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Category: Scientific Studies
Date 9-may-2003
Title Vertigo in patients with cervical spine dysfunction
Author Galm R; Rittmeister M; Schmitt E
Main Condition/ Disease  Hearing Disorders – Vertigo, dizziness
Source European Spine Journal: 1998; 7(1): 55-8 Eur Spine J
Abstract Summary of Abstract: This study evaluates the significance of disorders of the upper cervical spine as a cause of vertigo and impaired hearing. 67 patients are examined who presented with dizziness, 50 of which were studied. Physical therapy treatment protocol for 50 patients with a 3-month follow-up was implemented. Group A of 31 people was diagnosed with dysfunctions of the UpC spine and Group B of 19 did not have cervical spine dysfunction [CSD]. Dysfunctions were found in the UpC spine; 14 at C1, 6 at C2 and 4 at C3, with 7 having more than one segment involved. These dysfunctions were resolved using mobilising and manipulation techniques of manual medicine. Results showed that 77.4% of Group A reported improvement of their chief symptoms, with 5 completely free of vertigo. 26.3% of Group B improved, but no one was free of symptoms. It is concluded that examination of the motion segments of the upper cervical spine is important in diagnosing and treating vertigo. Non-resolved dysfunction of the upper cervical spine is a common cause of long-lasting dizziness.
Summary According to Galm et al “The appearance of dysfunctions of the upper cervical spine can be the cause of localised or pseudoradicular pain as well as the cause of vertigo and impaired hearing via disturbances of the proprioception from the neck” and “The significance of dysfunctions of the upper cervical spine as one cause of vertigo and impaired hearing has been commonly discussed in ENT and neurology literature “[Refs; as per the original article]. I find this extremely interesting because early-on in my research I discovered numerous papers and articles which demonstrate a clear link between hearing disorders and functional misalignments of the upper cervical spine vertebra, and regularly find reference to chiropractic manipulation in restoring hearing and removing vertigo and dizziness. Yet I still come across medical practitioners who discount the link exists and doubt that chiropractic intervention has any effect on hearing disorders. The authors go on to say that the thinking is that it is only the upper cervical spine segments (that is, C0, C1, C2 and maybe C3) which are responsible for vertigo when there is dysfunction.” Further they state, “Clinical experience correlates with anatomical studies, which were able to identify links between cervical spine receptors and vestibular nuclei. A large supply of receptors was found in neck muscles, especially when muscles were short and in close proximity to facet joints.” Of course, these receptors are positional sensors and provide a significant amount of special positional feedback to the brain; therefore it stands to reason that dysfunction in the segments of the cervical spine, cause ‘faulty’ input into receptors that in turn provide incorrect positional data back to the brain. For you and I this manifests itself as dizziness and vertigo. It also stands to reason that this dysfunction may be reversible.Of the 50 patients studied, if they had been diagnosed with CSD prior, then an outlined approach to manual therapy was applied. According to Galm et al “if dysfunction of the cervical spine segments were diagnosed in the studied patients with vertigo, they were subsequently resolved with manual therapy. Mobilising techniques without impulse as well as manipulative techniques with high-velocity impulses were applied.”Results: In Group A, which consisted of 31 patients, 16 of which “reported a significant improvement in vertigo. Four patients with a temporary improvement after initial manual therapy” and “24 of the 31 patients (77.4%) reported a lasting improvement … and 5 reported complete relief of vertigo. Seven patients had no improvement.” In is stated that none of the patients in group B, had an improvement and none had CSD. Galm et al “conclude that physical therapy is more likely to succeed in reducing vertigo symptoms if these patients present with an upper cervical spine dysfunction that is successfully resolved by manual medicine prior to physical therapy. We regard the cervical spine dysfunction seen in patients of group A as the principal cause of their vertigo.” Further “The existence of links between neck muscles and vestibular nuclei is known [6].”Note: the reference to the need for ‘manual medicine’ (I assume manipulation) before physical therapy. In my mind this lends support to my suggested “New Approach to Wellness” published on my site which involves amongst other things, chiropractic and muscular rehabilitation, especially for people who have had their condition for a long period.
References [6] Dutia MB (1991) The muscles and joints of the neck: their specialisation and role in head movement. Progr Neurobiol 37: 165-178
Keywords Vertigo, upper cervical spine dysfunction, manual medicine, manipulation, dizziness, proprioception

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