January 28

Physical Therapy: Vertigo

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Do you or a loved one have vertigo?

Do you want to feel better WITHOUT medicines or surgery?

If you answered “YES” then keep reading!

Like I always say, when you’re dizzy and you don’t know which way the floor is… you’re sure to end up on it!

Dizziness is a horrible condition. Many falls and injuries occur from dizziness or “vertigo.” So what can you do about it? Physical Therapy of course! (Really? PT for Vertigo?!) When I went to PT school, I remember being shocked that PTs could help treat dizziness. But it’s true and very effective.

There are 4 main causes of vertigo:

  • The inner ear
  • Vestibular Occular Reflex (VOR)
  • Cardiac issues
  • Medication side effects

The inner ear provides important information on the position of our head and its movement in space. This is how you know you are “tilting” sideways. The inner ear can get overwhelmed, making you feel dizzy or nauseous. The inner ear is made up of 3 canals or tubes. These tubes have tiny microscopic crystals in them. When you turn your head to one side, the crystals on one side vibrate. This tells your body that your head is turning. These crystals help keep your head in the correct alignment and tell your body where you are.

If there are too many crystals in your ear, it can trick your brain into thinking that your head is moving when it’s not, hence the dizzy or spinning sensation. We call this Benign Paroxysmal Positional Vertigo (BPPV). It usually occurs when you bend forward or lookup.

Why does this happen?

In short, we aren’t exactly sure, as there is a lot about the cause of BPPV we don’t yet know.

Here are some fundamentals of BPPV:

  • It is common after an ear infection
  • It can occur after you hit your head (i.e., a fall or car accident)
  • You are more likely to get it as you get older
  • You are more likely to get it if you’ve had it before

The good news is that we know how to treat it! Treatment is fast, easy, and cheap. Best yet, there are no medicines, shots, or surgery involved, and 97% of people are better after only 1-3 treatments!

Are you unsure if you’ve had BPPV? BPPV can cause dizziness when a person:

Looks up

  • Gets out of bed
  • Looks into a low shelf/cabinet
  • Turns their head while driving, especially in reverse
  • Lies flat

If you’ve experienced BPPV, your Vestibular Physical Therapist can perform the Epley Maneuver. For this, we move the crystals around your 3 ear canals and help them reabsorb and return to where they are supposed to be. Your PT will have you lie down and they will turn your head in various positions for 15 to 20 minutes. Dizziness medication may only cover up the symptoms of vertigo, but PT can FIX your vertigo. And the PT treatment is quite effective!

Vestibulo Occular Reflex (VOR)

The VOR is a reflex that helps your head and eyes coordinate. It tells your head and eyes whether you want them to work together or separately. For example, if you are watching a car drive on a street, your head and eyes move together as you watch it drive by. But if you are climbing up the stairs, your body is moving up while your eyes slowly move down to stabilize your vision. That way you can maintain focus and not get dizzy even though you are moving. Your VOR reflex helps your brain and eyes know what do to.

At times, this VOR gets messed up. It can’t tell whether you want your head and eyes to move together or separately. This can cause dizziness when you move.

VOR Dysfunction can cause dizziness when a person:

  • Turns their head quickly
  • Reads
  • Watches tv
  • Observes lots of movements or colors in busy places

Your physical therapist can help treat this! When your VOR is not working properly, we can retrain it. Just like any of your body’s reactions, to improve upon it, you need to practice.

Your body works in the same way for balance and dizziness. We help retrain your body to do the things you have trouble with (e.g., turning your head left and right, climbing upstairs, looking down) without getting dizzy. Then the VOR will remember how to do this the next time you want to quickly turn your head.

IMPORTANT POINT: Not all PTs perform Balance and Vertigo treatments; they are a specialty of Physical Therapy. Make sure to ask if your PT performs the Epley Maneuver and treats vertigo patients.

Have vertigo? Trying physical therapy is a great option. No doctor referral is needed, and PT may help you avoid medication, shots or surgery in treating vertigo.

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