Question
I went to a doctor who practices osteopathy and did a treatment where he
twisted my head a lot - no cracking but it wasn't comfortable.  I've been
having dizzy spells (mostly on getting out of bed or lying down) and some
weird sensations (blurry eyes on waking) since and almost fell in the office
after treatment to which he said I was an unusual patient who felt things
more deeply.  I am hoping this will go away and after having such a great
initial treatment with him, am unsure of what to do.  My body doesn't respond
well to cracking of any sort and I feel like I need something for my neck but I
don't know what.  Thank you for your help.  Jenifer

Answer
Dear Jenifer,

There are a few things this could directly stem from.  Any manipulation of the neck if not done inappropriately can create dizziness symptoms due to an alteration in the proprioception of the joint structures in the neck.  The muscles of the neck as well as the joint spaces have the highest concentration of receptors in the entire body, so it is a powerful area to work on.  However, it usually improves proprioception rather than making it worse.  

Inner ear issues are also something to consider, such as canalithiasis, or otoliths, but these can be treated with repositioning maneuvers fairly easily over the course of just a few treatments, and the dizziness often goes away completely.  This can be checked by any competent doctor in just a few minutes...they are looking for a return of symptoms and something called nystagmus (twitching eyes).  If you go to my website, there is an entire article written on this subject with diagrams for better understanding.

Completely unrelated is a condition called orthostatic hypotension where your blood pressure temporarily drops with raising from a seated or lying position.  This is usually temporary and the dizziness quickly goes away as the blood pressure is re-established.  This is also easy to check with simple blood pressure checks, and is usually not a big deal.  

The fact that you almost fell in the office may or may not be a factor.  After neck manipulation, some people respond differently than others due to the increased neurological stimulation of the brainstem.  This is often called "high gain" referring to the inability of the brain to process all of the joint and muscle spindle information being sent for processing.  Most patients do not react this way, but others do.  Nausea, dizziness, and even vomiting can occur...this is rare but any physician who utilizes manipulation should be aware of this and should have explained this to you prior to care.  

Lastly, and the area of most concern, is that the blood supply to the brain from the posterior arteries could have become compromised.  The basilar and vertebral arteries are the main concern here.  The scientific literature is conflicting on this issue but relates the risk of this injury from neck manipulation to be anywhere from 1 in a million to 1 in ten million.  So again this is very rare, however it can lead to stroke like symptoms and needs to be followed up on.  If you smoke, have a family history of heart disease or stroke, or take oral birth control you are at a higher risk.

You need to confront your doctor on these issue and make sure that everything is being considered.  I would ask him to explain them all in detail as I have only touched on the information here.  If he cannot or will not, find a better doctor.

Hope this helps Jenifer.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net