Dizziness and Vertigo
Updated: Mar 3
Vertigo. The spins. The dizzies. Disequilibrium. Woozy. BPPV.
Whatever you call it, if you've ever had it, it's no fun and it can keep you from being able to perform your normal daily activities as well as exercise.
Dizziness and vertigo can affect people of all ages though it's most common in adults. It has a variety of causes as well. In order to find a solution for your dizziness, it's important to figure out what is causing it. We're going to talk about some of the major causes of dizziness we see as PT's and discuss what physical therapy treatments can help resolve the issue.
Before we get started, let's talk about balance really quickly. Your balance is regulated by 3 systems that all work together...
-Vestibular: this is the inner ear system consisting of some canals (they contain little hairs or cilia, fluid and crystals -- more on that soon) and nerves that carry that information to the brain.
-Visual: this is exactly what it sounds like, it's what you see! Have you noticed it's harder to balance with your eyes closed vs open? That's because your vision helps you balance.
-Proprioception: this is your body's ability to tell where it is in space. It is regulated by receptors throughout the tissues in your body that feed information to the brain to tell it where you are. Try this, put your hand behind your back. Can you tell if you have your palm facing up, down or sideways? That's proprioception!
All of these systems work together in order to keep you balanced, upright, and not dizzy. If there's an interruption somewhere in one of them, that can disrupt your balance and cause dizziness, vertigo and unsteadiness.
Ok, now that we got that out of the way, let's talk about 3 of the main types of dizziness and vertigo we see as physical therapists...
Benign paroxysmal positional vertigo or BPPV for short, is the sensation of the world spinning around you even though you aren't moving at all. It often comes on suddenly and for no apparent reason. The spinning happens when you change positions such as getting into/out of bed, rolling over or turning your head.
BPPV is caused by an inner ear problem. Your inner ear has a set of canals lined with little tiny hairs (cilia) and contain fluid and little crystals (otoconia). As you move your head around, the fluid moves through the canals sending information to your brain via the vestibulocochlear nerve. Combine that with other information received from your vision and receptors in other tissues of your body and your brain is able to tell you where you are in space.
When someone has BPPV, a crystal becomes loose and moves freely into the canal. And when that certain canal is stimulated by positional movement (i.e. bending over/rolling over in bed), the fluid moving through that canal is disrupted by the crystal and results in the sense of spinning and dizziness. You might have heard someone say their "crystals are out of place" in their ear. This is what they are talking about.
This condition can stop you dead in your tracks, making it difficult to move around and perform your normal daily activities. Many people experience extreme dizziness and even nausea and vomiting.
The good news though, is BPPV can be quickly solved with a trip to your PT. In addition to doing testing to determine the cause of your dizziness, there are treatments we can do in the clinic that provide almost immediate relief.
While the symptoms can sometimes present similarly to BPPV, vestibular hypofunction has a different cause. The same treatments the can reduce/eliminate BPPV won't work for vestibular hypofunction.
You can think about vestibular hypofunction as a weakness in your vestibular system, similar to a weak muscle. The less you use a muscle, the weaker it gets. The more you use a muscle, the stronger it gets. The vestibular system naturally declines some with age but there are other things that can cause it to decrease as well such as infections, illness, an inflammation in the nerves of the vestibular system and autoimmune disorders.
The natural decline of the vestibular system can be seen if you look at how kids move vs adults. Kids are constantly rolling, spinning, twisting, turning, hanging upside down etc. There aren't many adults doing those same movements on a regular basis. Kids are constantly stimulating their vestibular system with these movements, keeping it nice and sharp. Remember back when you could spin around in circles on a stool or office chair or with your forehead on a bat and just hop up and walk off like nothing happened? Try doing that now as an adult and report back...
This decline can sometimes become so pronounced, you start to notice it with daily activities or athletic activities. Similar to working our muscles out and making them stronger, we can also "workout" our vestibular system and make it stronger as well.
If your hypofunction has another cause such as illness, inflammation or autoimmune disorder, there may need to be other treatments along with vestibular rehab to fully return to normal. Unfortunately, with some of these causes, there may always be some issue with the vestibular system but symptoms can be improved or managed with PT.
Did you know your neck may be causing your dizziness? Cervicogenic (meaning originating in the cervical spine or neck) dizziness or cervical vertigo can give you a feeling or being disoriented, unbalanced or unsteady. It is different than a typical vertigo (room spinning) presentation.
Cervicogenic dizziness can be caused by a neck injury or lack of good range of motion or strength/control in the neck. It often presents with neck pain and can be associated with headaches as well.
Physical therapists are musculoskeletal experts and can determine if your neck is causing your dizziness. Cervicogenic dizziness is not the kind of thing that would show up on an image such as an x-ray or MRI. It is diagnosed with a thorough medical history, physical exam and special test to determine the source as well as ruling out other sources of dizziness.
Treatment for this condition would primarily be aimed at the neck, using manual therapy to improve range of motion and specific exercises to improve strength and control as well as posture work. Vestibular exercises often accompany the manual therapy and neck/posture exercises as well.
Other causes of dizziness and vertigo
We highlighted 3 of the main causes of vertigo and dizziness we see in patients and the ones we treat most often. There are other causes of dizziness PT can help with as well such as post concussive dizziness/vertigo and vestibular migraine. While PT may not be the first and only line of defense for those conditions, there are things a vestibular trained therapist can do to help improve symptoms and manage dizziness, along with other treatments and medications from your physician.
Some other causes of dizziness/vertigo that have limited or no improvement with PT are Meniere's disease, blood pressure and vascular issues, multiple sclerosis, medication related dizziness and visual problems.
What can I do if I'm dizzy?
If you know your dizziness is related to one of the causes we just mentioned with little or no improvement with PT, the best thing to do is to continue to speak with your physician managing your condition. You can ask them if they think physical therapy may help in conjunction with other treatments.
If your dizziness or vertigo sounds like any of the other conditions we discussed though (BPPV, hypofunction or cervicogenic dizziness as well as post concussion and migraines) a visit to a PT who can do a vestibular evaluation and treatment would be a good place to start. In the state of Tennessee, there is no referral needed to see a physical therapist.
It's our goal to keep active people active. Dizziness and vertigo are both things that can keep you from being able to participate in the activities that you want to. That's why a few of our PT's at Nashville Physical Therapy & Performance evaluate and treat dizziness and vertigo. Jenn Scott and Sara Bandy in our East Nashville clinic and Amy Crouse and our South and West Nashville clinics all work with vestibular/dizziness/vertigo patients.
If you would like to set up an appointment with either Jenn, Sara or Amy, can CLICK HERE or call/text 615-428-9213.