Balance Therapy in Your Practice
By Michael J Koch
It is a relatively unknown fact that the average human loses .5 of 1 percent of their vestibular functioning every year after the age of 20; this equates to 5 percent loss per decade. Therefore, by age 60, one loses approximately 20 percent of their balance and by the age of 80, approximately 30 percent or more. Very few, if any, can maintain much balance with that much loss.
It has been estimated that up to 40 percent of Americans - approximately 90 million people - will complain to their physician about dizziness. It is the second most common complaint made by seniors. The seemingly innocuous problem of vertigo and dizziness is actually the primary reason for falls, which are the number-one cause of traumatic death among seniors.
The unfortunate fact is that very few clinics or hospitals do much to treat vertigo and balance disorders. The good news is that the balance system can be restored, rebuilt, rejuvenated or rehabilitated - and chiropractors can play a major role.
Interestingly enough, the vestibular system does not actually atrophy, but simply goes to sleep; therefore, in most cases, it can be awakened rather quickly.
The general category or classification of "balance disorders" encompasses many different descriptions and diagnoses, including but not limited to: disequilibrium, disorientation, dizziness, falling, fear of falling, imbalance, Meniere's disease, motion sickness, nausea and vomiting, room or head-spinning, shuffling, stumbling, and vertigo. Many of these descriptions are used universally to describe various feelings and symptoms that lead to impairment, disability, falls and injury.
The primary contributors to balance disorders are inner ear and/or hearing weakness; medications; diabetic neuropathy; weak joints and joint sensors of the back, neck, hips, pelvis, feet and ankles; osteoporosis; arthritis; vision weakness; knee and hip replacement; Parkinson's; ALS; migraine headaches and light-headedness; multiple sclerosis; high blood pressure; mental confusion, anxiety, and depression; heart disease; stroke or lower extremity vascular deficiencies (poor circulation); orthostatic hypotension (low blood pressure upon standing); smoking; and alcoholism.
Benign Paroxysmal Positional Vertigo
Approximately 25 percent of all balance problems are benign paroxysmal positional vertigo (BPPV). The two most important words here are positional vertigo; that is, the patient experiences vertigo (dizziness / disorientation) with specific movement(s). While it can be any position, the most common ones are lying down, turning over in bed, bending forward or backward, and looking or reaching up.
The most telling differential diagnosis comes (as it does many times) from the patient's own mouth: "Doctor, I feel dizzy when I (fill in the blank - turn over in bed, put their head back in a beauty shop wash bowl, bend over to pet the dog, etc.)."
BPPV is easily diagnosed by this incredibly simplistic (no-tech) diagnostic technique. Other exam procedures, as well as high-tech vestibulo-videonystagmography (VNG) can confirm whether this is the primary diagnosis and/or whether there might be additional concomitant conditions at work.
It is important to note that rarely is there only one condition involved with abnormal balance. Our seniors are replete with multiple conditions affecting their balance. We must remember that muscular degradation is almost always preceded by fine sensory loss, mostly of the proprioceptive fibers. It is this loss of peripheral proprioception that affects the afferent signals to the brain, thereby affecting the motor output.
BPPV is primarily caused by an accumulation of microscopic, calcium-like particles in the lower levels of any one or more of the semi-circular canals (tubes). Similar to a clog in the "P" trap of a sink drain, these small "ear rocks" create a slowing of the normally free-flowing fluids in these tubes, thereby creating abnormal signals to the brain. Those abnormal signals are then "interpreted" by the brain as an imbalance, vertigo, dizziness, etc.
How Chiropractic Can Help
The best news about this disorder is that it can usually be corrected very quickly with one or two treatments by using one of several particle repositioning maneuvers, the most common of which is the "Epley maneuver." Many physical therapists, chiropractors, occupational therapists, audiologists and otolaryngologists know how to perform this procedure.