Vertebrobasilar insufficiency - uncommon, but important. We are talking about the equivalent of a boxing KO here.

These pages are about quite safe methodsᵃⁿᵈ ˢᵉᵉ ᵇᵉˡᵒʷ for you use. Problems are pretty much confined to manipulation treatments, but even then are rare.

When people have stiff joints in their neck, I seldom have to resort to manipulation(when one “cracks” the joint.)

My preferred method of neck treatment is stretching it sideways so as to have the maximum effect in the particular joint which is stiff. This is done with them laying on their back.

I always warn them to be careful as they get up after the treatment . They often have a little wobble as they stand up and resume their seat. This passes within half a minute.

This mild, brief dizziness is due to stretching neck muscles.

Role of neck muscle proprioception sense

You may be aware that the inner ear is an important organ concerned with balance.

Less well known is the role of the neck muscles. These are also responsible for sending information to the brain about our movement and position. This is called neck proprioception.

Stretching the neck muscles can send confusing messages to our brain, with resulting balance disturbance. This is not dangerous, but there is another rare scenario which is.....

Vertebrobasilar artery syndrome

This name emphasizes the role of the arteries in vertebrobasilar insufficiency.

The back of the brain is responsible for vision and for balance.

The blood supply to this part is via two little arteries (the Vertebral arteries,) which run up the neck on each side of the spine very close to the joints.

Some people are born with one of these two arteries very small, and later in life either of them can get partially blocked with fatty deposits (atheroma.)

If the remaining dominant artery then gets irritated and tightens up, one can suddenly have the blood supply to the back of the brain severely reduced.

The symptoms so produced constitute the vertebrobasilar insufficiency syndrome.

This can also happen if the artery wall tears (dissecting aneurysm.) as in car accidents.

I have seen presumed spasm many times in the course of my neck pain treatment - mobilizing or manipulating neck joints.

I have not seen spasm from doing any of the stretches described in this website, but just in case here is the advised emergency first aid if you do get badly dizzy.

First aid for dizziness

Take a large plastic bag such as a supermarket bag, about the size of your head. Hook one edge of the open top, under your chin. Now hold the rest of the edge against your cheeks and forehead, so that you’re looking into the empty bag, full of air.

As you breath, the bag should rise and fall, indicating a good seal against your face.

rebreathing one's expired air

There is enough oxygen in the bag to keep you going for a couple of minutes. When it is getting short, you will start to breathe more rapidly and deeply. Take it off at this stage.

During the two minutes, your expired carbon dioxide will have stayed in the bag. The level of carbon dioxide in the bloodstream will have risen.

This has the effect of forcing all the arteries in the head to open up to full bore, eliminating the spasm of the vertebral artery.

If your dizziness has now gone, it may have been due to vertebral artery spasm, and you will need to see your doctor to investigate this, before you have any other neck treatments.

Provided you know that you are allowed to (no stomach ulcer nor allergy to aspirin nor other blood thinning medication etc,) you could also now take half an aspirin.

Atlas Orthogonal, NUCCA etc - gentle upper neck methods

Balance disorderrs from neck muscle involvement in mechanical cervical spine derangement, often involve the joints at the top end of our neck. One can feel under our mastoid process, behind the ear, to see if our head is on straight or not.

The first bone in our neck is immediately under the tip of our mastoid process. With practice one can learn to feel through the muscles here, and see how far in one has to press to push against the C1 lateral mass. If the head has shifted sideways, one has to go in further to find it, compared to the other side.

There are specialist chiropractors who treat the upper cervical spine, using the methods above and others. These all have the same gentle approach, without typical manipulation.

A good resource on these, is Greg Buchanan's www.upcspine.com.

A look at his testimonials page shows the range of conditions people have been labeled with, who responded to various techniques.

Although anecdotal, this shows the value of getting a skilled assessment of your spine, no matter what you have been told.

While on the subject of dizziness - re BPV

Recurrent vertigo brought on by neck movement, from a treatable condition of the inner ear, rather than vertebrobasilar insufficiency.

Benign positional vertigo is common, especially in women and especially ages 50 to 70. It is due to calcium carbonate crystals in the inner ear acceleration and inclination sensors, breaking loose and getting in the road. They can be tipped out of the way, relieving symptoms with one treatment in 85% of episodes.

Dix and Hallpike provocative positional test is ideally done with special video goggles, followed by Epley repositioning treatment.

For a good description with plenty of pictures, see the chiropractic-help vertigo dizziness page.

Vestibular Rehabilitation Therapy

Cawthorne and Cooksey observed that people with chronic balance disorders who moved more, recovered more.

They devised a series of exercises¹ to repeatedly provoke the start of symptoms to help the vestibular system get used to being damaged. I prescribe shuffling on the spot, clockwise, surrounded by furniture or wall one can immediately steady oneself against. One keeps going until vertigo starts, then resting until it subsides each time.

In chronic conditions, drugs such as prochlorperazine which relieve symptoms, are likely to work against recovery and are best avoided.

A vertebrobasilar insufficiency case history

Mrs. A, aged 65, told of getting "dizzy, rolling over in bed, standing up from bed, looking up to clothes line" for 10 years, worse 3 months.

This followed a fall out of bed then a rear-end car collision with whiplash injury to her neck.

Investigation at a teaching hospital had been OK, and she had been told her symptoms were due to tension.

She had found herself getting very tired and giddy after breakfast, and worked out that cheese made her worse.

On examination she had stiff joints between her 2nd, 3rd, 4th and 5th cervical vertebrae. A test which deliberately occludes the vertebral arteries one at a time, reproduced her symptoms on one side.

I didn't attempt any physical treatment, but ordered a neck X-ray, vitamin B12 blood test and prescribed betahistine2 2mg three times a day.

When reviewed 5 days later, she was feeling better, but the test of her vertebral arteries was still positive, so I increased the Serc to 4mg tds.

Her X-ray showed osteoarthritis with narrowing of her cervical discs, posterior joints and the foraminae where the 6th and 7th nerves leave the spinal canal.

It is quite likely that one of her vertebral arteries was obstructed by an arthritic knob. It was not safe to use manual therapy on her, for fear of putting the other remaining vertebral artery into spasm and causing a stroke from vertebrobasilar insufficiency.

Just to complicate matters, her vitamin B12 result was low in its' reference range (275, range 122-679.) This always raises the possibility that a person is deficient, another cause for balance disorders.

Vertebrobasilar insufficiency can be from cervical spondylosis

From vertebrobasilar insufficiency page to home page

More on the wobbles at ataxia page.

References for vertebrobasilar insufficiency page


2. Betahistine in vertebrobasilar insufficiency.


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The contactpage.

The posterior joints are little paired joints at the back, between adjacent vertebrae.

A foramen is here a gap between bones and elsewhere may refer to a hole in a bone.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.