OMT May Be Helpful in the Management of Benign Paroxysmal Positional Vertigo
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Luke Tegeler
Papa L, Amodio A, Biffi F, Mandara A. Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness. J Bodyw Mov Ther. 2017;21:866-872. doi:10.1016/j.jbmt.2017.03.001
In 2013, Fraix et al1 reported that osteopathic manipulative treatment (OMT) for spinal somatic dysfunction improved balance in patients with chronic dizziness. Benign paroxysmal positional vertigo (BPPV) is an episodic spinning sensation with head repositioning arising from dysfunction of the inner ear. Pathophysiologically, BPPV is associated with calcium debris in the semicircular canal. It is typically successfully managed using repositioning maneuvers (eg, Epley maneuvers, Semont maneuvers, home exercises) and sometimes with medication.2 Refractory BPPV can be managed surgically.3 However, this study by Papa et al suggests that osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) could be helpful for managing refractory BPPV.
To determine the effectiveness of OMTh to relieve dizziness associated with BPPV, the researchers measured patient stability and assessed their behavior. Patients were enrolled if they had dizziness 2 weeks after traditional clinical therapies. After a baseline assessment consisting of a Dizziness Handicap Inventory (DHI) and stabilometric examination, patients were randomly assigned to a treatment group (n=20) or sham group (n=20). Patients in the treatment group underwent an objective osteopathic evaluation and received 3 weekly 20-minute OMT sessions consisting of articulatory and muscle energy techniques, fascial unwinding, balanced membranous tension, and high-velocity, low-amplitude to the thoracic and lumbar spine. The sham group underwent light touch over areas of dysfunction, 10 minutes for evaluation and 10 minutes for treatment. Both the DHI and stabilometric assessments of all patients were taken before the first week and 1 week after the last intervention.
The treatment group had significant improvement in global, physical, and functional emotional aspects of DHI from baseline to follow-up (all P<.001). Compared with the sham group, the treatment group also showed statistically significant DHI improvements in global (P=.02), function (P=.03), and physical (P=.03) scores, but not emotional scores (P=.62). Regarding stabilometric assessment, the treatment group showed a significant decrease in velocity (P=.007), swinging of area (P=.006), and swinging on Y-axis-O (P=.023); the only difference between groups for stabilometric assessment was area measure (P=.02). Within the treatment group, there was a significant correlation between reduced swinging area and global DHI changes (P=.02), functional DHI subscale changes scores (P=.03), and physical DHI subscale variation scores (P=.01).
Having determined improvement in the treatment group in stability and behavior measures, the authors concluded that OMTh in combination with traditional therapy may be of clinical benefit for patients with BPPV. Manual techniques may assist in promoting proprioceptive inputs to the central nervous system, indirectly contributing to the observed improvement in body stability. The lack of significant improvement of the emotional subscale between groups could result from either benefits of light touch or a lack of time to appreciate the full improvement in mood. One weakness in this study was the high dropout rate (40%) in the sham group (7 patients perceived a lack of efficacy).
In summary, this study suggests that OMT can benefit the integration of proprioception, vestibular information, and visual input. Osteopathic physicians should consider OMT in combination with traditional medical therapy for the management of BPPV.
References
1. Fraix M , GordonA, GrahamV, HurwitzE, SeffingerM. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness. J Am Osteopath Assoc. 2013;113(5):394-403.Search in Google Scholar
2. Kim JS , ZeeDS. Benign paroxysmal positional vertigo. N Engl J Med. 2014;370(12):1138-1147. doi:10.1056/nejmcp1309481Search in Google Scholar
3. Fife TD , IversonDJ, LempertT, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70(22):2067-2074.10.1212/01.wnl.0000313378.77444.acSearch in Google Scholar PubMed
© 2018 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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