Vertigo and Balance Disorders – The Role of Osteopathic Manipulative Treatment, A Systematic Review

Methods

• Articles analyzed: 5
• Criteria of inclusion: peer-reviewed experimental studies; randomized controlled trials (RCTs), quasi-randomized, randomized uncontrolled, cohort, case-control and non-randomized studies; English-language studies; studies published in any year; studies with no restriction on the subject-matter (there were therefore people of all economic backgrounds, age and gender); studies that reported balance disorders – vertigo, dizziness (stunning), oscillopsia, postural instability, diplopia, and any central or peripheral neurological disease that manifested with some disturbances in balance – related or not to neurological conditions; studies that reported subjects with oscillating postural instability, alterations in the center of gravity and risk of falling; studies with clinical-instrumental diagnosis, in case of pathologies, or with self-diagnosis, in case of symptomatic conditions (eg, dizziness); studies where OMT was the main intervention, alone or with other interventions.
• Criteria of exclusion: retrospective, case reports, case series, comments, letters to magazine editors and experts’ opinions; studies where only a single OMT technique was applied.

Characteristics of the studies

• 2 studies on vestibular deficit
• 1 study on balance disorder associated to Parkinson’s disease
• 1 study on dizziness with no specific cause
• 1 study on elderly people with oscillating posture and altered gravity center
• All studies have been considered of a good quality (≥5 score according to the Newcastle-Ottawa Scale)

Participants

• Number in the smallest study: 9 people (4 female and 5 male)
• Number in the biggest study: 40 people (10 female and 30 male)
• Total: 114 people (48 female and 66 male)
• Mean age: from 27 to 89 years

Interventions and evaluations

• 20-30 minutes OMT sessions
• 20-60 minutes control interventions
• 1 to 12 treatment sessions
• In the OMT groups: both direct techniques (muscle energy, high-velocity and low amplitude) and indirect techniques (counterstrain, myofascial release, balanced ligamentous tension and cranial OMT)
• In the control groups: palpation with light touch as sham treatment, counseling, no treatment (2 studies did not have a control group)
• Both OMT and sham treatments were performed by osteopaths and osteopathic physicians
  Evaluation of the effectiveness through computerized dynamic posturography (CDB) (4 studies), Dizziness Handicap Inventory scale (DHI) (3 studies), or Mini-Balance Evaluation Systems Test (1 study)

Results

• Primary outcomes: OMT proved to be able to improve sense of balance, reduce postural instability, prevent worsening of benign paroxysmal positional vertigo and improve mobility in case of Parkinson’s, also immediately.
• Secondary outcomes: 9 people reported light and temporary (with a duration of less than 24 hours) adverse effects, from not feeling well (1 person) to an increase in vertigo (3 people) up to muscle soreness (5 people). No other adverse effects related to neurological conditions have been reported.

Discussion

Although with limitations due to the methodology of the studies (e.g. lack of control groups, few patients, dropout rate – high in a control group), OMT seems a useful intervention to manage and improve balance disorders, also given the almost zero reported adverse effects. The reasons behind the usefulness of OMT are many: on the one hand, osteopathy is characterized as a patient-centered approach, for which the osteopath evaluates the most appropriate techniques to use on the basis of the patient’s clinical picture and the somatic dysfunctions detected during the palpatory examination.

On the other hand, the reduction in pain and the increase in range of motion (ROM) often induced by the OMT can favor a better proprioception, that is, a better perception of the body in space and of its movements, which naturally leads to a better balance. A better proprioception could then increase the patients’ body awareness and their confidence in their own body, consequently reducing the fear of moving and falling.

Considering that a OMT, personalized on the patient’s clinical picture and needs, could also reduce the use of drugs (with associated expenses and possible adverse effects) or the use of surgical interventions, except for the most extreme cases, future studies assessing more carefully the effectiveness of the OMT in the event of balance disorders are essential.