You Don’t Have to Live with Dizziness!

As I stated in my previous post, there are many treatment options to decrease or rid of dizziness. In some instances it only takes one treatment for the patient to feel back to normal. However, just because you feel back to normal doesn’t mean you shouldn’t continue to seek treatment to ensure that the vertigo is gone for good.

I mentioned many factors that can play a role in causing vertigo. One I forgot mention is the neck. Your neck muscles can get tight from repetitive movements, your job, sleeping wrong, or fear of turning your head due to dizziness. This tightness can add to the sensation of dizziness. Having tight muscles along with the fear of movement limits the range of motion in your neck. This lack of motion feels safe for the time being because your head doesn’t move which in turn makes you feel less dizzy. However, your body has now forgotten what it feels like to move normal thus throwing your balance system off once again. Maintaining your neck range of motion is important when rehabbing for vertigo.

Physical Therapy

– Soft tissue mobilization to loosen musculature

– Canalith Repositioning Maneuvers

– Vestibular Rehabilitation Therapy

– Balance Training

Soft Tissue Mobilization

This is what most people would call the “massage” portion of therapy. Using their hands or dry needles, the therapist works through the trigger points (knots) in your muscles to free up your range of motion. At times this is a necessary first step before performing the Canalith Maneuvers due to the lack of range of motion. Joint mobilizations of the cervical spine will also be performed. When the muscles lock up, so do the joints.

This hands-on therapy also gives the therapist and the patient a chance to build trust with one another. Typically, patient’s that come in for treatment of vertigo are skeptical and fearful. The last thing they want to do is set off a vertigo episode. Working together at this stage helps to build that trust.

Canalith Repositioning Maneuvers

There are several repositioning maneuvers that can be done, choosing the right one is key. These maneuvers are done to observe the eye movements. The examination of eye movements is critical for defining and localizing vestibular pathology.

The Dix-Hallpike test is the most common positional test used to examine for BPPV. The patient sits on a table with legs straight out in front. Their head is then turned 45 degrees to one side. The therapist holds the patient’s head and ask them to “fall” towards the table while keeping their eyes open. While on their back their head will be extended 30 degrees beyond neutral. This is where the physical therapist will observe the eye movements. This test can then be turned into a treatment called the Eply maneuver. Once the therapist has observed the eyes, they will keep the patient in that position for 30-45 seconds after eye movement has stopped. Then the therapist will roll the patient’s head to the opposite side. The patient is fully relaxed and should not activate their neck muscles to move their head. Then he patient is asked to roll to that side keeping their head looking down towards the floor, wait another 30-45 seconds. The therapist will assist the patient into a sitting position, waiting another 30-45 seconds.

There are multiple maneuvers that can be performed, and depending on which canal the dysfunction is located determines which maneuver will be performed. However, they can get complex and are at the discretion of the treating therapist.

Performing these maneuvers can cause the patient to experience an increase in symptoms. In order for the therapist to know exactly how to treat the issue, they have to recreate the dizziness.

Vestibular Rehabilitation Therapy

This refers to the retraining of the eye musculature. They can be referred to as gaze stabilization exercises and VOR (vestibule-ocular reflex). The purpose of these exercises is to improve the VOR and other systems that are used to assist in gaze stability with head motion. These exercises are broken down into X1 and X2.

In X1 exercises, the patient moves their head side to side as quickly as possible while maintaining focus on a stable target. If the target becomes blurred the patient needs to slow their head movement down. The target should be arms length away.

In X2 exercises, the patient moves their head and target in opposite directions.

Both these exercises can be performed with side to side movements and up and down movements.

Balance Training

This is exactly what it sounds like – the therapist works with the patient to regain their balance in everyday activities. Typically, it will start with simple tasks and progress to complex balance exercises. The exercises chosen depend on the patient’s goals and the type of activities they want to perform.

Examples of Balance Training Exercises

– Single leg stance

– Feet close together, eyes open or closed

– Standing one foot in front of the other, eyes open or closed

– Walking over different surfaces

– Walking over different obstacles

– Walking while turning head left/right and up/down

– Walking one foot in front of the other on a line

– Walking backwards

-Walking forward with eyes closed

– Turning while walking

These are just some examples of balance exercises that can be performed in the clinic. Obstacle courses are a great way to get a patient ready to return to the community.

Other Treatment Options

– Meclizine is one of the most common prescriptions for vertigo. This suppresses the activity of the inner ear – There is some research to support that use of Ginkgo Biloba to help treat vertigo. – Increasing your vitamin D has also shown to decrease your BPPV symptoms – Increasing your water intake – Ensuring you are getting the proper amount of sleep – Decreasing stress – Avoiding alcohol – Adding a water pill if the cause is Meinere’s Disease Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.