The Lowdown on Vertigo (And What PT Can Do About It)

It is commonly known that Physical Therapists work primarily with rehabilitating pain and injuries, focusing on improving movement and strength, but did you know that we also work wonders with balance and dizziness? 

One of our clients recently had a sudden onset of dizziness on Christmas Eve, just standing in the kitchen when the room suddenly started spinning. She had to lie down and was unable to get up without waves of dizziness and nausea, unable to eat or drink to keep anything down. Not the best Christmas. 

Luckily a mutual friend of ours knew that we worked with dizziness and vestibular problems and recommended she call us. We were able to get her in and calm down the majority of the symptoms in the first session. This kind of thing is our jam! 

Dizziness turns out to be one of the top reasons for medical visits in the US, affecting 15-20% of the population annually. 40% of the population will have some sort of vertigo episode during their lifetime, and leads to a series of other problems including falls, which leads to other injuries. So we had better know what we can do to prevent and fix these problems when they occur!  

When we look at problems with balance, we check on  3 different systems: Visual, Vestibular, and Proprioception. 

VISUAL

Try a little test: stand on one foot and see how well you balance. Make sure you are near something solid to hold on to, and then try doing it again with your eyes closed. You will feel that balancing with eyes closed is much harder than with eyes open. Why is that? We humans are designed to use our vision to tell us where we are in relation to the horizon. Our brains take the subtle clues that our eyes tell us when we tilt or twist and make those subtle corrections to keep our bodies steady. Take that away and things get harder. 

VESTIBULAR

So when we don’t have our eyes open, or it’s dark out, what happens then? That is where our vestibular system comes into play. There is a tiny complex of bony tunnels deep in our inner ear that look like a gyroscope and are responsible for sending signals to our brains, telling us how we are tilted in space regardless of our vision. If you ever played games as a kid where you were blindfolded then spun around in circles to wobble after something then you were messing with your vestibular system. 

When something goes wrong with this system it can be quite alarming. You can move your head and suddenly feel as if the room is spinning around you: dizziness, nausea, loss of balance all can occur. This alarming yet common malady can lead one to check immediately to the emergency room, wondering what is wrong. A series of exams to determine the cause can lead to treatment with medications which dulls the overall neurological response to calm things down, but in the real world we need those responses to get around in the world. Some people deal with these symptoms for months or even years, just struggling along and limiting their overall activity levels as a response. Not optimal. 

So what can we do for this Vestibular dysfunction in Physical Therapy? 

First step is a thorough examination. We want to determine through the history of the onset if this is a true Vestibular problem we are dealing with. There are different conditions that can manifest as vestibular dysfunction and our clinical tests done in the office will determine the proper course of action. 

If it was a sudden onset with very distinct responses to clinical tests, then there is a good chance the issue can be quickly resolved with physical techniques done in the office that can reset the crystals in the inner ear to normal functioning. I know that sounds woo-woo, but trust me, there is science behind it! 

I will also mention this: Sometimes a more vague vestibular problem can be caused by dysfunction in the upper cervical area that can closely mimic inner ear problems, and it is something that gets overlooked quite often in traditional medicine, even by many PTs. These clients will present with more of a vague, “foggy” or “fuzzy” feeling that can affect their vision and balance, but can respond very well to evaluating and treating the cervical area.  We have been having a lot of success in treating these chronic dizziness issues and resolving things that have been problematic for a long time.  

Don't underestimate the upper neck muscles when it comes to vertigo!

Once the vestibular dysfunction has been resolved we start to focus on the 3rd system which is the PROPRIOCEPTIVE system. This is how your body responds to the signals that the brain is telling it when you are moving and balancing yourself. You have sensors in every joint of your body, particularly in your feet, ankles, and hips, that respond to slight changes in position. The better those responses, the better your balance. 

As we get older, or more accurately as we stop training these systems as much, our balance tends to get worse. Physical therapy works wonders to help improve your body’s response to these changes in position and improve your proprioception. Just like any muscle gets stronger with work in the gym, your balance can improve with frequent progressive challenges, first to reset your vestibular system, then improve your balance system to be more resistant to falls, very important as we get older and continue to remain active! 

Static to dynamic, stable to unstable, slower to faster, there are levels of challenges that we can always progress. Our program is designed to address these problems and optimize the function of how all your balance systems work together, also addressing overall strength and mobility at the same time, because why not? 

                       Cutoff jean shorts during training is optional.

And that's about it! If you have been dealing with any kind of vertigo/dizziness or loss of balance, either a newer onset or something that has been bothering you for a long time, then give us a call! We would love to chat and see how we can help guide you to being balanced for life!