What can you do for vertigo

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 a 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 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. I did this at a hearing and balance center because I had no idea what to do with dizziness. On my first day there, everything was brand new to me. My dad was a physical therapist, and I grew up around physical therapy. To my surprise, this was a field I had never seen or heard of before. So, I was very intrigued.

Are our physical therapists able to treat vertigo?

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.

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. When they’re loose, they cause a faster shift or flow of fluid in their inner ear canal. This 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 when I evaluate the patients, I’ll ask them, “What side do you feel your dizziness is on?” 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 notice 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.

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. Then afterward, 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. Often, people will say, “I’ve had this for years and I just know I can’t lie flat. If I roll over, I have to do so very carefully.”

What can you do for vertigo?

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. When I was evaluating her she told me that she can’t lie 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. Often resetting and improving your balance is necessary. So, your vestibular system, (your right and left systems, which work in symphony with each other), needs to be rebalanced.

Number one, we can avoid some issues in the future.

And, number two, we can reduce our risk of falling because fall-risk and fear of falling and being off-balance, is a very common complaint anytime somebody has a vestibular problem.

Watch this video for two easy exercises for vertigo.

How can you treat vertigo?

So, 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. Sometimes people will get into a crowded area, or where there’s a lot of people. The 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 of 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
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