Vestibular Issues in Physical Therapy

By: Jenna Buckwalter

Physical Therapy has increasingly become important in the treatment of vestibular issues, specifically Benign Paroxysmal Positional Vertigo. BPPV is caused by calcium crystals, called otoconia, that dislodge from their original position in the utricle, a structure in the ear, and travel to the semicircular canals. Here they disrupt the flow of fluid and cause dizziness or vertigo. Common symptoms of vertigo include dizziness, lightheadedness, unsteadiness, a loss of balance, blurred vision, nausea and/or vomiting. Furthermore, torsional movements of the eye called nystagmus may occur. These symptoms are usually brought on by position changes of the head such as lying down, bending over, nodding the head or shaking the head side to side. 

A physical therapist will determine the symptoms' origination point in your ear and canal systems by having you perform a series of movements. It is important for the physical therapist to perform this thorough examination of the patient, to determine if the reported signs and symptoms are from that of a vestibular origin, and not something more serious. Signs and symptoms that may suggest a more serious pathology include the 5 D’s: dizziness, dysarthria, dysphagia, diplopia or drop attacks. Additionally, different or sudden severe headaches, hearing loss, leg or arm weakness, numbness or tingling, and chest pain can all be signs of a more serious diagnosis. If physical therapy is unsuccessful in resolving a patient’s vertigo, or if the vertigo suddenly worsens with no explanation, further medical referral may be needed. 

Physical therapists may be recruited to treat other conditions with vestibular issues such as Meniere’s disease, MS, vestibular neuritis, labrinthitis, Parkinson’s disease and cervicogenic dizziness. One should always be informed of the patient’s constantly evolving status, and keep in mind the implications that these syndromes present to treatment. Although canal repositioning maneuvers are more than likely not implicated for these conditions, balance training and habituation exercises can be a very powerful tool to improve the quality of life for these patients. As it stands, BPPV is the most common vestibular issue treated by physical therapists. Please visit the following links for more about BPPV. 

http://www.tchain.com/otoneurology/disorders/bppv/bppv.html
http://www.mayoclinic.com/health/vertigo/DS00534/DSECTION=symptoms

Using Gymnastics in Adult Fitness Programs: The Key to Decreasing Vertigo

Many adult fitness programs are now utilizing gymnastic exercises in their classes to enhance our mobility and skills training. These gymnastic moves that we heavily favored as children can give us a very nauseated feeling as an adult. The dizziness, lightheadedness, and nausea can become extreme after performing forward or backward somersaults. Some individuals have these feelings with handstand holds or any other inverted positions.  Despite these challenges, it is important to perform these gymnastic skills. Let’s learn why we get so nauseous and what we can do to decrease that horrible feeling after flipping upside down.

Somersaults and other gymnastic moves are a great way to work on flexibility and strength. It places your body in positions that are not performed on a regular basis and allows for end range activity. Gymnastic skills also improve your body’s proprioception (how your body relates to other parts of your body) and body awareness (how you are able to move your body, or, in other words - coordination). Gymnastic moves encourage full body training that requires a “skill” component that will also allow you to track progress of your workouts.  Not to mention that gymnastics is pure fun!

Many adults become extremely dizzy when flipping upside down. This is completely normal and does not suggest a problem with sensory systems. The feeling of dizziness, more accurately vertigo, occurs when there is a conflict between signals sent to the brain by various balance systems of the body. Your brain receives input from four sensory systems of your body - vision, joints or proprioceptive system, skin pressure, and the vestibular system of the inner ear. 

The vestibular system is the primary sensory system in our body that contributes to balance and spatial orientation. The vestibular system comprises of two components - the semicircular canal system (for rotational movements) and the otoliths (for linear movement).  After a rotational movement (somersaults) or linear acceleration (swinging), the vestibular system sends signals to the brain structure of the eyes and the muscles. When you perform a novel activity such as a somersault, handstand or cartwheel, your body reacts to the movement, causing vertigo. The vertigo becomes even more complex when you take away the vision component while performing a backwards somersault. As kids we spent MUCH more time spinning, swinging, and in inverted positions. By increasing the time spent in inverted positions as adults, your sensory system will become more automatic, reacting faster with less less adverse feelings of vertigo.

You may ask, “How can I decrease the feeling of dizziness/vertigo during gymnastic drills?” The best way to improve is to practice. The increased repertoire of movement creates better sensory and neural connections, allowing for your system to react without the extreme feelings of vertigo. Additionally, remember to exhale when you roll, cartwheel or flip upside down and maintain a good level of hydration. Try not to close your eyes, allowing your visual system to assist with the vestibular system. 

If these tips do not eliminate the feeling of vertigo, you may still flip, spin, or hang upside down–just as long as the vertigo dissipates within a few minutes. If you have the feeling of vertigo and dizziness for hours after the workout you may want to call your physician.