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Vertigo

Vertigo Treatment

Vertigo and Vestibular Disorders: Not Just Maneuvers

Vestibular therapy may be one of the most interesting groups of diagnoses we see in physical therapy.  In some cases it becomes one of the few diagnoses that can be fixed in just one visit, a rarity in the world of healthcare in general!  In other cases, we have to work with patients to develop a lifelong program to maintain abilities and compensate for various disease processes! Unfortunately, because of this complexity, many patients are left scrambling for answers, attempting home remedies proposed from various corners of the internet, or feeling as if there is no resolution for their problem for months and sometimes years on end!

The good news is that research has illuminated a great deal about this family of disorders, and better yet there are quite a few of us who find this research absolutely fascinating, and have spent far too much of our time learning about it!

While it is true that vestibular disorders can be complex in regards to various causes which can include anything from a physical injury to the bony canals that make up the vestibular sensory organ or the nerve that relays messages from this organ to the brain to autoimmune disorders directly attacking this system, a relatively simple set of tests that can be performed by qualified physical therapists and ENTs can often rule in direct issues over just a few visits, often with extremely non invasive testing.

The even better news is that the vast majority of the deficits that result from these disorder are often highly treatable, with the majority of patients recovering within anywhere from a few visits to a few weeks!  It can be very important to find therapists and physicians well versed in these disorders, however, as the “classic vestibular exercises” that are often blanketed across all cases of dizziness are not useful for all types of vertigo, and can lead to the misconception that a particular patient is “untreatable” as they did not respond to something which, sensibly, did not apply to their particular condition!

We are lucky enough at Hohman to have quite a few of our family who have taken special interest in the treatment of these disorders, and our thorough exams and personalized treatments are designed with current research at the forefront!

Vertigo Conditions We Treat

What is it?
Positional vertigo is the sensation of room spinning dizziness, usually caused by debris within the very small bony canals that make up the vestibular organ, located near the inner ear structures that make up hearing.  Debris within these canals is subject to gravity, unlike the momentum dependent viscous fluid that normally moves within this sensory organ, and can trigger a reflex causing the eyes to repetitively adjust to perceived “movement” detected by the organ when we change through gravity dependent positions (like rolling over in bed, or looking up to rinse our hair in the shower).
Treatment
Affected canals can be diagnosed with simple testing on a bed to determine which specific position or positions triggers your vertigo.  From this analysis, the debris can usually be guided back out of the canals through a series of position changes until the debris drains into its appropriate location within the affected sensory organ.  Normally this takes only 1-3 visits!
Important facts to know
Positional vertigo left untreated can create adaptations in the brain in a systematic attempt to regulate these symptoms.  This can create some residual dizziness even after treatment resulting in a presentation similar to a Vestibular Hypofunction.  Since messages from this affected organ are suppressed by normal medications for vertigo like meclizine, dramamine, and vertigen, it is important to not take these medications the day of your appointment with a vestibular therapist to ensure an accurate diagnosis!
What are they?
The nerves that transmit messages from the organs of the inner ear that detect movement normally work very well in concert.  When your head is still they maintain a base rate of fire to tell your brain that you are not moving, and when you turn one way or the other, the ear of the direction you turn speeds up and the opposite side normally slows down accordingly!  Your brain can then use this to let you know how fast and how far it feels you have turned!  However, things like pressure on the inner ear from a local infection, diseases that attack our nervous system, and autoimmune disorders like Meniere’s Disease that directly attack the vestibular nerve can affect this base firing rate.  If one side is hit harder, that side starts firing slower at baseline, sending your brain the erroneous message that you are turning in space when you really are not!
Treatment
The nervous system is remarkably adaptable and highly trainable.  Specific exercises involving head movement and eye control exercises can allow your brain to reset its baseline and re-tune its perception of how far it feels you are moving and when!
Important facts to Know
Vestibular Hypofunction can be cause by a variety of disorders, and while physical therapy can help greatly with the symptoms, it can be very important to ensure that the root cause (like an ear infection or autoimmune disorder) is also well controlled by a physician.  Medication like meclizine is designed to help with the dizziness symptoms, but does not address these root causes, and if an infection or disorder is suspected, it is important to seek treatment for this as well!
What are they?
This family of disorders is usually the result of an adaptive change the brain makes treating one of its 3 balance systems more preferentially than the others.  Normally, your brain is supposed to weigh input from the eyes, inner ear, and pressure sensation of the skin throughout the body to assess degrees of movement, severity, and speed.  However, in many cases the body may adapt to becoming overly reliant on vision (like if we are taught to “spot” to prevent dizziness in sports, or if we have an infection that affects the reliability of our other systems), which means that any time the body sees movement with the eyes it assumes it is real.  This can be at odds with the other messages being delivered to the brain, like if riding simulators, or if a car goes by us quickly giving the illusion that our speed has changed.  We believe that the resulting symptoms are an attempt by the brain to get the body to stop and re center.
Treatment
Diagnosis of this condition will usually find that all balance systems function, however when certain systems are given erroneous input, dizziness or imbalance results.  Once the affected systems are diagnosed, treatment begins with a gradual exposure protocol, essentially working on challenging the system or systems affected at a level that requires re adaptation, but with a focus on not flaring up symptoms.  This is usually a slow process involving many tiny progressions over time, and may involve variable surfaces, stances, and visual perturbations like use of virtual reality.
Important facts to Know
While sensory integration issues are often triggered by things like simulators, spinning, and car trips, complete avoidance of these activities may actually result in a worsening of the condition.  Under guidance of a therapist, reintroduction of activity should occur over time!

What are they?
Similar to sensory integration disorders, central organization issues are thought to be caused by a difficulty “piecing together” where we are in space, but rather than being due to a natural adaptive change over time, they are usually the result of direct insult to the central nervous system itself, the processing center of all of these systems.  Traumatic brain injuries, history of concussion, history of stroke or TIA, and disease processes affecting the brain and central nervous system are the typical causes of these disorders.
 
Treatment
Thankfully, the brain is remarkably adaptable!  Central disorders are often slow to progress, but the plasticity of the nervous system will often allow gradual improvement to the various processes that may be affecting the symptoms.  Usually these conditions will involve a combination of exercises across the vestibular realms, including eye coordination, balance practice, gradual exposure to physical activity and visual stimulus, and gait retraining.  While the prognosis for these conditions is often longer than for other dizziness, the adaptability of our nervous system often still means that the prognosis can be very good!
 
Important facts to know
Progress through conditions like these is often a team effort.  A neurologist, ENT, and physical therapist will like be involved in your rehab team, and each will play a very important role in recovery!
What is it?
Disequilibrium is a blanket term used for the perception of imbalance or instability, which can be the result of several causes.  Momentary disequilibrium when rising from lying down to sitting, or sit to stand, may be caused by low blood pressure as affected by hydration, various medications, or heart conditions as the cardiovascular system momentarily struggles with providing oxygen to the brain.  Sensory loss such as peripheral neuropathy or loss of vision can also contribute to a sense of imbalance as the brain has a difficult time gathering accurate information from less sensitive systems.  Even inactivity can result in a desensitization of systems, which can cause poor balance and instability during standing and walking.
 
Treatment
Thankfully, the majority of conditions can be treated with increased targeted activity.  For patients with blood pressure issues, guided lower extremity strengthening and cardiovascular conditioning can improve cardiac output and lessen their issues when changing position.  Patients with neuropathy and desensitization can often still improve their processing of their remaining sensation with targeted balance training as well!
 
Important facts to know
As with the exception of deconditioning, many causes of disequilibrium also need concurrent medical management, you should keep your primary care provider well informed of your symptoms as medications may need to be changed or adjusted in cases like this!

Vertigo Online Course

You don't have to suffer from dizziness or vertigo any longer! Get back to living your life.

You’ll get:

  • Knowledge of how your body systems work together to maintain balance
  • Tests to perform on your own to know exactly what is causing your dizziness
  • Maneuvers and exercises to feel better AND STAY BETTER!

Register for the course

Improve your quality of life.
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We are not your typical therapists. All we do is help men and women stop pain and get more active. Many of our clients include athletes, elderly, pregnant women, and business executives. People of all ages, who wish to fix their bodies and enjoy life.

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