Vestibular Dysfunction

Vertigo

Vertigo

Today we’re discussing a topic that many people are shocked to find out physical therapists are able to treat.

Vertigo.

We’ve seen hundreds of vertigo patients over the years at our clinic and, without a shadow of a doubt, 99 out of 100 will say something to the effect of:

I’m here because I’m dizzy. I don’t know what physical therapy is going to be able to do for me.”

Or

Why is my doctor sending me to physical therapy when I have dizziness?”

Or they’ll say something like, “Do you guys ever treat dizziness?”

One of the most satisfying aspects of treating dizziness or vertigo is how quick and immediate the results can be. Often, after three visits, patient’s are nearly 100% better with their dizziness and can now focus on their balance and fall prevention (as vertigo and balance are closely connected). More often than not, the dizziness is a result of what many doctors refer to as “crystals” that lie within the inner ear. These crystals can become dislodged or loose. As a result, these loose crystals cause a faster shift or “flow” of fluid in the inner ear canal. And this creates a sensation of spinning that only lasts as long as it takes those crystals to stop moving in the canal (typically 30 to 90 seconds).

So, when we evaluate patients, we’ll ask them, “What side do you feel your dizziness on?” And at first glance, the question seems absolutely ridiculous. But the more you think about it and the more you consider which side tends to irritate or initiate the dizziness, you can quickly identify “Oh it’s on my right side. Every time I lay to the right or turn to the right, I notice my dizziness starts or is much worse than if I do it to my left” or vice versa.

It doesn’t necessarily always happen on the right. It can happen on both sides, but often times after some consideration and thought, it’ll become clear as to which side the dizziness occurs most on.

The dizziness that tends to be the most easily treated is the “room spinning” sensation, lasting from seconds to minutes and is typically followed by nausea. Sometimes a headache or a lingering feeling of uneasiness remains. So, many times we hear people say, “I’ve had this for years and can’t lay flat, and if I roll over, I have to do so very carefully.”

That’s because they tend to “avoid” the symptoms altogether just by managing their head position.

But…

This is no way to live life!

We recently had a patient who was being seen at our clinic for her lower back pain who informed us during her evaluation that she cannot lay flat because when she does, she gets dizzy.

We asked her how long that had been going on and she replied “Five years”.

Five years? And never thought to seek treatment for it as she just thought it was her “getting older”.

We did one treatment on her to get rid of the dizziness. The next visit she came back and said, “My dizziness is all gone based on that one treatment that you gave me. Why did I wait so long?!”

Sometimes it is really just that easy. Here she suffered for five years having to monitor and manage her head positions so that she wouldn’t get dizzy, and very quickly we were able to treat her.

Now, just because the dizziness is gone in one or two treatments, it does not mean that you don’t need physical therapy anymore because often resetting and improving your balance is necessary.

So, your vestibular system, your right and left systems that work in symphony with each other, need to be rebalanced so that number one, we can avoid issues in the future. And number two, reduce our risk of falling, because fall-risk and fear of falling and being off balance or unsteady is a very common complaint anytime someone has a vestibular problem.

We do a series of balance exercises under different conditions, low-light, no light conditions, eyes closed, surrounding, moving, or depth differences in how people move and how they are able to differentiate near-field and far-field vision differences. Because, often times, people will get into a crowded area, like a mall, and that difference in people moving around causes them to lose balance.

A lot of little exercises and techniques that we go through here at Preferred Physical Therapy help our patients to help regain their equilibrium, improve their balance and overall lower their risk of falling.

So the question is…

Do physical therapists treat vestibular organ or vestibular dysfunction conditions?

Absolutely.

But, they have to be trained and competent in dealing with those kinds of situations. And not all physical therapists are. When you seek treatment, it’s vital to ask if your physical therapist treats vestibular dysfunction or dizziness…

Because sometimes they don’t.

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Nick Hunter, PT, DPT
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