Dizziness, Vertigo and Vestibular Rehabilitation: STOP THE SPINNING!

Sep 25, 2019

Have you ever felt the room spinning around you? If you have you will know just how sudden it can happen and how debilitating it can be. Vertigo is a problem with the vestibular system. But what is the vestibular system and how can physical therapy help?

What Is The Vestibular System?
Our balance is maintained by three systems; our vision, inner ear or vestibular system, and our sensory system/proprioceptive system which lets us know our position in relation to our surroundings. The vestibular system helps us detect changes in head movements or body position to maintain balance. If the vestibular system is not functioning properly, dizziness, vertigo, imbalance, spatial disorientation, and other symptoms can result. Vertigo is defined as a sensation of spinning and loss of balance caused by disease affecting the inner ear or the vestibular nerve. To those who have experienced it, vertigo is extremely disabling and unpleasant and sometimes it’s even accompanied by nausea or even vomiting.(Horak 1992).

What Causes Vestibular Disorders?

  • Allergies
  • Head Trauma (car accidents, falls, impact sports)
  • Aging
  • Medications
  • Vestibular Neuritis
  • Positional Vertigo (BPPV)
  • Ear Infections
  • Cervicogenic Vertigo
  • Stroke and brain injury
  • Meniere’s Disease

Physical therapy can be a very effective in treating many of the most common causes of vertigo including Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, and cervicogenic dizziness.

By far the most common cause of vertigo is BPPV . BPPV occurs when calcium crystals, called canaliths, enter the semi-circular canals of your inner ear. Although, these are naturally occurring crystals help detect acceleration and deceleration motion when they are in the wrong place they result is intermittent, but severe symptoms, where the room appears to spin around you. They can make simple tasks such as getting out of bed, looking over your shoulder, or having a drink of water, nearly impossible. Our physical therapists at Elevate Physical Therapy have been specially trained to reposition these crystals into their proper place so your body can dissolve them naturally. This eliminates your symptoms and can happen in as little as one treatment! (Muncie 2017)

Another type of vertigo is caused by inflammation of the nerve, typically termed vestibular neuritis. This can result in a condition known as vestibular hypofunction. In this situation your inner ear organ function is depressed or inhibited, and does not send appropriate information to your brain. This imbalance of input causes symptoms of dizziness, nausea and feelings of unsteadiness or just being ‘off’ (Krebs 1993, Muncie 2017). While treatment duration here involves several sessions, physical therapy is very effective here as well with habituation exercises targeted to normalize vestibular function.(Shepard 1993, Herdman 2003).

A third cause of symptoms can be the upper cervical joints and muscles. These often cause pain, headaches, dizziness, and even vertigo. Here physical therapy takes on a more familiar form in joint, muscle and postural work. At Elevate Physical Therapy, we include dry needling in these patients, which can be one of the few things to help differentiate and treat this condition (Malmstrom2007, Escaloni
2018).

Vertigo, headaches, dizziness; this group of symptoms are some of the most intolerable that people experience. Physical therapy is a proven and fast treatment pathway to get you better. At Elevate Physical Therapy, we prioritize these patients for evaluation as soon as possible so you can get back to your life more quickly free from vertigo.

What Is Vestibular Physical Therapy?
One of our specially trained Physical Therapist will first perform a thorough evaluation. This includes special tests as well as observing posture, balance, movement, and compensatory strategies. Using the results of the evaluation, the therapist will develop an individualized treatment plan that may include specific head and body motions, eye movement and exercises in order to strengthen muscles and increase tolerance for certain stimuli. Some of the exercises and activities may cause an increase in symptoms at first, as the body and brain attempt to sort out the new pattern of movements. With time and consistent work, the coordination of signals from the eyes, inner ear and sensory system will occur.

Often new patterns of movement strategies are used to compensate for the change in the vestibular/ inner ear function. People begin to avoid head movements that are apt to create symptoms of dizziness and nausea. For example, individuals may limit turning their head while walking to avoid symptoms. Unfortunately, these adaptations can result in headache, muscle stiffness, general fatigue, and inability to retrain the brain to adjust to the vestibular problem, hence making the symptoms worse. Vestibular Physical Therapy retrains the brain to recognize and process signals from the vestibular system to develop normal responses to movement and alleviate symptoms. This involves desensitizing the system through various movements and positions that may provoke symptoms. (Muncie, 2017)

Jonathan D. Cowie, DPT, Cert DN, Cert VRS

References

  • Horak FB, Jones-Rycewicz C, Black FO, Shumway-Cook A. Effects of vestibular rehabilitation on dizziness and imbalance.
    Otolalyngol Head Neck Surg. 1992;106:175-180.
  • Krebs DE, Gill-Body KM, Riley PO, Parker SW. Double-blind, placebocontrolled trial of rehabilitation for bilateral vestibular
    hypofunction: preliminary report. Otolalyngol Head Neck Surg. 1993;109:735-741.
  • Shepard NT, Telian SA. Programmatic vestibular rehabilitation. OtolaIyngol Head Neck Surg. 1995;112:173-182.
  • Escaloni , J.,et al. The use of dry needling as a diagnostic tool and clinical treatment for cervicogenic dizziness: a narrative review
    and case series. Journal of Bodywork & Movement Therapies. (2018). https://doi.org/10.1016/j.jbmt.2018.02.015
  • Muncie et al. Dizziness: Approach to Evaluation and Management. American Family Physician. 2017. 95 (3) : 154-162
  • Shepard et al . Vestibular and Balance Therapy. Annals of Otology, Rhinology & Laryngology. 1993. 102 (3) . 198-205
  • Herdman SJ et al. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg.2003; 129(8): 819-824
  • Malmström EM, Karlberg M, Melander A, Magnusson M, Moritz U. Cervicogenic dizziness – musculoskeletal findings before and after treatment and long-term outcome. Disabil Rehabil. 2007;29:1193-205.

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Elevate Physical Therapy LLC
14 Vista Dr, Suite 100,
Gorham, ME 04038

Phone: 207 222 8055
Fax: 207 222 8053

E-mail: welcome@elevateptme.com

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