People often use the word “dizziness” when talking about a variety of symptoms. It is important for you to be able to differentiate between these symptoms, because the cause, diagnosis and treatment cn be quite different. Dizziness is a sensation of lightheadedness, faintness, or unsteadiness. Unlike dizziness, vertigo has a rotational, spinning component, and is the perception of movement, either of the self or surrounding objects.
Vertigo is often caused by an inner ear problem. One common cause is called benign paroxysmal positional vertigo (BPPV). This occurs when tiny particles of calcium form in canals of the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. With this move of crystals from one area to another, the inner ear tells the brain you’re moving when you are really not.
Physical therapists can perform specific testes to determine if you have BPPV and will guide the treatment. One such test includes examination of the eyes for nystagmus, an involuntary rapid eye movement. If BPPV is found, the patient is guided through a repositioning treatment involving the head and neck called the Eppley maneuver. The PT will guide you through a series of position changes designed to relocate the crystals to their appropriate area in the inner ear. With treatment, symptoms should significantly decrease or completely resolve.
Physical therapy can play a strong role in recovery of symptoms. Treatment would involve an exercise-based program to improve balance and reduce symptoms related to dizziness. Specifically, treatment would include:
● visual stabilization training
● postural education
● balance training
● cervical mobility and stretching
Expected outcomes from treatment include decreased risk of falls, improvement in balance, improved ability to stabilize vision, an increase in cervical mobility, and a return to prior level of function.
by Dylan Bartley, MSPT, CMP
- Falls are the leading cause of death from an injury in persons over 65
- 75% of emergency visits are fall-related
- 40% of hospital admissions in persons over 75 are the result of fall-related injuries
- Balance is a complex process involving the reception and integration of sensory inputs, and the planning and execution of movement, to achieve a goal requiring upright posture. It’s the ability to control the center of gravity over the base of support in any given sensory environment.
- Reflexes are automatic responses by the peripheral or central nervous system to help support postural orientation; they occur rapidly enough to not be under volitional control
Balance comes from 3 places
- Visual System: helps us see things in the environment and orient us to the hazards and opportunities presented
- Vestibular System (the inner ear): provides the brain with information about the position and motion of the head in relation to gravity; it contributes directly to postural stability
- Proprioceptors/somatosensory receptors: located in joints, ligaments, muscles, and the skin
Balance is also dependent on:
- Good flexibility
- Reflexes and motor planning
When Things Go Wrong
- The Brain needs input from all 3 systems (visual, vestibular, proprioception) to distinguish motion of the self from motion of the environment
- Nausea, vomiting, dizziness often result as a mismatch in inputs
- It takes the brain a little “extra work” to deal with mismatches
- Example: When sitting in car at a stoplight and seeing car next to you creeping forward, you slam on your brakes
- Example: When you are boating, proprioceptors perceive a rocking boat under your feet, but your eyes just see a steady horizon
- there may be medical reasons why one of the three systems are not functioning like a stroke or diabetes or just poor vision. Make sure you are getting the help you may need to address these problems whether it is from a Physical Therapist, Doctor, or Optometrist
Use it or lose it! Through practice and repetition, you can help the brain get used to these mismatches and be able to distinguish when the mismatch means trouble, or when it’s OK.
Do your routine 3 times a day, 10-20 reps to get your brain reprogrammed.
It may be a quick routine that only takes 5-10 minutes.
Extrinsic Risk Factors to Address
- Check your environment: loose cords and rugs can pose threats
- Does your home have adequate lighting, adequate space?
- More injuries and falls are likely in crowded situations
Single Leg Stand
Stand on BOSU or Wobble Board or Trampoline
Ways to increase the difficulty with the above exercises:
- Close the eyes
- Swing the arms, Spiraling, Reaching outside of your center of gravity
- Tossing an object with a friend or bounce one against a wall
- Scanning your eyes and turning your head from side to side
- Walk and read
- Walk while reading a moving book
- Walk and turn head while reading
- Walk and turn head with eyes closed
As always, we are here at Active Marin to help you through an individualized program to enhance your balance, whether to prevent another potentially debilitating fall, or improve your performance in your favorite sport.
call us at 415 385 3755 or email us at firstname.lastname@example.org for an appointment or more info