When people find themselves having vestibular issues, the first course of action would be to go to the ENT. However, for others, this is often not enough. What else should we do if we find these issues continue to persist? In this episode, Dr. Kevin Pecca interviews Dr. Jeffrey Scott to discuss the root cause of the problem and the solutions for these vestibular issues, particularly vertigo and Meniere’s disease. Pointedly, Dr. Scott dives deep into the relationship of our vestibular system to our upper neck and why upper cervical care can help. Dr. Jeff Scott is a Doctor of Chiropractic (D.C) at Montclair Upper Cervical.
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Solutions For Vertigo And Meniere’s Disease With Dr. Jeffrey Scott
This is a very special episode. We are going to go over everything that ties into vestibular issues, Meniere’s disease, vertigo, tinnitus, ear fullness, and hearing loss. There are so many people walking around with this diagnosis, and they have absolutely no answers. It's something we have been addressing in our practice at Montclair Upper Cervical.
We have been specializing in it. We started about 5 or 6 people up a week with it, mostly because people are going to their ENTs. They are getting these vestibular issue diagnoses on Meniere's disease and vertigo, and they are not getting any answers. They are trying a bunch of different medications when we think we know what the root cause of the problem could be and how upper cervical care can help.
Before we jump into that, this episode is sponsored by Setex. You can visit SetexGrip.com for the best gripping technology on your eyeglasses, earbuds, phones, and gaming controllers. Save 25% when using the promo code, DrPecca25, at checkout. Dr. Jeff, welcome to the show. Once again, this might be your third episode here. He is a Blair Upper Cervical chiropractor at Montclair Upper Cervical. We are excited about this episode. It's going to be a lot of great information that's going to help a lot of people. Dr. Jeff, how are you?
Doing well. It's a beautiful Thursday, so no complaints on my end.
We are talking about vestibular issues and Meniere’s disease. Can you do a quick rundown of why vestibular issues may happen and the neuropath that takes in the body of why these symptoms are occurring?
We know that the vestibular system is a system that's continuously providing feedback to certain areas of the brain. It's instrumental and provides a sense of balance equilibrium, especially coordinating with how body movements or movements of the head and the neck. What it does is it provides this feedback to the brain, and that allows the brain to integrate this information and to make adaptive corrective or compensatory movements based on both internally and externally generated forces in and around the body.
In this vestibular system, there are different regions of it. The one on the outside that most people are aware of is the organs organelles in the inner ear. The vestibule and the other canals in the inner ear. What that does then is these are providing information into the brainstem where the vestibular nucleus is, the cerebellum which helps control muscle coordination and posture, as well as the somatosensory cortices.
This is going to be instrumental. When we have damage or issues with the vestibular system, what winds up happening is that it’s going to affect our sense of balance. It's going to affect the body's ability to control eye movement, especially when we are moving the head. It's also going to affect our sense of orientation in space.
If somebody has a problem with their vestibular system, especially it could be coming from their upper neck, they could be suffering from vertigo, tinnitus, ear fullness, hearing loss, and some type of headaches or eye pressure as well. This is all tied into what you are talking about, that vestibular system, correct?
Exactly. To build on what you said, how does the neck come into play here? I mentioned the ears and the eyes. How does the neck come in? I like to look at it deals with this idea of proprioception, which is a very fancy term that we use in the medical community for your body's ability to sense where it is and time and space. That's how I like to think of it.
You get this proprioceptive positional information from receptors in your skin, muscles, and joints. Those are the three areas it comes from. Studies have found that the joint capsules on the facet joints in your cervical spine are highly innervated with these tactile receptors and pain receptors from free nerve endings part of this proprioceptive information.
How does this tie into? What winds up happening is they have also found that about 50% of your proprioceptive information from your neck occurs between C1 and C3. There are seven bones in the neck. The first three bones in the neck are going to supply a significant amount of this positional information to the brain.
On top of that, we also know that the deep cervical muscles in the neck also provide a significant amount of this proprioceptive information from the muscle spindle fibers, which all makes sense based on the anatomy and mechanics of the neck because the vast majority of your rotation in your neck occurs between C1 and C2. Literally, the Y axis looks like an axle, and Atlas is a ring that rotates around it.
Continuing to build, how does this all make sense in terms of vestibular issues? When we have damage, it changes the structures in the neck, whether through trauma, muscular fatigue, changes in the curvature of the neck or direct pain degeneration. What this is going to do is it's now going to affect the ligament stability and the ligament system in the upper neck.
It's going to affect the tendons and the connective tissue that also helped to provide stability to this area of the neck. That's going to affect the stability and the function of these cervical facet joints that are feeding this information. When you have now abnormal positional signaling coming from these facet joints in the neck into the brain, and that is now not matching up with the information being sent in from your vestibular system, that difference or mismatch is now going to cause a jumbling of information in the brainstem, and the cerebellum. That's where you can get this production of things like vertigo.
We have many patients that come in and say, “I hear what you are saying. Trauma, car accidents, sports injuries, slips, and falls, I have never had any of these, and I'm suffering from these issues. Why is this going on?” It doesn't have to be that big of trauma or impact. Keep in mind that there is no disc space up top between C1 and C2. It's held together by the ligaments and muscles. It's very easy for that area to slip out of place. It could happen as early as getting pulled out of a birth canal too hard. If anybody's ever seen a little baby try to walk for the first time, they fall down 20, 30 or 40 times, maybe even more before they can take their first steps.
We do have so many people come into our office that said, “I have never had a car accident. I have never fallen. There is no trauma history.” They have vertigo or tinnitus. They have all the vestibular issues going on. We take the 3D X-rays, and their neck is a mess up there. You don't have to be in a huge action or anything for this to occur. Usually, what we find is there's some type of trauma. It could start as early as the child’s birthing process or childhood, and the body is so good at adapting and compensating. Those symptoms don't show up until 15 to 20 years later. That's what people say, “I woke up with all these vestibular issues.” From what we have seen in our office, what's the first route people usually take when they do get these vestibular issues? Usually, I see people go right to the ENT.
I would definitely say the ENT seems to be the big one. I would say maybe a close second as a neurologist because they maybe have someone that's had similar issues might say, “This could be a nerve issue.” ENT, for sure. A lot of the time, the ENT is going to look to do an Epley Maneuver. That seems to be what makes sense because people think vertigo, the crystal is in the inner ear because that's where the vestibular system is. ENT number one. Neurologist number two. Maybe 25% to 50% get sent to physical therapy for vestibular therapy. Sometimes it's regular physical therapy. Sometimes they try more of a routine chiropractic application.
Epley Maneuver is great. They are trying to realign those crystals in the ears there to help vertigo pass, and sometimes you have great results. If you've tried the Epley Maneuver 3 to 4 times, and it's not working, and sometimes it's made you feel worse, it's time to explore different avenues. We have had patients through the Epley Maneuver, steroid injections, water pills, and getting the ear wax out of the ears. People have tried everything and usually end up in our office as a last resort. Why is it so important like we hear that the facet joints, the joints that chiropractors adjust especially between C1, C2, and C3, are so important, “I'm going to go to my chiropractor, and I'm going to get this fixed?
Only about 5% of people specialize in the upper cervical chiropractic field. It's such a delicate area. The brainstem is right there, and these bones have to be put in place down to the exact millimeter for the blood flow and nerve flow to be completely put back in place. If you are going to a chiropractor, they are not taking X-rays and are twisting and cracking your neck, chances are, they are not going to realign this issue.**
In our office, we take very precise three-dimensional X-rays. We figure out what your neck looks like and put everything back into alignment down to the exact millimeter. We use the Blair Upper Cervical technique. What we love about this technique so much as we say, “Holding is healing.” Our goal is to do the adjustment as few amount of times as possible and have it hold in place from weeks to months to years.
Holding is healing. If you are getting an upper neck adjustment every single time, you are at the chiropractor 2 or 3 times a week, there's not much holding going on. That area is not staying in place, and you are not healing. Granted, Dr. Jeff and I would like to do it as few amount of times as possible. Sometimes it does take a few times for everything to start holding. This is the million-dollar question we always get, “How long does it take for this issue to resolve?” Let's talk about that real quick.
This is one I wish for our patients that we had a crystal ball and that was part of your exam process, and definitively, here it is. You and I have talked about this plenty of times. It comes down to you having to look at the system as a whole. We are adjusting some of these misalignments. We are allowing the body to hold were helping to try to reestablish stability in this upper cervical region.
It depends on not only the severity of the misalignments, the chronicity of the misalignments or the subluxations but you also have to look at the whole system. What's the connective tissue like in the area? What's the ligament system like in the area? What's the muscle tone and the tendon tone in the area? We are continuously working on getting the joints back in proper alignment, taking pressure off the nervous system, and allowing the nerves to heal but these other areas take time to heal as well. These other structures in this area, nothing in the body is done in isolation.
We know that the connective tissue and the ligaments get a lot of different quality and quantity of blood supply than your muscles and muscle tendons. If you've had long-term misalignments that have not only put a lot of compression and pressure on your nerves and nervous system, that not only has to get fixed. We know it takes the nerves about 180 days to replace their outer coating. On top of it, your ligaments need time to heal. All the structures that help maintain the stability of these joints need time to heal.
If you've consistently stretched and irritated these ligaments and connective tissues over time, they might need a long time to heal. Putting things back into place, allowing the nerves to heal, then allowing this whole anatomy of this upper cervical complex time to heal, that's what's going to determine how long it takes to heal.
From your story, Kevin, you had three major ice hockey concussions. We also know you from ice hockey, me from soccer and rugby. Those are the big three. Let alone probably a ton of minor head knocks, body crashes, bumps, and bruises along the way from playing the sport and other activities. It took time to heal because not only were nerves needing time to heal, the body needing time to recover itself but everything that was helping to maintain the stability in this area needed that time to heal. That's the big thing we are not trying to do a quick fix of symptoms. We want our patients to get better but truly want to reestablish the health stability of this upper neck area so that our patients have an optimal life and can do the things they want to do going forward.
From what we have seen in our practice, it usually takes about 3 or 4 months to stabilize the upper cervical spine. In that process, a lot of people have that forward head carriage. That's turning their neck in the exact wrong way. We usually see that it takes about 3 or 4 months to bring back. Stabilize the muscles, ligaments, and tendons up there, and every single case is different.
We have had people with very severe Meniere's disease that, after the first adjustment, they are 50% better. A lot of things have gone away. We have other patients where the needle doesn't move for a month or two, and around that 2 or 3-month mark, everything starts to get better. We don't know which category you are going to be in but that's why we say give your upper cervical chiropractic about 3 or 4 months because some things are going to get better. Some things are going to stay the same.
The first six weeks, we love showing this chart to people. It can be a little bit of a roller coaster ride. A couple of days where it's the best you have ever felt in a long time, and you think you are healed. 2 or 3 days later, you start getting your old symptoms back, and it dips down again. It's a little bit discouraging because you were feeling so good but the nervous system remembers everything. It heals through all its past injuries and traumas. It can be a little bit of a roller coaster ride as you are healing up in the first six weeks.
I had a great first adjustment but if I only came in once or twice, there was no way I would ever be where I'm sitting now. I constantly keep getting checked, especially within the first 3 or 4 months, and make sure you are holding your adjustment. You can hold that adjustment all the way through. That's the goal but it's still worth getting checked because we want to make sure, first and foremost, it's in place. It's going to be tough for that patient to tell within the first couple of months if they are holding. We also offer support work to keep that in place. We also do a little bit of massage around the neck. We check the hips, the shoulders, and the mid back to see if there's anything going on there. We call that support work to help hold that upper cervical spine.
I would add on top of it too. It also depends on what you are doing outside of the office. We are going to try to give you our best every time you come in because that's our goal. We want to get you feeling better. If you are not fostering an environment where your body has a chance to heal. If you are getting adjusted, you are going out, and putting your neck if you are constantly looking down, you’ve thrown up heavyweight over your head. You are not giving your body a chance to heal. Like I said, look at it as a system. It’s the joints that have to heal. The ligaments have to heal. The connected tissue has to heal. If you are constantly putting stress on that upper neck area, your body is going to go back to what it's used to.
If you've been subluxated in 1 to 2 different positions at multiple levels for 4, 5, 6, 7, 10 or 20 years, the body can heal a lot faster than it can get damaged but you have to give it time. If you are creating a scenario where you are not being mindful of what's going on with your body, you are going to put a little bit of resistance. It’s going to take that much longer because you have to work uphill instead of giving yourself more even trained to work with.
We usually say the first 48 to 72 hours after the first adjustment is going to be the most important timeframe to let your body heal and hold. We recommend no heavy lifting or exercising. If you want to go for a walk, that's absolutely fine. As Dr. Jeff said, “The goal is to help this stay in place.” If you have muscle or ligament instability, it's going to want to go back to its old position.
It's like super glue. You put the super glue down, and for two days, you want to let it mold together and so it stays in place, and then you have a better chance of holding your adjustment. We also say, “Try not to sleep on your stomach with your head turned for six hours because that's going to put a big kink in your neck.
Try not to fall asleep on the sofa in a weird position that first night of the adjustment. Usually, what we find is overhead activity, shoulder presses, pull-ups, and pull-downs. That's going to pull directly on the neck. We usually say be careful. There are patients whose necks are strong. They can handle this. We have patients that teach yoga, and we tell them, “Take it easy for two days,” and they are out teaching a yoga class on day three doing handstands, and they do hold their adjustment, and it's fine.
A lot of people come to us with upwards of 10 to 20 neurological symptoms, blurred vision, dizziness, headaches, vertigo, ear fullness, tinnitus, and all this stuff. I tell them, “You have been through hell the last 5 to 10 years. Let's give this a chance to hold in place, so we get you better.” If somebody is more for maintenance, they want to come in for maintenance care, go for it. After 2 or 3 days, be careful. Resume your other workouts. If you have been suffering tremendously over the last couple of years with a lot of neurological symptoms, we recommend taking it easy for 2 or 3 days and being very careful within the first month to help everything stabilize in place.
You can probably attest to this. If we had a video vlog of what each one of our patients was doing every day, we could probably go in and say, “Be careful with this. This is okay.” Obviously, we don't. Giving the instructions to patients is more of our way of saying, “We know that if you reduce or modify these activities, postures, and habits, that facilitates a more optimal healing environment, the more optimal mechanical or physiological environment for this upper neck to heal,” and that's what you are coming in for. We want to get you better, and that's what we know is the way to help get you better. We want to try to foster the best environment for you so we can help you out at the best that we possibly can.
You’ve got to give your upper cervical doctor a chance to fix things, too. What we do is we take your 3D X-ray, and we write down every single misalignment you have in the upper neck and the lower neck. Sometimes the misalignments all of them don't show up right away. For me, my C3 didn't show up for probably four months into care.
I don't know why that is yet. I think the body heals through things in layers. Sometimes, certain misalignments take a little bit of time to show up, and that can be one of the biggest things that determine the outcome and success of your healing. If I just, after one month said, “I'm going to stop doing this.” I probably would never have my C3 adjusted. I would not have gotten the results I wanted.
You got to give your spine time to heal and give your upper cervical doctor a chance to put everything back in place because we write down all your misalignments but sometimes they don't show up right away, neurologically in your leg check. The body is constantly adapting and healing under care. You got to give your upper cervical doctor a chance to get everything situated. I keep going back to give it about 3 or 4 months.
I would agree. That's a big difference from the upper cervical approach. At large in the chiropractic profession as well. It's a different type of approach of you are saying, “We can help you. It's going to be conservative, specific, and impactful but you need time.” That's sometimes the hardest message to convey. It's like, “The body can heal itself. It knows what needs to get healed and has that capacity but you have to give it time.”
Unfortunately, when we live in more of a global world of very instant, whether commercially or medically. When it's instant feedback and wanting this but not wanting to change habits or not wanting to give it time, that's where it can get a little bit of a battle. You need time. Your body can do amazing things. As I said, it can heal in a lot faster time than it probably began getting dysfunctional but you got to give it that opportunity. If you give it the opportunity and you keep asking questions and being diligent, that's where they expect miracles to happen.
If you are a person suffering from vertigo, Meniere's disease, and all the symptoms we were talking about before, what should you do? We do work with neurologists and ENTs. They are great. If you want to go and get your hearing, MRIs or CAT scans checked and make sure everything is okay, that's a great idea. We are not saying you don't go to the neurologist or ENTs. That's a good place to go even to get diagnosed, check your hearing, and all that.
You can try the Epley Maneuver. That's good too but people wait too long or don't even know that upper cervical chiropractic exists. If I knew what I knew now, upper cervical chiropractic would be my very first stop, and I wouldn't have had to wait five years to land in an office to get help and get my life back. If you are struggling with these symptoms, I would, first and foremost, find an upper cervical chiropractor near you.
We are obviously biased. We believe The Blair Upper Cervical technique is the best. I would go to BlairChiropractic.com and see if there is a Blair Upper Cervical chiropractor near you to help resolve these issues. If there isn't a Blair chiropractor, you can visit UpperCervicalCare.com, and there are about 7 or 8 different upper cervical techniques that are still great that could help you out. It's amazing what we have been able to see in our office, and people get their vestibular issues fixed. The hearing came back, tinnitus went away, and vertigo was gone. It truly is expected miracles when you are talking about upper cervical chiropractic.
We have talked about this before. Those are vestibular issues, let alone probably a lot of other stuff that has been muffled in the background because of the vestibular issues. That's probably going to also get better. You see it when we do our re-evals on some of our patients that are coming in with vestibular issues. There are other things that they might have going on, and they are like, “My acid reflux has also gotten better. My hip pain is gone and stuff like that.” Little things that you might not even realize like, “I can see the room looks brighter.” Little things that might even be in the background because of the intensity of these vestibular issues get better.
For those reading, it's not normal to wake up with a blaring headache every day. It's not normal to have blurred vision and be in chronic pain. Your symptoms become an area where you start to live with them. You don't have to live with it if you are suffering from any of these issues. You have probably been told it is not fixable or you can't get better, and it's simply not true. Always keep exploring for your own health. You can always get better. Never give up on those issues because you just never know.
At the end of the day, you truly have nothing to lose because, especially if you are going to a Blair doc or if you are going to an Upper Cervical doc, they are going to give you a very precise and detailed assessment. They are going to most likely find something. If for any reason, if not, they will certainly tell you but they are probably going to find something that they can help chip away at. Get the ball rolling.
I truly think you have nothing to lose. Give it a try. Be patient, invest in yourself, and give yourself the opportunity. You are certainly going to start to see the volume, turn that dial down, get the needle moving, and get these things starting to feel better. Give in time and healing capacity. That’s when these things start to go away. The body had the chance to heal itself up.
If anybody suffers from these vestibular Meniere’s disease issues, find an upper cervical chiropractor near you. Dr. Jeff and I are going to start doing more videos on certain conditions and how upper cervical chiropractic can help. If there's any condition for those reading that want us to do a video, please leave us a comment. We would be happy to do one. If you have any questions about upper cervical chiropractic, we can do an episode on that.
Let us know. We are here for you. We are both at Montclair Upper Cervical Chiropractic in West Orange, New Jersey. We specialize in the Blair Upper Cervical technique. This is the Expect Miracles show. You can look at it on iTunes, Spotify. We have close to 200 episodes. A lot of upper cervical doctors have been interviewed, health issues, and other practitioners. It's a great show. Check it out. Please, if you guys have any questions, let us know. Dr. Jeff, any closing comments here?
Expect Miracles, that's what we are all about. It sums it all up.
Everybody, have a great day. We will see you soon.
- Montclair Upper Cervical
- Dr. Jeffrey Scott
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