Dizziness When Standing

Most of us have an occasion when we’ve stood up too quickly and experienced a brief period of dizziness, wooziness, or lightheadedness. This occasional sensation can be disorienting and scary but is usually not related to a serious health condition. However, if your dizziness is frequent or occurs when you are lying down or walking, physical therapy can be a valuable treatment option.

Vertigo is often used interchangeably with dizziness, but they are actually different sensations. Vertigo causes you to feel like you or the room you are in is spinning. Kids spinning on tire swings are likely to feel vertigo when they are done, and adults may experience vertigo if they’ve consumed too much alcohol.

Understanding Dizziness

Dizziness is an umbrella term that includes the sensations of vertigo, imbalance, lightheadedness, and anxiousness or fear. Vertigo includes a spinning sensation that is not present in other forms of dizziness. These symptoms can cause feelings of motion sickness or other uncomfortable sensations.

In order to understand why you are becoming dizzy or experiencing vertigo, you need to first understand how our bodies normally keep us balanced. The vestibular system is the most important contributor to maintaining consistent balance. It monitors your body position and tells your limbs how to keep you standing upright or walking in a straight line. Another important contributor to good equilibrium is the circulatory system, which is responsible for delivering oxygenated blood and nutrients to your brain. Most cases of imbalance are related to the vestibular system.

Physical therapy has been successfully used for decades to help minimize or cure dizziness. Whether your dizziness is related to the vestibular or the circulatory system, the physical therapists at FYZICAL can help you minimize or eliminate your dizziness using holistic, pharmaceutical-free, and surgery-free techniques.

The Vestibular System

The vestibular system is a part of your nervous system that sends information to your brain about how your body is positioned and whether you are moving or not. When it is working properly, you probably don’t think about how to stand up and move in a purposeful direction. But if you’re frequently dizzy or having episodes of vertigo, the vestibular system can be a serious source of frustration and disability.

The peripheral vestibular system, in your inner ear, relies on: 1) a network of fluid-filled canals to sense rotational (turning) motions, and 2) two tiny organs called otoliths to sense movement direction (forward, backward, up or down). Every time your head moves, the peripheral vestibular system sends information about how you are moving to the central vestibular system, which is located in the brain. When the central vestibular system receives information about how your body is moving, it will proceed to tell all of the muscles throughout your body how to adjust in order to keep you moving in the direction you want to go.

If anything goes wrong in the peripheral or central vestibular system, the information your body gets about how to move will be inaccurate, and you will feel a form of dizziness called dysequilibrium. Although the vestibular system is incredibly complex, there are clues that you can use to help narrow down where your dizziness is coming from.

Most people who experience chronic dizziness have an abnormality in the peripheral vestibular system, which will often respond well to physical therapy. For example, tiny crystals on your otoliths may clump together and change the signal that your brain gets, leading to spatial disorientation in the form of dizziness and/or vertigo. Vestibular rehabilitation therapy (VRT) is a form of physical therapy that can break up these crystal aggregations and stop you from feeling imbalanced. Contact the experts at FYZICAL to learn more about VRT.

The Circulatory System

Another common cause of dizziness is abnormal regulation of blood pressure. This is particularly relevant to cases of dizziness that occur when you stand up from sitting or lying down. When you’re sitting or lying down, your blood tends to pool in your legs or abdomen. If you stand up quickly and the pooled blood isn’t returned to circulation fast enough, you will experience a moment of low blood pressure. This is called orthostatic (or postural) hypotension, and it means that your brain isn’t receiving enough oxygenated blood. As a result, you will feel woozy or lightheaded. Normally this sensation is over very quickly (about a second), but if you are experiencing prolonged dizziness after you stand up there may be a more serious underlying issue.

Physical therapy can be a very beneficial treatment for dizziness caused by poor circulation. The experts at FYZICAL can help you develop a holistic, whole-body approach to managing orthostatic hypotension using evidence-based therapeutic techniques and exercises.

Dizziness When Standing Up and Walking

Dizziness that is experienced while you are standing (as opposed to immediately after you stand up) or walking is likely to be related to your vestibular system. If you experience sudden dizziness while you are standing, take note of the position of your head and what you are doing when you feel imbalanced. This can help you and your physiotherapist identify the specific cause.

If you experience vertigo when look up or down or you tilt your head, you may have benign paroxysmal positioning vertigo (BPPV). BPPV is a consequence of peripheral vestibular system (inner ear) dysfunction or injury. The inner ear is responsible for sending information about your balance and physical orientation to the brain. When the inner ear doesn’t function properly, it sends inaccurate information about your body’s position to the brain. The result is a mismatch between your actual position and your position as perceived by your brain, which causes you to feel dizzy. BPPV responds very well to physical therapy.

Vestibular neuritis and labyrinthitis are two other common causes of dizziness when you are standing. The vestibular nerve connects your peripheral and central vestibular systems, and if it becomes infected or inflamed the signals it conveys can be affected. Constant, severe vertigo is a key symptom of vestibular neuritis and labyrinthitis.

If turning your head causes you to feel dizzy, you may be suffering from vestibular paroxysmia, which means that a nerve connecting your inner ear and your brain is being compressed as your head turns. Physical therapy exercises can help you strengthen the muscles that support the vestibular nerves, which will reduce or eliminate dizziness related to a compressed nerve.

If your dizziness occurs exclusively when you are walking, particularly in the dark or over uneven surfaces, you may be experiencing symptoms of unilateral or bilateral vestibulopathy. Every time you take a step, your brain activates specific reflexes that manage your balance and correct any potential missteps. If these “postural reflexes” are trying to keep you upright based on inaccurate positioning signals from your brain, you will feel very unsteady when you walk. In cases of unilateral vestibulopathy, only one side of your vestibular system is affected, and you will experience vertigo and drift to one side when you try to walk in a straight line. Bilateral vestibulopathy affects both sides of the vestibular system and is rarely associated with vertigo, but you will feel very imbalanced when you walk.

If you have unexplained dizzy spells that last for 20 minutes or more, fullness and/or ringing in your ears, intermittent hearing loss, you may have Menière’s disease. Menière’s disease is a poorly understood disorder of the vestibular system that causes spontaneous dizziness that may be severe and last for hours.

FYZICAL provides vestibular physical therapy that can help you manage dizziness symptoms associated with BPPV, vestibular paroxysmia, vestibulopathies, and other disorders of the vestibular system.

Dizziness When Bending Over

If you only get dizzy when you bend over, your circulatory system may be to blame. Both low blood pressure and low blood sugar can affect how well your blood can deliver oxygen and nutrients to your brain, leading to dizziness. Anemia, dehydration, and some medications can also cause unexpected dizziness when you bend over.

The vestibular system may also be the origin of dizziness when bending over, especially if vertigo is involved. BPPV and vestibulopathies are both potentially related to dizziness when bending over.

Finally, cervical vertigo may be the cause of dizziness when you turn your head. Cervical vertigo is often caused by a head or neck injury. If your dizziness goes along with neck pain, you may have nerve or arterial damage or compression related to a previous injury.

Dizziness When Getting Out of Bed

If you get dizzy when standing up after lying down, you may be experiencing orthostatic (or postural) hypotension, which occurs when you get up quickly after sitting or lying down. Orthostatic hypotension literally translates to low blood pressure (hypotension) when you are in an upright position (orthostatic).

When you are lying down, blood tends to pool in blood vessels in your abdomen. When you stand up, your heart can’t pump the pooled blood through your body fast enough, and your brain doesn’t get the oxygenated blood and nutrients it needs. Thankfully your heart is generally able to get your circulation going within a second or so, but the woozy feeling you have when you stand can be scary.

BPPV may also play a role in dizziness when you get out of bed. Many people with BPPV report that they have dizziness when they roll over in bed (without getting up) or when they lay on one side of their body. This dizziness may be experienced when getting up too.

What Causes Dizziness and Lightheadedness When You Stand Up?

Dizziness and lightheadedness that are caused immediately after you stand up are probably related to low blood pressure. Orthostatic hypotension (described in the previous section) is a major contributor to dizziness that occurs when you stand from a sitting position, and it is caused by blood pooling in your legs. Standing up requires increased blood circulation, and if your heart can’t get the blood pooled in your legs back into circulation fast enough, you will feel dizzy or lightheaded for a second or two.

Why Do I Get Dizzy and Blackout When I Stand Up?

Some people may experience severe dizziness and even temporarily lose consciousness when they stand up. This is also likely caused by orthostatic hypotension but may indicate a more serious problem with your circulatory system. For example, if you have a blood clot or constricted arteries, you may be prone to blackouts caused by poor blood circulation.

If you regularly blackout when you stand up, make an appointment with your doctor to rule out serious health problems.

Other Causes of Dizziness When Standing

Balance when you are standing and walking involves lots of coordination between your brain and your body, and if anything goes wrong throughout this process, you will likely feel dizzy. If you occasionally experience unexplained dizziness, there may be a simple explanation.

Dehydration is a surprisingly common cause for dizziness. If you don’t drink enough water, your blood will lose some volume and it won’t circulate through your body efficiently. The result is that your brain doesn’t get enough oxygen and nutrients, and you may feel woozy.

Low blood sugar (hypoglycemia) and a lack of oxygenated red blood cells (anemia) are two other common causes of dizziness. Normal brain functions depend on sugar and oxygen carried by your blood, and if your blood sugar or oxygen is low, you will likely feel dizzy.

When to See a Doctor

While dizziness itself may not indicate a medical emergency, there are some symptoms that you should never ignore when they occur with dizziness. If you are dizzy and experience any of the following symptoms, call your doctor immediately:

• Double vision
• Ongoing vomiting
• Paralysis of arms or legs
• Numbness in face or limbs
• Severe headache
• Slurred speech
• Passing out

In addition, if you have fallen as a result of being dizzy, you may want to contact your doctor immediately, especially if you hit your head.

Dizziness Treatment

FYZICAL offers holistic therapeutic approaches to helping you manage dizziness symptoms. Using a medication-and-surgery-free approach, our providers can help you develop a tailored regimen that can help you get your confidence and your life back.

We offer free assessments that can help you understand why you are feeling dizzy and what you can do about it. Find a FYZICAL location near you and make an appointment with one of our physiotherapists today.

To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book.