From Dr. Natalie Meiri’s Clinical Pearl Stories:

Author: Natalie Meiri, D.C.        Posted: 7/24/21

This was a 49 year old male patient with chief complaints of neck pain and vertigo. To be HIPAA compliant, I will call him Andy instead of his real name. Andy had a car accident which caused his neck pain and vertigo.  Moreover, he experienced the vertigo with maintaining certain head positions.

After the auto accident, Andy was treating with me for his spinal injuries.  However, the vertigo/ dizziness was so terrible he also went to see a ear-nose-throat specialist.  This was to rule out any possible complications related to his ear-nose-throat and the vertigo.

In Andy’s vertigo case, it wasn’t surgical and he didn’t want drugs.  The canalith repositioning maneuver by the ENT specialist wasn’t successful.  He decided to just have chiropractic treatment for the vertigo symptoms and do the physical therapy exercises at home.

Andy’s Examination, X-rays and

Treatment for Vertigo

The x-rays taken in my office showed findings consistent with a sprain with myospasm (muscle contraction) in his cervical (neck) and thoracic (mid back) spine. Upon examination, I found positive tests for a cervical (neck) sprain with thoracic (midback) myalgia (muscle pain) diagnoses.

Firstly, he received chiropractic adjustments/ manipulation to his cervical (neck) and thoracic (mid back) spine along with soft tissue work (myofascial release, pressure point and various post isometric relaxation procedures) and exercises to continue at home.  Secondly, recommendations were made on diet/lifestyle:

-Distribute food and fluid intake evenly throughout the day.

-Avoid foods and beverages that have a high salt or sugar content.

-Drink adequate amounts of fluid daily.

-Avoid foods and beverages with caffeine.

-Limit or eliminate alcohol consumption.

-Do not use tobacco.

-Ginger may ease vertigo symptoms, like nausea and lightheadedness.

Thirdly, I did several homeopathic consultations with Andy and prescribed a number of homeopathic medicines.

Andy responded well to his chiropractic treatment for vertigo.  Furthermore, his neck and mid back spinal injuries healed.  Finally, Andy’s vertigo decreased in frequency and intensity gradually and then resolved. 

Dr Meiri adjusts a patient

What is vertigo?

Vertigo is the sensation that you, or the environment around you, is moving or spinning.

This feeling may be barely noticeable or it may be severe.  So severe that you find it difficult to keep your balance and do daily tasks.

Attacks of vertigo can develop suddenly and last for a few seconds, or they may last much longer.

Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain.  Additionally, it can be caused by neuromusculoskeletal problems in your neck.

Depending on the condition causing vertigo, you may experience additional symptoms, such as ringing in your ears (tinnitus) and hearing loss.

Here are some causes of vertigo:

Cervicogenic Vertigo

Cervicogenic means the problem is coming from a source in the neck. Either overstimulation of upper cervical (neck) proprioceptors or degeneration of these proprioceptors occurs with cervicogenic vertigo. A proprioceptor is a sensory receptor which receives stimuli (regarding position and movement) from within the body. Additionally, proprioceptive pathways may cause an imbalance of information. This  leads to a perception of vertigo or disequilibrium.   Chiropractic adjustments stop the overstimulation and balance out any misinformation in the pathways.

Benign paroxysmal positional vertigo

BBPV is vertigo lasting seconds to a couple of minutes. BPPV is due to “degenerative debris” (small bits of calcium carbonate) floating in the semicircular canal in your ear. The semicircular canals are three tiny, fluid-filled tubes in your inner ear that help you keep your balance.  Common head positioning changes causing BBPV are extension (i.e. looking up at a shelf) or rotation, bending over and straightening back up, or rolling over in bed.  Trauma and age appear to be important factors.  BPPV is the most common cause of vertigo.

Meniere’s disease 

These are paroxysmal (sudden and recurrent) attacks of severe vertigo accompanied by low-tone hearing loss, low-tone tinnitus, and a sense of fullness in the ear. The episodes last for several hours to a day. Vertigo-free periods last for weeks or months. Hearing loss is progressive, while vertigo attacks appear to “burn out” over time. Some patients have sudden “drop” attacks without loss of consciousness. Increased fluid maybe causing distention and symptoms.

Causes of  Vertigo Due to an Infection:

Vestibular Neuronitis (Neuritis) 

Vestibular Neuronitis is most commonly associated with an ear infection.  So severe vertigo occurs rather suddenly and lasts for days to weeks. There is often associated nausea and vomiting.  The cause is unknown. However, it may be due to a viral infection of the vestibular nerve (nerve of inner ear). Patients report a respiratory infection prior to this vertigo. Similarly, of patients with vestibular neuritis, 50% report having had a common cold.


The patient complains of an acute onset of vertigo with or without hearing loss.  A viral or bacterial infection (ie ear infection) causes damage to the inner ear leading to complete destruction of the inner ear.


Symptoms associated with Vertigo

Symptoms of vertigo are all dependent on each individual and may vary from this list. Some common vertigo symptoms may include:

  • Swaying
  • Unbalanced
  • Headache
  • Sweating
  • Ringing in ears
  • Loss of hearing
  • Nausea
  • Spinning

Common natural vertigo treatments include:
  • Chiropractic Manipulative therapy
  • Physical therapy (exercises which aim to strengthen the vestibular system)
  • Epley Canalith repositioning maneuver- (non-invasive treatment for the most common cause of vertigo, benign paroxysmal positional vertigo (BPPV). Epley Maneuver is a type of maneuver that helps to clear the debris that is settling  in the ear.  And if there is debris that collects, it will cause you to experience symptoms of vertigo.
  • Diet/lifestyle changes

Meiri Chiropractic serving West Palm Beach, Jupiter, Palm Beach Gardens and North Palm Beach offers excellent chiropractic treatment for vertigo. Call us in West Palm Beach at 561-253-8984 to schedule an appointment or to find out more about Vertigo and Dizziness: The Causes and How Chiropractic Can Help.


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Chiropractic treatment for shoulder impingement syndrome is effective even if you have a bone spur.  This was a 55 year old patient who had an insidious (came on slowly, gradually) onset of left shoulder pain.  To be HIPAA compliant, I will call her Sharon instead of her real name.  Sharon presented to my office unable to lift her left shoulder to do overhead activities without pain. Moreover, Sharon also had sudden shoulder pain with overhead or lifting activity  which brought her to see me.

Sharon didn’t have any history of trauma involving her left shoulder. She was a retired teacher and did a lot of  housework and gardening at home.  Sharon also regularly went to the gym to keep in shape. She felt there was an accumulation of repetitive activities past and present in her life requiring her to perform work/movements in an  overhead position of her shoulder.  At first, Sharon thought her left shoulder pain was due to her chronic neck pain.  She had received chiropractic care for the neck pain on and off for years.

adjustment of patient's shoulder

Sharon’s Examination and X-ray

The x-rays taken in my office showed moderate osteoarthritis in her left shoulder, cervical (neck) and thoracic (mid back) spine. This is the “wear and tear” type of arthritis when the bones rub against one another causing pain, stiffness, inflammation, disc degeneration and bone spurs (also known as osteophytes) which can “pinch” surrounding nerve/tissues.  For Sharon the most notable finding on x-ray was the bone spur on her shoulder x-ray. 

Upon examination, I found positive tests for a shoulder impingement syndrome diagnosis. Sharon’s shoulder impingement was mostly due to the bone spur visualized on her shoulder x-ray.  The bone spur was due to the osteoarthritis (degenerative wear and tear arthritis) in her shoulder. I would order an MRI of her left shoulder if there was no improvement after 12 visits.

What is shoulder impingement syndrome?

A shoulder impingement syndrome is defined as a compromise of the space between the coracoacromial arch (portion of top outer edge of shoulder blade) and the proximal (situated nearer the center of the body) humerus (upper arm bone). So several structures may get impinged (pinched): The biceps tendon, superior labrum (cartilage in shoulder joint), supraspinatus (1 of the rotator cuff muscles) tendon, and the subacromial bursa (a fluid-filled sac for countering friction at a joint ) are all vulnerable to being impinged.

Causes for shoulder impingement include both structural and functional reasons:

Structural reasons:

-variant acromial types that are hooked or lengthened (top portion of shoulder blade developed/grew abnormal)

-degenerative (wear and tear arthritic) changes on the undersurface of the acromion

-an inflammatory process in the subacromial space (which could be due to i.e. bursitis, rotator cuff tear, or/and all of the above)

Functional reasons:

-abnormal position of your spine or scapula (ie. thoracic kyphosis)

-tightness of your shoulder capsule (membrane around shoulder joint),

-decrease in the space between the coracoaromial arch and proximal humerus due to past injuries

-abnormal motion due to nerve related problems (i.e. nerve palsy)

Dr. Natalie Meiri adjusts a patient

Chiropractic Treatment for Shoulder Impingement Syndrome


Starting at 2 times a week and then 1 time a week, Sharon’s treatments included chiropractic adjustments/manipulation to her left shoulder, and associated regions.  Associated regions adjusted were her cervical (neck) and thoracic (mid back) spine. Additionally, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) and modalities (cold/heat therapy and electric muscle stimulation) were administered as needed. Finally, therapeutic exercises to continue treatment at home were given.

Firstly, the goal was to get her out of pain. Secondly, restore normal range of motion to her shoulder. Thirdly, to strengthen the rotator cuff and scapulothoracic (mid back where her left shoulder is attached) musculature. As Sharon made progress, I also adjusted her low back to optimize her athletic performance at the gym and daily activities. The long-range goal was to stabilize her shoulder with a progressive rehabilitation program and modification of sport or/and occupational/daily lifestyle activities.

Sharon felt better from the first treatment.  After a few months of treatment, she got her full range of motion back in her shoulder. Furthermore, Sharon was able to gradually introduce overhead activities without pain.  Lastly, she no longer experienced pain with lifting. 

Chiropractic is for people who want to move and perform better in life. Chiropractic is for patients who don’t want drugs or surgery. Ultimately, it’s not just for pain relief.  It’s for those who want a better quality of life.

Meiri Chiropractic serving West Palm Beach, Jupiter, North Palm Beach, and Palm Beach Gardens offers chiropractic treatment for shoulder impingement syndrome. Call 561-253-8984 today to schedule an appointment.


It is estimated that chiropractors treat more than 35 million Americans (adults and children) annually. 3 in 4 patients who received chiropractic care in a 2018 study felt it was effective.  In a comparative-effectiveness trial, 94% of manual-thrust manipulation (chiropractic) recipients experienced a 30% reduction in their pain, compared with only 54% of medical care recipients. Yet if it is your first visit, you might be feeling nervous? It can help to gain a better understanding of what a typical visit looks like. Read on for some information about Your First Visit with a Chiropractor: What to Expect. This will help you feel prepared when you go in for your first chiropractic visit. This will help you feel less nervous.

Choosing a Good Chiropractor

Firstly, you need to pick the right chiropractor for you.  So how do you choose a good one?  It’s important that a chiropractor is willing to give you a personalized treatment. At Meiri Chiropractic we carry out treatments after a thorough history and examination to get a proper diagnosis.  Because an accurate diagnosis is crucial to ensure the treatment is focused on what your body needs.

Each chiropractor may have a different approach to their treatment. And they have training from different schools. Some might also treat different health conditions. For instance, many chiropractors are versed in treating sports injuries, whiplash or extremities as well as the spine.  Conversely, some only treat the spine.  Find out what you can ahead of time by reading the chiropractor’s website. Also, call and ask to speak with the doctor. Check on the chiropractor’s qualifications and the treatments they offer. Double check the chiropractor’s qualifications/ licenses online.

At Meiri Chiropractic, we are happy to answer questions and discuss  your condition for free prior to your visit.  After all, Your First Visit with a Chiropractor: What to Expect can make all the difference in your healing. 


Insurance and payment

More and more insurance companies are offering coverage for chiropractic care as research is showing how effective the treatment can be for both preventative and curative medicine. But you need to find out before you make your appointment.   Meiri Chiropractic is always happy to check on your insurance (we accept insurance, medicare and cash). Of course, if your insurance provider does not cover chiropractic care, you can find a chiropractor who accepts cash and offers quality, personalized care for you and is affordable.  Your health is your wealth and you are saving money in the long run with chiropractic care.  Moreover, be aware that when it comes to your health, the cheapest isn’t always the best. 

Make an Appointment

There may be a chiropractic clinic near you that will see walk-in patients. However, making an appointment will ensure you are seen at an exact time. By just walking in, you risk not being seen or waiting along time.  At Meiri Chiropractic, same day treatment is available for emergencies.  And there is very little wait time or no wait time if you make an appointment in advance.

Initial visit

The doctor of chiropractic starts by taking your history, and then performs a physical examination, to include the assessment of spinal and musculoskeletal joint function. The chiropractic examination focuses on evaluation of joint pain or tenderness, asymmetry, changes in range of joint motion, muscle tone and strength, posture and spinal or other joint stability. The chiropractor will also do tests (orthopedic, neurological, physical examination tests) as any other doctor would. Furthermore, imaging such as MRI, CT scan or X-ray may be indicated.

With the combination of the history, examination, and diagnostic studies, your chiropractor will determine your diagnosis. Finally, the doctor will explain the clinical findings, recommend a treatment plan and review the prognosis (likely outcome) and benefits of all procedures. This last part of your visit is the review of findings.  However, many times the review of findings maybe on your next visit. 


Dr. Meiri adjusts the spine


Initial Treatment

Most chiropractors also begin treatment during this initial visit.  Through a process of shared decision-making,  you and the doctor will determine if it is appropriate to proceed with a trial of chiropractic services.

Some common treatment modalities they’ll use include:

  • Manual (by hand) neck, spinal and extremity adjustments
  • Soft tissue manipulation
  • Healing modalities (electrical stimulation, hot/cold application, etc.)
  • Stretching and/or strengthening exercises to help improve muscle balance, coordination, and strength

Based on the clinical indications, timing or severity of your condition, chiropractic interventions may require a series of visits in order to relieve pain and improve joint function.  Your chiropractor may also talk to you about ways that you can manage your pain and condition outside of the office. This might include adjusting your workspace to make it more ergonomic. They might also suggest making changes to your nutrition to reduce inflammation and promote faster healing.

Visit a Chiropractor Today

Now that you know about your first visit with a chiropractor: what to expect, are you ready to give it a try?  

Chiropractors focus on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on your general health. These disorders include, but are not limited to: back pain, neck pain, pain in the joints of the arms or legs, and headaches.  Whether you’re dealing with an acute injury, chronic pain, or just need some help for better health, we are here for you.  Call Meiri Chiropractic today at 561-253-8984 for an appointment or to ask about Your First Visit with a Chiropractor: What to Expect.



 Schneider M et. al. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain. Spine 2015; 40(4):209-217.

 “One in Four Americans Sought Care for Neck and Back Pain Last Year,”, accessed November 2018 


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