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Getting Off the Merry–Go-Round: Treating Dizziness

The feeling of dizziness can be absolutely awful. Most of us have been there, where we turn too fast and get a sudden moment of dizziness and feeling off balance and it typically goes away as fast as it came on. What happens when it doesn’t go away so quickly or when it happens more frequently than normal? Even worse, what happens when that sensation makes us sick? Nausea, vomiting, balance issues, ick! Let’s talk about a few of the different reasons for dizziness and how physical therapy can help.

BPPV, Benign Paroxysmal Positional Vertigo, or more simply just vertigo is probably the most easily recognizable diagnosis for people with dizziness seeking help from a physical therapist, and it’s our favorite because we can be so helpful in this case! People usually describe this as the classic room-spinning sensation or they are spinning in the room after their head changes positions. Most often, it occurs with looking up, looking down, turning your head, or rolling over in bed. Some people don’t notice the room spinning but rather notice a sudden difficulty with balance when getting out of bed. It is typically fairly short, lasting less than 30-60 seconds, but can cause some residual dysequilibrium after the spinning sensation calms down. Less often, the room spinning can last longer than 60 seconds and be more debilitating. The reason for the spinning is a mismatch between what you are seeing, what your body is telling your brain you are doing for movement, and what your inner ear system is telling your brain you are doing for movement. There are very tiny crystals in your inner ear which move around in a gel-like substance when you move your head. When they move into the wrong area of your inner ear, or worse yet, get stuck in the wrong spot, your brain senses movement of your head which is not actually happening. This causes the spinning sensation. We can usually fix this easily in physical therapy using maneuvers which help redirect the crystals to move back where they belong. Except in severe cases, Meclizine is not typically helpful because it may reduce the effect of the symptoms temporarily but it will not redirect the crystals. Vestibular physical therapists are specifically trained in these maneuvers and can be very helpful in getting you feeling much better very quickly, usually in only 1-2 visits.

 (Image from Bangkok Hospital Hua Hin)

A vestibular hypofunction, as we call it in the physical therapy world, more commonly known as  labyrinthitis or vestibular neuritis in the medical world, is more rare than BPPV. This is an inflammation of one of the areas of the inner ear system and can cause more severe symptoms which do not come and go the way BPPV does. It is referred to as a hypofunction because the inflammation causes the vestibular system to be impaired compared to your normal functioning. Often people will describe having cold-like symptoms first but sometimes it comes out of nowhere and causes severe dizziness, nausea/vomiting, difficulty with balance, and difficulty with walking straight. Normally able-bodied people sometimes even need a cane or walker or will report running into walls. Depending on the area of inflammation, it may even affect your hearing. This dizziness is often reported as being present at all times. While physical therapy cannot resolve the inflammation, we can help with restoring your ability to focus your vision in order to reduce the dizziness faster than would occur on its own in addition to helping regain your balance and ability to walk. Some medical providers will also prescribe medications to help in the early phase of inflammation and this is an area where working with both your provider and your physical therapist is very beneficial.

(Image from NewYork - Presbyterian)

Postural deconditioning is something we have seen more commonly since the quarantine era of COVID-19. This affects older adults more often and while they may report some chronic dizziness, it is often described more as a severe decline in balance and endurance. These in turn affect each other because having less endurance will decrease your tolerance to activity, further worsening your balance, and having poor balance will increase your fear of falling and reduce your confidence in moving and further decline your endurance. When we don’t move, our body becomes less tolerant of moving. Have you ever wondered why kids can tolerate swinging and going on rides better than we can as adults? It’s because they do it all the time and their system is used to it. This is the classic concept of if you don’t use it, you will lose it. How do you get out of this cycle? Come to physical therapy and we can help get you moving again in a safe, gentle, progressive way. This does take some time but the improvements can be life changing!

(Image from Marketplace Physical Therapy)

Orthostatic hypotension is a sudden drop in blood pressure which occurs when we move from a sitting or laying down position and stand up quickly. This will cause more of a lightheadedness sensation. Most people have this feeling occasionally and it is not cause for concern, but if it happens frequently, causes falls or near falls, or actually makes you feel like you could faint, you need to talk to your doctor about this. Medications can be a source of this problem or other medical related dizziness which is also more appropriately addressed by your doctor. This is not typically a type of dizziness which is appropriately treated with physical therapy.

(Image from Mayo Clinic)

This list is not all encompassing and there may be other reasons why you feel dizzy or off balance, but hopefully you find it is a good start in understanding why you might be feeling that way and how it can get better. Come see us at Point Forward Physical Therapy where we have specially trained therapists in vestibular therapy. We will start with a thorough evaluation to determine if physical therapy is right for you and begin an individualized treatment program to help get you feeling better and back to moving again as soon as possible!

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