Vertigo is a sensation in which you feel like you are spinning or the room is spinning around you, even when you are sitting still. In some cases, the spinning may last for only a few seconds, for others, the sensation may be more chronic and last for several minutes or feel continuous. Vertigo can be extremely debilitating making it difficult to change move and change positions, stand on your feet, or walk.
If you've ever felt like the room was spinning, you've had Vertigo. You're unsteady on your feet, disoriented, afraid you might fall, and a little frightened. You may even believe you're having a stroke or suffer from some other neurological disorder.
Vertigo is usually caused by a condition located in your inner ear. The most common form of Vertigo is Benign Paroxysmal Positional Vertigo, better known as BPPV.
Unfortunately for some, this happens consistently — even chronically — and significantly limits their normal daily lives.
The good news is, two of the most common causes of Vertigo can easily be treated with physical therapy.
“The irony of vertigo is that it can be so intrusive and debilitating, yet so easy to resolve. Hands-on, manual therapy — the kind Results therapists specialize in — has been shown to do wonders with our vertigo patients.” - Craig O'Neil, Results VP of Learning and Affiliation
Benign Paroxysmal Positional Vertigo, or BPPV, is triggered by movements. It can be something as simple as rolling over in bed, getting up from bed, or looking up or down. Patients usually feel a spinning sensation for 30 to 60 seconds and, occasionally, nausea and imbalance, too.
This is because small crystals in the inner ear get out of place and cause dizziness. The clinical explanation is that calcium carbonate crystals called otoliths migrate from the utricle of the inner ear into the semicircular ear canals. There, they float freely or stick to a structure called the cupula and affect the flow of enolymph fluid.
Regardless of why, someone with BPPV feels horrible. However, it can be eliminated with one or two sessions of physical therapy.
Another form of vertigo is called Cervicogenic Dizziness, commonly known as Cervical Vertigo. Cervical Vertigo is related to the neck, or cervical spine.
BPPV, is triggered by head movements. It can simply occur from rolling over in bed, getting up out of bed, or from looking up or down. BPPV can also occur due to head trauma, like a car accident or fall. It can also happen after the head is tilted for a prolonged period, such as at the dentist or hairdresser. It is more common in women, particularly in middle age or their senior years, than in men.
This is because small crystals in the inner ear get out of place and cause dizziness. The clinical explanation is that calcium carbonate crystals called otoliths migrate from the utricle of the inner ear into one of the semicircular ear canals. There, they float freely or stick to a structure called the cupula and affect the flow of enolymph fluid.
General dizziness can be caused by several things, many of them medical. They could include problems with blood pressure, blood sugar (as in diabetes), and reactions to medication. Neurological causes can include problems with the central nervous system, vascular system, or vision. In some cases, dizziness are caused by psychiatric issues.
Those with BPPV may also experience nausea, vomiting, sweating, and abnormal eye movements, in addition to dizziness, imbalance, and the sensation of “spinning.”
BPPV is more common in women, particularly in middle age or their senior years, than in men. The good news is that BPPV can be eliminated with one or two sessions of physical therapy. Without treatment, BPPV typically resolves in two to six months. But 90 percent of patients can get results with one five-minute procedure in an outpatient physical therapy clinic. And it doesn’t require drugs, x-rays, or surgery.
In most states, patients have what is called Direct Access to Physical Therapy services. This means that you are able to schedule an evaluation with a Physical Therapist without needing a referral from a physician.
During the evaluation, your physical therapist will, first, ask several questions about your dizziness. If he or she suspects BPPV, a few quick tests are given to determine which semicircular canal is affected.
Without treatment, BPPV typically leaves in two to six months. But 90 percent of patients can get results with one five-minute procedure in an outpatient physical therapy clinic. And it doesn't require drugs, x-rays, or surgery.
Patients often find success with one treatment. Once BPPV is confirmed, your therapist will guide you through a series of movements called the Modified Epley Maneuver. These maneuvers return the crystals to the proper part of the ear canal, restoring equilibrium.
This is successful 80 to 100 percent of the time, though some patients need a second treatment to clear it up completely. Your therapist will follow up in a week, then in a month to make sure it hasn’t returned.
Cervical Vertigo or Cervicogenic Dizziness often occurs because of a flexion-extension injury, such as whiplash injury. It can also be caused by a sports injury, arthritis, or surgery.
Symptoms include lightheadedness, a “swimmy” feeling, unsteadiness walking, and difficulty sleeping. These symptoms are usually worse during head movements or when sustaining neck positions and usually occur after the onset of neck pain. Headaches are common and sometimes the dizziness may seem to last for several hours.
During you initial evaluation, your physical therapist will ask you several questions related to your symptoms. Then, a cervical examination will be administered to determine symptom provoking movements and positions.
Gentle mobilization of the neck through hands-on, manual therapy, along with exercise and instruction in proper posture and neck use, improves symptoms in approximately 75 percent of patients.
In certain cases, vestibular retraining is also needed. This may include the need to learn exercises in Gaze Stabilization, Balance Training, and Habituation.
To prevent reoccurrence of BPPV after your initial evaluation, it usually recommended as a precaution to “take it easy” for the next 24 hours. You will want to avoid making any sudden head movements or sleep on your affected, symptomatic side. Even though you will most likely feel relief of your symptoms, it common for you to feel slightly “off” for the next 24 hours as your body and brain readjust back to your prior, normal self.
How Can Physical Therapy Soothe BPPV and Vertigo?