Vestibular Physical Therapy

Dizziness can be complex! There are many different reasons and causes behind dizziness, which requires skilled assessment by an experienced therapist in order to correctly identify and diagnose your dizziness. Causes such as age-related changes, certain conditions/diseases, concussions or head injuries, etc can cause symptoms of dizziness.

What is “Dizziness”?

“Dizziness” can be described as many different things including spinning (or false sense of motion), lightheadedness, fogginess, and/or off-balance. This means it can also have many causes.

Common causes of dizziness include the following:
1) Inner ear (vestibular) problems
2) Changes in circulation (change in blood pressure and/or circulation)
3) Other (including dehydration, anxiety, low blood sugar, multi-medication use, headaches/migraines, changes in sensation, vision impairment, etc.)

Dizziness due to the vestibular system are specifically referring to your inner ear. This system senses head position, eye movements, perception of self-motion, and spatial orientation (i.e. where your body is in space). The vestibular system is vital in order to feel “balanced and steady”.

Your body takes in multiple input from your sensory systems to tell where your body is in space such as the following:

• Vision
• Inner ear (vestibular)
• Proprioception and Sensation

If any of these systems are abnormal or the systems are not working together (and talking different “languages”) then this can leave someone feeling “off” or “dizzy”. Below are the following systems we use

Different Kinds of Dizziness

There are many different causes and conditions that can cause dizziness, but below are common vestibular conditions physical therapists treat:

• Vestibular hypofunction
• BPPV (vertigo)
• Central vestibular dysfunction (mostly from head injuries and/or concussions)
• Cervicogenic dysfunction (i.e. meaning coming from neck)
• Headaches and Migraines
• General balance/dizziness

One common cause of sudden, severe dizziness is called “Benign Paroxysmal Positional Vertigo”, otherwise called BPPV or simply vertigo. This usually causes brief episodes of mild to intense sense of dizziness or spinning caused by specific head positions. This type of dizziness is caused by loose crystals in your inner ear that when moved with head positions it can cause a false sense of movement and vertigo.

Age is also another common risk factor for dizziness. Prevalence increases as you age! For example, 30% of people older than 60 years of age experience dizziness. Even more surprising is 50% of people older than 85 years experience symptoms of dizziness.

Concussions and post-concussion syndrome is another cause of chronic, prolonged dizziness. Physical Therapy specifically focused on symptom management and vestibular rehabilitation has shown great success to get people back to playing and competing in sports!

Some neurologic diagnosis can have dizziness are part of their clinical presentations. Common diagnosis that can experience dizziness include Multiple Sclerosis or peripheral neuropathy

Vestibular Rehabilitation and Physical Therapy

Vestibular rehabilitation is a specialized and highly effective therapy focusing on alleviating symptoms. Therapy will focus on habituation (including de-sensitization to tasks that make you dizzy), gaze stabilization, balance system integration, and balance re-training. Overall the brain is very flexible and able to adapt with the help of vestibular rehabilitation.

Your plan of care and therapy will be individualized to your level of comfort and tolerance as well as education on the cause and management of your symptoms. According to research, the success rates for vestibular rehabilitation ranges from 80-90% of people reporting a decrease in symptoms!

Physical therapy can provide the necessary tools to treat vestibular dysfunction, here are our general recommendations to know when to seek help from a physical therapist:
• For acute vertigo or BPPV, see PT immediately as able to provide quick treatment to resolve symptoms. This includes positioning maneuver to remove the crystal from the inner ear.
• For other dizziness, recommend seeing PT as soon as possible in order to improve quality of life by decreasing symptoms
• For post-concussion, recommend seeing PT after persistent symptoms for x1-2 months as well as to help return to work or sport
• For balance issues due to dizziness, recommend seeing PT as soon as possible especially to reduce falls risk

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