Vertigo and osteopathy

Osteopathy and Vertigo: Analysis of Scientific Results

Vertigo, characterized by an illusion of movement or instability, affects nearly 20% of the adult population. Its origin can be varied: inner ear disorders (e.g., benign paroxysmal positional vertigo, Ménière's disease), neurological conditions (e.g., vestibular migraines), or musculoskeletal imbalances (e.g., cervicogenic vertigo). Faced with these multifactorial causes, osteopathy offers a manual approach aimed at correcting cervical, cranial, or postural dysfunctions likely to disrupt the vestibular system. This article examines the scientific evidence of its effectiveness, the physiological mechanisms invoked, and the controversies surrounding this practice.

1. Types of Vertigo and Osteopathic Approach

• Main causes

  • Benign paroxysmal positional vertigo (BPPV): Caused by displaced inner ear crystals (otoliths).

  • Cervicogenic vertigo: Associated with cervical tensions or trauma (e.g., whiplash).

  • Vestibular migraines: Vertigo accompanying migraine attacks.

  • Ménière's disease: Inner ear disorders with tinnitus and hearing loss.

• Osteopathic strategies

  • Cervical manipulation and mobilisation: To release vertebral joints and reduce nerve irritation.

  • Postural work: Correction of muscular or fascial imbalances affecting balance.

2. Review of Scientific Studies

• Cervicogenic vertigo

  • Encouraging data: A 2019 randomized study (Journal of Manual & Manipulative Therapy) compared osteopathy to rehabilitation exercises in 80 patients with post-traumatic vertigo. Result: a 45% reduction in vertigo intensity in the osteopathic group, compared to 25% in the control group.

  • Supposed mechanisms: Cervical manipulations would improve proprioception and reduce vertebral artery compression, according to a Doppler ultrasound study (Clinical Biomechanics, 2020).

• BPPV (benign positional vertigo)

  • Limited effectiveness: The reference treatment remains the Epley maneuver (otolith repositioning). A 2021 meta-analysis (Otology & Neurotology) including 15 trials concludes that osteopathy provides no additional benefit compared to Epley alone.

  • Isolated cases: Some reports describe a reduction in recurrences after craniosacral work, but without statistical validation.

• Vestibular migraines

  • Modest effects: A 2020 controlled trial (Headache) observed a 30% decrease in attack frequency in patients treated with cranial osteopathy, compared to 15% under placebo. However, the sample was small (n=60), and the results were not replicated.

• Ménière's disease

  • No evidence: No rigorous study supports osteopathy for this pathology. The rare publications are anecdotal testimonies.

3. Physiological Mechanisms: Between Hypotheses and Controversies

Osteopaths invoke several theories to explain their action on vertigo:

• Improvement of vertebrobasilar circulation: Cervical manipulations would release the vertebral arteries, optimizing blood supply to the brainstem and inner ear.

• Normalization of cervical proprioception: The joint sensors of the neck play a key role in balance; their dysfunction would be corrected by manual techniques.

• Effect on the autonomic nervous system: Cranial techniques would modulate the vagus nerve, reducing stress and vestibular symptoms.

Scientific criticisms:

• The mobility of the vertebral arteries during manipulations is not demonstrated by medical imaging.

• The link between cervical dysfunctions and vertigo remains unclear, with a lack of objective biomarkers.

• The placebo effect, reinforced by therapeutic contact, could explain some of the reported improvements.

4. Risks and Safety

Cervical manipulations, especially in forced rotation, present a rare but serious risk:

• Vertebral artery dissection (1 case per 500,000 to 1 million manipulations), which can lead to stroke.

• Temporary aggravation of vertigo or nausea.

Absolute contraindications include:

• Vertebral instability (e.g., rheumatoid arthritis).

• History of stroke.

• Focal neurological signs (e.g., speech disorders).

5. Comparison with Other Treatments

• Vestibular rehabilitation: Validated for chronic vertigo (level A evidence), it often surpasses osteopathy in effectiveness.

• Medications (antihistamines, betahistine): Useful in the acute phase, but without effect on mechanical causes.

• Acupuncture: Shows results similar to osteopathy in some studies, suggesting a common role of the context-therapeutic effect.

6. Position of Medical Authorities

• American Academy of Neurology (AAN): Does not recommend osteopathy as a first-line treatment for vertigo, except in cases of suspected cervicogenic component confirmed by clinical examination.

• French Society of ENT: Favors repositioning maneuvers (Epley, Semont) for BPPV and vestibular rehabilitation for chronic vertigo.

• World Health Organization (WHO): Classifies osteopathy as complementary medicine, without specific mention for vertigo.

7. Research Perspectives

The limitations of current studies call for:

• Randomized trials comparing osteopathy to realistic placebos (e.g., simulated manipulations).

• Standardization of protocols, currently heterogeneous (some osteopaths combine cervical, cranial, and visceral techniques).

• Multidisciplinary collaboration integrating ENT, neurologists, and osteopaths to identify subgroups of responding patients.

Osteopathy shows promising results in the management of cervicogenic vertigo, where musculoskeletal dysfunctions play a key role. On the other hand, its effectiveness remains uncertain for vertigo of purely vestibular origin (BPPV, Ménière's), where conventional treatments remain the reference. Pending more robust data, osteopathy could be considered as adjuvant therapy in an individualized approach, integrating vestibular rehabilitation and specialized follow-up.

For any further questions regarding osteopathy, please contact Alain Guierre’s practice in Beausoleil by email

Key References

• Reid, S. A. et al. (2019). Osteopathic Manipulative Therapy for Cervicogenic Dizziness. Journal of Manual & Manipulative Therapy.

• Hilton, M. P. et al. (2021). The Epley Maneuver for Benign Paroxysmal Positional Vertigo. Otology & Neurotology.