Gettin’ Dizzy With It!
How Physical Therapy CanHelp Vertigo and Dizziness
The vestibular system is a small, complex system that resides in our inner ear. Yet, despite it being small enough to fit on the nail of your pinky finger, it can pack a punch. This article is designed to give you a better understanding of what the vestibular system is, how it works, how it can affect you when things “go wrong,” and how GWP Physical Therapy can help. Let’s get dizzy with it!
What is the Vestibular System?
We find equilibrium through the use of the vestibular system, visual and somatosensory systems, as well as our Central Nervous System (CNS). Our vestibular system is responsible for detecting changes in gravity and velocity. This lets us know where our head is in space, its direction of movement, and acceleration. Our vestibular system alone contributes to two-thirds of the input that we need to maintain equilibrium. So it’s safe to say that our Vestibular System is incredibly important!
Our Vestibular System consists of the utricle, saccule, and the semicircular canals. The utricle and saccule are designed to detect motion and orientation through the use of otoliths, or better known as our “ear crystals.” Our semicircular canals help us to regulate balance and detect head position.
Benign Paroxysmal Positional Vertigo (BPPV)
The most commonly diagnosed, and often misdiagnosed, disorder is BPPV. With this condition, people experience the phenomenon known as “vertigo.” Vertigo is defined as the external rotation or movement of the world around the person. It is important to note that vertigo is not a diagnosis but a symptom. BPPV occurs when the otoliths are displaced from the utricle and saccule and travel into the semicircular canals. This causes the sensation of additional movement and the feelings of extreme dizziness, nausea, and disequilibrium.
Treatment for BPPV consists of repositioning maneuvers (such as the Epley) and Vestibular Rehabilitation Therapy (VRT) for re-training of the systems to help the patient return to function. It is recommended that patients follow through with a VRT protocol in order to have prolonged results from treatment and ensure safety in the community.
Benign Paroxysmal Positional Vertigo (BPPV)
The most commonly diagnosed, and often misdiagnosed, disorder is BPPV. With this condition, people experience the phenomenon known as “vertigo.” Vertigo is defined as the external rotation or movement of the world around the person. It is important to note that vertigo is not a diagnosis but a symptom. BPPV occurs when the otoliths are displaced from the utricle and saccule and travel into the semicircular canals. This causes the sensation of additional movement and the feelings of extreme dizziness, nausea, and disequilibrium.
Treatment for BPPV consists of repositioning maneuvers (such as the Epley) and Vestibular Rehabilitation Therapy (VRT) for re-training of the systems to help the patient return to function. It is recommended that patients follow through with a VRT protocol in order to have prolonged results from treatment and ensure safety in the community.
Vestibular Hypofunction (Vestibulopathy)
This condition can either be unilateral or bilateral, depending on the mode of injury. Essentially, the inner ear is not functioning properly which can cause feelings of dizziness, oscillopsia, and postural instability. Unilateral hypofunction treatment aims to promote central compensation through Vestibular Rehabilitation, and relies on the “healthy ear” to perform most of the inner ear functions. In Bilateral hypofunction, vestibular rehabilitation is still beneficial, but the therapy process is longer and more difficult due to an absence of all inner ear functions. In this case, the patient will have to learn to rely on other systems to help maintain equilibrium, such as vision, proprioception, and the cervical-ocular reflex.
Cervicogenic Dizziness
While this may not inherently be a “vestibular disorder,” this condition still causes feelings of dizziness, nausea, and disequilibrium. More specifically, you may hear patients report neck pain, and the feeling that they have a “wobbly, heavy head.” Cervicogenic Dizziness is defined as the “non-specific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activity from the neck.” Cervicogenic dizziness rarely results in true vertigo as it is not related to vestibular dysfunction. Treatment utilizes aspects of VRT, with additional cervical stability and cervical proprioception exercises.
What is the purpose of Vestibular Rehabilitation Therapy (VRT)?
VRT is designed to return or reset the Vestibulo-Ocular Reflex, reduce exaggeration of motion or after-motion, strengthen the weakened systems, and strengthen the systems that remain. We also look to improve or restore coordination of head and eye movements, as well as balance and equilibrium function. VRT uses an integrative approach of adaptation, habituation, and substitution protocols. VRT consists of purposely and mildly provoking symptoms repeatedly to reduce the pathological response over time. We also help strengthen the weakened vestibular system by challenging the remaining systems (visual and somatosensory) by using challenging surfaces, or even just by closing your eyes! VRT protocols help reduce response to provocative stimuli and help get you back to a dizzy-free life!
Vertigo and dizziness can be debilitating. GWP Physical Therapy has the tools and knowledge to help get you back to a functional life! If you have been experiencing any of the symptoms above, please give us a call! We would love to answer any additional questions you may have about Vestibular Rehabilitation and get you scheduled for an initial evaluation!
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