Vestibular Dysfunction

Vertigo

Vertigo

Today’s topic is something that surprises a lot of people that physical therapists treat and that is vertigo. I have seen hundreds of vertigo patients over the years in my practice, and without a shadow of doubt, 99 out of 100 will say something to the effect of,

“I don’t know why 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 is sending me to physical therapy when I have dizziness?”

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

Everyone is surprised that physical therapists can treat vertigo, vestibular dysfunctions or dizziness. And to be honest, I was too. When I got into PT School, I had no idea that we treated vestibular dysfunctions or dizziness. In fact, I was so surprised, I did a voluntary rotation during school at a hearing and balance center because I had no idea what to do with dizziness. My first day there, everything was brand new to me. My dad was a physical therapist. I grew up around physical therapy, and this was a field I had never seen or heard of before. So, I was very intrigued.

One of the most satisfying aspects of treating dizziness or vertigo is how quick and immediate the results can be. Often after three visits, patients are nearly 100% better with their dizziness and now can focus on their balance and fall prevention (as vertigo and balance are so closely connected). It doesn’t always happen that way, but there are many cases where the dizziness is caused by what many doctors will refer to as “crystals” in their inner ear, that become dislodged or loose. And because they’re loose, they cause a faster shift or flow of fluid in their inner ear canal. And that creates a sensation of spinning that only lasts as long as it takes those “crystals” to move in the canal, usually 30-90 seconds.

So, in my questions, when I evaluate the patients, I’ll ask them, “What side do you feel your dizziness is on?” And, at first glance, that question seems absolutely ridiculous, but the more you think about it and the more you consider which side tends to irritate or initiate dizziness, often you can quickly identify that, “Oh, it’s on my right side. Every time I lay down to the right or turn to the right, I noticed my dizziness starts or is much worse than if I do it to my left and vice versa.” It doesn’t necessarily always happen on the right. It can happen on both sides, but very often after some consideration and thought, it’ll become clear as to which side the dizziness occurs most on. And often the dizziness that is most easily treated is the one that lasts from seconds to minutes of this room-spinning sensation, sometimes followed by nausea, but then afterwards, after a few minutes, the dizziness is gone. Sometimes a headache or a lingering feeling of uneasiness remains, but mostly it’s no big deal. So, often people will say, “I’ve had this for years and I just know I can’t lay flat and if I roll over, I have to do so very carefully.”

That’s because they can sometimes just avoid the symptoms altogether by managing their head position, but that’s no way to live life. I had a patient who I was seeing for her lower back pain who told me when I was evaluating her that she can’t lay flat because she gets dizzy and I said, “Oh, how long has that been going on?” And she said, “Five years.” Five years? Never thought to seek treatment for it. And I said, “Well, let’s try one thing.” I did a treatment on her, got 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 with the head positions.” Sometimes it’s that easy. Here she suffered for five years having to monitor and manage her head positions so 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 doesn’t 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, which work in symphony with each other need to be rebalanced so that, number one, we can avoid some issues in the future. And, number two, reduce our risk of falling because fall-risk and fear of falling and being off balance, unsteady, or like my equilibrium is off, is a very common complaint anytime somebody has a vestibular problem. So, we do a series of balance exercises and 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 sometimes people will get into a crowded area, like a mall or where there’s a lot of people and just that difference in people moving around can cause them to lose balance. So, a lot of little exercises and techniques are used to help regain their equilibrium, improve their balance, and overall lower their risk for falling.

So, do physical therapists treat vestibular organ or vestibular dysfunction conditions? Absolutely. But they have to be trained and they have to be competent in dealing with those kinds of situations. And not all physical therapists are. When you seek treatment, it is vitally important to ask if your physical therapists treat vestibular dysfunction or dizziness… because sometimes they don’t.

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Nick Hunter, PT, DPT

Nick Hunter, PT, DPT

Owner at Preferred PT
Dr. Nick received an associates degree in sports medicine from ByU-Idaho he then attended Brigham Young University in Provo, Utah where he received a Bachelor of Science Degree in Exercise Science. Following BYU, he received his Doctorate of Physical therapy from the University of Utah in Salt Lake City.

Dr, Nick’s greatest passion is seeing his patients recover from injury and return to their activities that bring them joy.
Nick Hunter, PT, DPT

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