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Written by: Janet Crosier, PT, DPT, MEd

Managing Dizziness – A Physical Therapist’s Perspective

“I just rolled over in bed and the room started spinning.”

“I don’t know how to describe how I feel. It’s a feeling in my head. It’s never really gone, but sometimes it is worse than other times. Sometimes I just move the wrong way and I have to sit down.”

“Every time that I get out of bed I have to stand and wait until my head clears before I can move. Then I’m ok.”

“No one can figure out what is wrong with me.”

These are among the most common symptoms that lead a person to seek help with dizziness or imbalance. The good news is that help is available from clinicians, including physical therapists who have advanced training in problems with the inner ear and vestibular system. And the majority of patients can and do get better with vestibular rehabilitation.

What is dizziness?

Dizziness is the common term used to describe the sensation of disequilibrium - with or without balance loss. The intensity of the sensation of disequilibrium can vary widely. Clinicians use the following terms to describe the different types of disequilibrium:

  • Vertigo – disequilibrium with sensation of spinning, usually visual
  • Lightheadedness – disequilibrium with the sense that one would faint if symptoms continued to increase
  • Dizziness – disequilibrium that is not vertigo or lightheadedness

What causes vertigo?

 Vertigo can be caused by a number of problems (including drinking too much alcohol!), but the most common cause is a condition called benign paroxysmal positional vertigo or BPPV. BPPV occurs when tiny crystals normally situated on the utricle in the inner ear dislodge and migrate to the semicircular canals. Once in the semicircular canals, the crystals stimulate tiny nerve endings causing them to fire at the wrong time providing misinformation to the brain about head motion. The brain responds to this misinformation by creating abnormal eye movements called nystagmus, which creates the visual effect of the room spinning. Symptoms can be mild or severe, including balance loss, nausea, and vomiting. Fortunately, this mechanical problem of the inner ear responds very well to positional maneuvers to relocate the crystals back to the utricle where they either reattach or dissolve. Some people are able to treat themselves using the Epley maneuver and sometimes the vertigo goes away without any treatment at all. However, many patients need the assistance of a physical therapist.

Other causes of vertigo include acute labyrinthitis (inflammation of the nerve to the inner ear), vestibular migraine, and nervous system diseases (like multiple sclerosis) and tumors.

What can be done for lightheadedness?

Contact your physician right away if you notice that a new medication or a change in dosage is creating lightheadedness. Cardiac and pulmonary (heart and lung) conditions should be ruled out before seeking assistance from a physical therapist to manage lightheadedness.

The most common cause of lightheadedness seen by physical therapists is related to changes in blood pressure as a person moves from lying to sitting or sitting to standing called orthostatic hypotension. Reflexes cause the blood pressure to change to assure the best flow of blood to the brain with changes in body position. In cases where the individual is debilitated or dehydrated from a fluid-poor diet, medication or treatment, these drops in blood pressure can be severe and create the sense of lightheadedness. After determining if orthostatic hypotension is the issue, the therapist will provide education to decrease the incidence of lightheadedness, including assistance in identifying fluid-rich foods; performing ankle pumps and other exercises to reduce the severity of the change in blood pressure; and planning for rehydration during work and exercise.

Is there any help for dizziness?

The answer is YES! Unfortunately, an individual suffering from dizziness is frequently told that his or her tests results are normal and that there is nothing that can be done. MRI, CT scan, and laboratory tests are not useful tools for assessing the patient with dizziness because the most common problem is related to the vestibulocochlear nerve that provides information from the inner ear to the brain.

The inner ear is a collection of specialized sensors that provide vital information to the brain about head position and motion in space. Unlike any other sensors in the body, the semicircular canals work in pairs with one member on each side of the body, for example the right posterior canal works with the left anterior canal. As a result, the information from the canal pairs traveling on the right and left vestibulocochlear nerves must arrive at the same time to the brain. When one nerve is damaged, usually due to a viral attack, that nerve is slower resulting in the sense of dizziness.

Vestibular rehabilitation consists of a series of progressively more difficult exercises that help the brain adapt to the difference in right and left nerve speed. The exercises are simple and result in significant reduction in dizziness symptoms and improved balance. Once the brain has adapted, most individuals can discontinue the exercises and will maintain gains made in rehabilitation.

How can I get help?

First, talk to your doctor about your symptoms and request a referral to a physical therapist with specialty training in vestibular therapy. Visit vestibular.org for more information and to find a vestibular therapist near you.

No one needs to feel dizzy, vertiginous, lightheaded, or off-balance. There is help.

Submitted by Dr. Janet Crosier, PT, DPT, MEd
Janet is a Doctor of Physical Therapy with advanced training in vestibular rehabilitation from Emory University and over 30 years of experience treating vestibular disorders. She practices at Fyzical Therapy and Balance Centers in Sequim and Port Townsend.