadedness or feeling faint or history or syncope. Check blood pressure issues, orthostatic symptoms, palpitations. Do cardiovascular work-up
Vestibular: if true vertigo symptoms, rule out benign positional vertigo with a Halle-Pike maneuver. Check hearing loss and tinnitus. Consider CT or MRI to rule lesions on or near the eighth nerve.
Disequilibrium: History of neck pain, tightness, history of trauma. Physical exam: check for limited range of motion and/or tenderness of attachment sites of splenius capitus, rectus capitus oblique, splenius cervices, facet ligaments, trapezius, levator scapula. Learn to exam these structures and be able to ascertain myofascial knots (trigger points), textural changes in the tissue.
Check for scars of head and neck; especially wisdom teeth extractions, tonsillectomy, head laceration, facial surgery, tail bone injuries. Scars of the upper extremities, especially carpal tunnel scars often cause problems with neck stiffness and pain. All should be treated appropriately with neural therapy.
Finally, there are some patients who have chronic dizziness due to partial deterioration of all three components. E.g., an elderly person who has poor vision, poor hearing, and stiff neck muscles. Many of these patients can be helped following the protocols discussed above.
For any physician truly interested in learning to treat this type of problem you are welcome to contact our office and spend some time in our office under a preceptorship.
M. Kyu Chung, MD
Director, Chung Institute of Integrative Medicine,
Clinical Professor, Cooper Medical School
Contact: either Carolann: 856-222-4766
Or email Brigid Bandomer: bbandomer@wonsookchungfoundation.org