Improving Posture and Balance - Part 4: Functional Repositioning Maneuvers

Addressing Sensory Errors in Posture and Balance

By Dr. David Traster, DC, MS, DACNB
Co-owner, The Neurologic Wellness Institute
Boca Raton • Chicago • Waukesha • Wood Dale

Repositioning maneuvers are classically used to treat benign paroxysmal positional vertigo (BPPV). Functionally, however, when someone is placed into a repositioning maneuver, gravity relative to the head is being changed while the neck is also placed into a specific position. Centrally, this creates convergence between cervical input and otolithic activation.

The semicircular canals and the otolith organs work together to tell the brain whether the head is being tilted or translated through space. When the eyes are open, visual input is added to this vestibular and proprioceptive information, and in many cases vision becomes the dominant reference for spatial orientation. When the eyes are closed, the brain must upregulate vestibular and proprioceptive input to determine where the head is in space.

This process of central integration can have a profound effect on the brain’s sense of spatial orientation. When the brain more accurately understands head position relative to gravity, there is often a meaningful downstream effect on body awareness, posture, and balance. This makes repositioning maneuvers a powerful yet simple clinical tool beyond their traditional use in BPPV.

Watch the assessment video below and see how it translates into a targeted functional repositioning maneuver treatment to improve posture and balance.

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