Chiropractic care for vestibular conditions is not unheard of in therapeutic circles. However, its representation in chiropractic literature leaves something to be desired. We know there are a range of case reports on cervicogenic dizziness and vestibular rehabilitation wherein individuals under chiropractic care received relief from symptoms concomitant with chiropractic care, but in the absence of significant larger studies, new case reports remain significant additions to new literature, especially when they include new presentations.
A new case published in the Chiropractic Journal of Australia included a novel case: that of Persistent Postural Perceptual Dizziness (3PD). Of significant note is the fact that the patient had been suffering for three decades, with symptoms including: foggy brain, difficulty concentrating, difficulty reading, “almost constant feeling of disorientation,” a feeling of “motion sickness”, poor balance, peripheral vision being sensitive to bright light, phono-phobia and intolerance to constant background noise .
It is interesting to note that 3PD is a relatively new terminology – a diagnosis of exclusion used to describe persistent vestibular symptoms. The author of the paper remarked that “The ‘History ’is very important in contributing to the diagnosis. The condition is Persistent, usually episodic, Postural, in that the signs and symptoms diminish or exacerbate in some postural positions and Perceptual in that the Dizziness (not spinning) is difficult to objectify and measure. It is a functional vestibular disorder often with conventional diagnostic tests and imaging being negative.” Usually, it occurs from a previous acute vertigo-related condition but the aetiology is complicated.
Interestingly, the patient had sought many other practitioners over the course of decades and had undergone “sophisticated” investigations including multiple imaging and testing regimes. Upon commencing chiropractic care, a detailed neurological exam was undertaken to search for any subtle signs or symptoms that might explain his situation.
The full case report, referenced below, includes the table of tests and the results of vestibular testing. More than 29 tests were run in order to ascertain a baseline before the commencement of chiropractic care. Of the 29, only three tests returned positive. This lead to a conclusion of motion sickness, visually induced dizziness, vestibular migraine, Mal de Barquement Syndrome, Benign Paroxysmal Positional Vertigo” and ultimately 3PD.
What the chiropractor did
Given the patient had suffered for so long, the chiropractor opted for a multimodal approach to care for the vestibular system, improve sensorimotor and visual integration, and undertake required rehabilitation. An extensive multimodal treatment plan was put into place that “focused on musculoskeletal, vestibular, oculomotor, and sensorimotor systems. The frequency of care was twice per week for five weeks .” While the full program, as well as home exercises is included in the original case report, it notes the self-reported changes being as soon as the third consultation. By the tenth session, (completion of the fifth week of care), he was able to achieve the goals set at the outset of care, and reported having whole days without fogginess. He now no longer felt “unbalanced.”
While the dizziness handicap inventory score had reduced from 32% to a post-treatment score of 20%, which still leaves room for improvement, it should be noted that an improvement above 10% is considered “clinically relevant.”
While this is only one case report, and thus we can’t make generalisations based on one case report alone, this one is thorough and gives a lot of clinically relevant detail when it comes to testing and multimodal treatment options for a complex disorder. Its well worth the read!
Richardson, D., (2022). A Novel Treatment for Persistent Postural Perceptual Dizziness: A Case Report. Chiropractic Journal of Australia. https://www.cjaonline.com.au/index.php/cja/article/view/293/136