Dizziness
Dizziness is one of our most common health problems and a symptom of the body's balance system not functioning properly.
There can be many reasons for this. The balance system consists of several centers in the brain that receive and process sensory information from vision, the balance organs of the inner ear and the movement apparatus. Dizziness occurs when the brain perceives the information it receives about the body's position, from our various senses, as contradictory.
Common causes of dizziness
Joint locks and joint dysfunction, muscle tension and jaw / bite problems are the most common musculoskeletal causes of dizziness. Among other things chewing muscle (masseter) myalgia can contribute to dizziness and headaches. Other causes include disease of the inner ear; crystal disease, viral infection or Menièr's disease - or imbalance from age changes in nerves and general sensitivity.
Also read: - Sore jaw? This may be the reason!
Also read: - Interdisciplinary collaboration between dentist and chiropractor
Common symptoms of dizziness
The word dizziness is a general description of a symptom that is experienced very individually from person to person. In medical language, we distinguish between vertigo and vertigo.
What is the difference between vertigo and vertigo?
- Dizziness is a feeling most of us have experienced. You feel unstable and unsteady, and experience a rocking and shaky feeling. Many people feel ears in the head and it can blacken a little before the eyes.
- Vertigo is a more intense and powerful experience that either the surroundings or themselves rotate; a carousel-like feeling (gyratory vertigo). Others experience a rocking feeling, as if on board a boat.
Possible diagnoses and causes of dizziness
There are a wide range of possible diagnoses and causes of dizziness. Among other things, there are a total of 2805 medications that have listed dizziness as a possible side effect. Here are some possible diagnoses:
Diagnoses / causes
Addison's disease
alcohol poisoning
Anemia
Anxiety
Arnold-Chiari deformation
Arterial injury or syndrome
Inflammation of the balance nerve (vestibular neuritis)
Lead poisoning
Borrelia/Lyme disease
Cervical spondylosis (light wear on the neck)
Chediak-Higashi syndrome
Down syndrome
Drip in the brain
diver flu
Exhaust Poisoning (Carbon Monoxide)
Fever
Fibromyalgia
heatstroke
cerebral haemorrhage
Concussion (symptoms after head trauma should be discussed with an emergency room!)
Stroke
Heart failure
Myocardial infarction
brain cancer
Heart failure
Hip Cancer
hyperventilation
deafness
altitude sickness
High blood pressure (hypertension)
Internal bleeding
Iron deficiency
Crystal Disease (BPPV)
Labyrinthitis (inflammation of the auditory organ; labyrinth)
Low blood sugar
Low blood pressure (hypotension)
Joint Restraints / Dysfunction in the neck and upper chest
Leukemia
Malaria
Drug overdose
Meniere's disease
Migraine
myalgias / miosis
Nervous vestibulocochlear disease
kidney Problems
panic attacks
shock Condition
vision problems
Takayasus syndrome
TMD jaw syndrome
ventricular tachycardia
viral infection
Vitamin A overdose (in pregnancy)
Vitamin B12 deficiency
Whiplash / neck injury
Common causes of vertigo
Your balance is dependent on sensory information from the eyes, balance organs and the body's muscles and joints. Dizziness can therefore be a symptom that can have many different causes. Fortunately, most causes of vertigo are harmless. If your dizziness is accompanied by symptoms such as hearing loss, severe ear ache, visual disturbance, fever, severe headache, palpitations, chest pain or difficulty breathing, consult a physician to rule out underlying disease conditions.
The balance centers in the brainstem and cerebellum
Here all information from the sensory organs is recorded and coordinated. As long as the balance centers work and get sufficient information from the sensory organs, we have a sense of equilibrium. Therefore, malfunctions and disease states in one or more of these systems may give rise to dizziness.
The faculty of seeing
The sense of sight is very important for the balance. You notice this well if you try to keep your balance with your eyes closed. Conversely, you often get less dizzy and get better balance if you fix your gaze on a fixed point, such as the horizon when you are aboard a boat. If you have been in simulation you have experienced how much visual impression means for the balance.
Eye Anatomy - Photo Wiki
balance organs
These sit in the inner ear and are called maze. From the maze, the balance nerve enters the brain stem. The most common problems here are:
- crystal Sick (benign dizziness or BPPV): crystals can form inside the labyrinth's archways, creating "false" signals that it is spinning / going around. Presents often acute and causes severe dizziness when changing position. The seizures are accompanied by some characteristic small and almost imperceptible twitches in the eye muscles called nystagmus. Can often be treated easily, safely and effectively with Epley's maneuver that most chiropractors master, as well as exercises the chiropractor can instruct.
- Inflammation of the balance nerve (Vestibular neuritis): may be associated with viral infection from eg throat, sinus or ear. The symptoms here may be more constant, and not so dependent on head or body position. An inflammation of the balance nerve will usually disappear by itself after 3-6 weeks. In a few cases, these symptoms will be troublesome for prolonged periods.
- Meniere's disease: is a troublesome and persistent, but not life-threatening form of dizziness. The symptoms come with seizures with severe dizziness, sounds in the affected ear and hearing loss that increase during seizures. The hearing will gradually deteriorate. The cause of the disorder is unknown, but probably several factors play a role; blue. viruses, hereditary factors and certain types of allergy or food intolerance.
Sensory information from skin, muscles and joints
This system helps maintain your balance through a continuous flow of feedback from the joints, tendons and muscles throughout the body to the balance centers. Small sensory nerves record movement and position in all parts of the body, and this information goes into the spinal cord and on to the brain.
Cervical facet joint - Photo Wikimedia
Upper part of neck
The neck is programmed to automatically allow the head to follow sensory impressions from sight and hearing. If we see something moving in the field of view or hear a sound behind us, we will automatically turn our heads to orient ourselves. The neck is also programmed so that we automatically move the head in the direction of movement of the body. The balance centers also always receive important information from the joints at the top of the neck about the head's position in relation to the body.
Balance systems depend entirely on correct information from the muscles and joints at the top of the neck. Dizziness is often caused or worsened due to dysfunction of the joints / joints and muscle tension in the neck, especially the upper levels.
Other causes of dizziness
- Stress, restlessness and anxiety
- Side effects of medications
- Diseases of the central nervous system
- Circulation problems
- High age
EXERCISE AND Dizziness
How to prevent dizziness with balance training?
The best advice for preventing balance problems is activity that stimulates the balance system. In the same way that muscles, skeletons and joints depend on activity and exercise, the balance apparatus must be kept active. If some parts of the balance device are damaged, other parts of the system can be trained to compensate for this. The training for dizziness is intended to challenge the balance system so that you get better balance function. Especially in old age, movement and balance training is important. Many injuries and falls are unfortunately due to dizziness and could have been avoided. Exercise must be adapted to the degree of ailments. Talk to your therapist and get good advice.
Also read: - Injury prevention training with bosu ball!
Bosu ball training - Photo Bosu
TREATMENT OF Dizziness
Manual or physical treatment of dizziness
First, the clinician (eg chiropractor, manual therapist or physiotherapist) must find out what type of dizziness you have. A thorough examination of the function of the neck is always useful for most patients with dizziness, as all or part of the cause of the problem may lie there. The clinician will then be able to provide you with effective and safe treatment, to restore normal function in those parts of the nerve-musculoskeletal system that aggravate other conditions of dizziness, so that treatment of these can be an important part of an interdisciplinary rehabilitation program for dizziness.
Chiropractic and dizziness
Chiropractic therapy seeks to restore normal functioning of the musculoskeletal system and nervous system to reduce pain, promote overall health and improve quality of life. In the treatment of the individual patient, emphasis is placed on seeing the patient in a holistic perspective after a total assessment. Interdisciplinary collaboration can be useful. The chiropractor mainly uses the hands in the treatment itself and uses a variety of methods and techniques to restore normal function of the joints, muscles, connective tissue and nervous system, including the following techniques:
- Specific joint treatment
- Stretches
- Muscular techniques
- Neurological techniques
- Stabilizing exercise
- Exercises, advice and guidance
Diet and dizziness: Do you get enough nutrition and fluid?
Drink water: If you are dehydrated, this can lead to low blood pressure (hypotension) - which in turn can lead to dizziness, especially when walking from a lying to a standing position and the like.
Take vitamins: The guidelines for the treatment of dizziness (especially among the elderly) state that one should take multi-vitamin if one suffers from this and has a little varied intake of nutrition.
Avoid alcohol: If you are bothered by dizziness, then alcohol is a very bad idea. In the vast majority of cases, alcohol will aggravate dizziness, both in terms of frequency and intensity.
Also read: 8 good tips and measures to reduce dizziness!
A little more about dizziness in general:
Dizziness is roughly divided into acute and chronic cases.
- Rotary or nautical dizziness
The feeling of dizziness is often described as rotational or nautical. Here it is mentioned that the nautical variant often indicates a more central cause. It is also mentioned that the more central causes often give a milder dizziness than the peripheral causes. Hence, nausea and vomiting often occur more often in connection with peripheral causes. The rotational form of dizziness is often frequent, acute and violent. This often gives the well-known "Vertigo quartet (falling tendency, nystagmus, nausea / vomiting, vertigo)".
What causes dizziness?
35-55% Vestibular
10-25% Psychogenic (primary)
20-25% Neck
5-10% Neurological
0,5% Tumor
Of course, the statistics will look different at our offices, but still interesting. I'm somewhat unsure of exactly what they put into primary psychogenic dizziness, but it was not particularly emphasized in the lecture. There is of course the opportunity to fall into several categories here. Regarding the category "Neck", one "hen and egg" problem is mentioned as they mention that there is very often an element of neck problem in the picture, but they are somewhat unsure if it is because the patient stops moving the neck / head off fear of dizziness for another reason or whether it is realistic with a primary neck dizziness. As we know it, literature on this is meager.
Differential diagnostics that should be kept in mind with dizzy patients:
Is the patient ill? - infection
Heart? - anemia, heart attack or drop in orthostatic blood pressure?
Brain? - tumor, stroke (unilateral neuro, speech problems, walking difficulties, etc.)?
Medications? - Especially older people who go on many medications
The sight? - Is this caused by a visual disturbance?
These were the main categories that were mentioned it is quite possible there are several problem areas that should be considered and kept in mind, but this seems to cover the more serious alternatives.
Extra hints:
Hearing loss? - Here one often thinks of schwannoma (national competence center at Haukeland), labyrinthitis, meniéres.
Tinnitus? - Here they like to think more about neck problems and / or PNS problems.
Most common cause of dizziness: BPPV aka. "Crystal disease"
About 80 cases a year in Norway - Common! Often recurrent. Expensive for society, a lot of sick leave etc. Most women over 000, more frequently at older ages. - Otoconia becomes more fragmented at an older age hence easier to loosen + get into the ducts.
- The posterior archway is most often affected by BPPV / crystal disease
Rear arch is most common (80-90%) followed by lateral arch (5-30%), anterior arch is extremely rare and other diagnoses should be considered.
Nystagmus is geotropic (towards the ground) in the "Dix-Hallpike test" with a sick side towards the ground (important part of the diagnostic picture - Ageotropic? Think DDX). Nystagmus will flush with the affected archway. Nystagmus may have a short latency period when testing (1-2sec) and a duration of about 30sec. The ear facing the ground by a positive "Dix-Hallpike" will be the affected organ. The correction maneuver is the known one "The Apple Maneuver".
At lateral arch BPPV: This is tested by having the patient lying on his back with a flexion of about 30 degrees of the neck / head. Here the head is rotated from side to side. It is common for there to be nystagmus on both sides, but you then look for the side that gives the MOST nystagmus. Nystagmus should also be geotropic (towards the ground). Correction is done using "Barbeque Maneuver", here the patient is placed on his back (preferably on a mat on the floor) to then rotate his head 90 degrees at a time AGAINST FRESH SIDE until the patient has been through 360 degree rotation.
Paper model of the channels is attached as pictures / files below.
Important extra points:
Previous advice on having to sleep in a sitting position is not necessary after correction, no restrictions are probably the best advice. Corrective maneuvers should preferably be performed 2-3 times per treatment or until it no longer triggers a nystagmus / vertigo sensation. Nystagmus (low grade) is a common phenomenon that does not necessarily indicate a problem. Is no nystagmus present during testing? Think DDX, but also be aware that similar movements to correction maneuvers can occur in daily life. One example that will be highlighted here is often going to look up at the sky / treetops etc, which often gives similar movements of the neck / head.
A differential diagnosis: paresis of the cupula will cause apogeotropic nystagmus towards the paresis side. But as a general rule, I probably think that if you see apogeotropic (away from the ground) nystagmus, you should refer on to one competence center.
- Basilar migraine and dizziness
One point is also mentioned regarding basilar migraine, this diagnosis is speculative / new. But this should be considered as an alternative if you get frequent episodes with something reminiscent of vestibular neuritis (violent rotational dizziness, constant over a long period of time) and if this happens periodically (Duration: as migraine hours to days, Can be with and without headache). Vestibular neuritis is in itself a diagnosis that is quite rare, and one is somewhat uncertain about exactly what it is due to, but this then gives full paresis of one balance organ over a certain period of time.
What causes BPPV?
At least 50% are called ideopathic. Other hypotheses that have some evidence are low vitamin D, osteoporosis, inner ear disease and neck / head trauma (if severe, one can end up with several archways involved).
Chronic dizziness:
As with chronic pain, much of the follow-up here is about activating and de-dramatizing the causal relationship. Here it should be possible to talk openly about everyday problems due to dizziness and other things, be reassuring and supportive. Regarding activation, both Vestibular rehabilitation and general everyday activities are presented. Vestibular rehabilitation is described here as progressively more complex movements with / without different head movements.
Specific suggestions are: Start with the back to one corner of the room (for a feeling of security), here the patient can try rhombergs with open / closed eyes, stand on one foot, with his legs in line or march on the spot. Eventually you can include head movements such as "shake your head (2 Hz - 2 shakes per second) aka" Mother-in-law's exercise "or nod your head aka" Yes, thank you for the movement ". Another focus point during vestibular rehabilitation is to be able to reposition the head with closed eyes. Here it is suggested to draw a dot on the mirror / wall, turn your head fully towards one side - close your eyes - return to the center position without opening your eyes. For the more advanced ones you can use an "ace" from a deck of cards, then you can vary the distance to the focus point with head movements (2 Hz) and eventually you can also include walking. The point here is to give a feeling of security when moving and stimulate neurogenic adaptation to varied movements that are necessary in a normal everyday life.
TESTS / FORMS etc for investigation of dizziness:
Cranial nerves (2-12)
Coordination tests: repetitive bvg, alternating bvg, walking on line, marching on the spot, rhombergs, finger to nose.
Head impulse test aka "Doll head" (+ woe hangs on to sick side)
Nystagmus by eye testing and / or by eye focus [Nystagmus: Vertical = CNS, Horizontal (+ rotation) = PNS, This is only a general rule of thumb, there are of course exceptions]
Cover-uncover test (+ ve is by vertical correction by uncover) - NOTE some correction happens in many healthy people, especially about vision problems or latent numbness.
Cervicogenic dizziness tests: "Saccades" / "smooth pursuit" with twisting of the head (45 degrees) [+ woe by more choppy / problematic to follow finger], Twisted head - return to center line with closed eyes, fixed head - twisting of body (use swivel chair aka office chair). As mentioned earlier, neck dizziness is a "chicken and egg" problem, but will probably be useful to help with exercise and make it more mobile.
- Physiotherapy and investigation of dizziness
The physiotherapist also looks at the patient's posture (avert?), Walking, relaxation ability and a test called "DVA test" (Dynamic visual acuity) - This test is done using a "Snellen chart". Look at the form / picture on the wall - which line do they come to? Max deviation is 2 lines when head movement is added in the form of shaking of the head (2 Hz).
Form that is mentioned in the physio's report (after they have been through a doctor / neurologist to eliminate red flags etc): VSS-SF (vertigo signs and symptoms - short form), DHI (dizziness handicap index) - here it is mentioned that he only uses parts of this, SPPB (functionally oriented for the elderly population - used by Bergen Municipality in the home care service).
Other useful tips and tricks:
DEMO of response rate at the different nuclei in the brainstem can be done using one sheet with markings / writing and head movements. Shake your head + read: OK (VOR / VSR, 10ms), while shaking on the sheet + read is slightly more washable (ROR, 70ms).
- Self-corrections
We should be happy to train patients who have dizziness as a persistent problem to make self-corrections. This can be done easily by using some pillows on the floor. This is also an important point for people a little more out in built Norway. Pillow under the thoracic spine for posterior arch and under the head / neck for lateral.
- Video glasses and dizziness?
There is a cheaper alternative to "video glasses" which are some German-made magnifying glasses of some glasses, but it seemed somewhat uncertain where you might get such. She who mentioned these mentions that she had to order them from Germany for a couple of euros each. I'm a bit unsure of the name here, so if anyone has more info this can be attached in the comments field.
- Neck and dizziness
The chiropractor part with a focus on neck-related dizziness and our clinical everyday life was much centered around the quality of movement and the interaction between neck movement and how it could possibly affect each other. Our role as a competent primary contact was strengthened here and the opportunity for further collaboration was aired. The physiotherapist quickly mentions here that he often refers to a manual therapist rather than a chiropractor, often out of his own bias due to his education, but will now be more open to referring to chiropractors, especially if someone excels as competent with an interest in the field. Perhaps a closer collaboration with competence centers is an important focus point that should be given more priority? There are also common misconceptions of chiropractors such as these claims to be able to cure all sorts and our mythical origins with DD and BJ, and assure our visitors that we are much more "down to earth" nowadays. WFC's database / reading list is discarded and simple studies regarding manipulation and dizziness / headaches come into play. Some talk regarding neck manipulation and risk / danger is taken up, in a good mood we probably agree that there is nothing particularly dangerous with neck manipulations. However, a good anamnesis to rule out risk factors is still preferable. (Here I can recommend reading the following literature: "Cervical arterial dissection: An overview and implications for manipulative therapy practice Lucy C. Thomas" and "International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopedic Manual Therapy intervention A. Rushton a, *, D. Rivett b, L. Carlesso c, T. Flynn d, W. Hing e, R. Kerry f ”.
Since Svimmelogaktiv.no is mentioned as a long-term project for activating chronic dizziness.
It is also mentioned that she alone doctor runs a larger study (RCT) that uses the "chair" that can rotate frequently in all directions for testing and correction of lateral archway vertigo. So if you have someone with this type of problem, especially near the Bergen area, it is recommended to contact "Camilla Martens" at the Balance Laboratory at Haukeland Hospital.