Stopping the Spins–Physical Therapy for Vertigo

Remember when you were a kid and loved spinning around until you were so dizzy you fell to the ground laughing, waiting for the world to stop spinning? While you may have gotten a thrill out of this feeling when you were a kid, if you are having that room-spinning feeling just from rolling over in bed or bending down to tie your shoes, or perhaps you just woke up this way–you are experiencing an uncomfortable sensation known as vertigo.

Vertigo refers to the sensation that a person or their environment is spinning, when in fact neither is occurring. Vertigo often develops suddenly and typically signifies a problem in the inner ear, though it is important to rule out other potential sources. This article will help you to better understand the possible causes of vertigo and how physical therapy plays an important role in treating this condition. 

WHERE IT ALL BEGAN

We are going to start by taking a look at some of the structures of the inner ear. Deep inside the inner ear lie what are called the vestibular organs. These organs are part of the vestibular system that gathers sensory information about the position and movement of the head and plays an important role in balance and stability. Inside each inner ear lie 5 small organs–3 semicircular canals that provide information about angular acceleration (head rotation) and 2 otolith organs that are sensitive to linear (straight line) acceleration.

When the head and body move, viscous fluid inside the organs in each ear is displaced which triggers sensory receptors and sends information via the vestibular nerve into the brain to update the nervous system about how the body is moving so it can fire the proper muscles to keep you balanced and stable. Typically, the signals in each ear balance one another. Certain medical conditions can cause a sudden imbalance in vestibular input between the ears. When this happens, the brain interprets this information as a sign that the body is moving, when in fact it is not, and the result is the intense and uncomfortable spinning sensation we call vertigo. 

WHAT MIGHT BE THE CAUSE OF MY VERTIGO?

Vertigo can have several underlying causes ranging from benign to very serious. It is important to determine the cause of your symptoms as it helps determine what treatment will be most appropriate. While many people may describe vertigo as a feeling of “dizziness”, it is important to distinguish between the sensation of room-spinning vertigo and other feelings of dizziness such as lightheadedness, as the underlying causes differ.

A common cause of vertigo is a condition called Benign Paroxysmal Positional Vertigo or BPPV. BPPV is characterized by brief episodes of vertigo that are triggered by changes in position. For instance, rolling over in bed or bending down to clean out the dishwasher may trigger a bout of vertigo in someone with BPPV. BPPV occurs when small crystal-like otoconia which normally exist inside the otolith organ called the utricle are displaced into the semicircular canal. When the head changes position, these otoconia drift through the canals causing an increase in signaling from the affected ear and results in the sensation of vertigo. As the fluid slows and the otoconia settles, the sensation will stop until the head is repositioned again. This condition may feel very distressing and even cause moderate to severe nausea, but as the name implies, is relatively benign and can be treated by a physical therapist. It is diagnosed by a physical therapist through a series of head and body positions (for example the Dix Hallpike or Roll Test).

Other causes of vertigo that originate in the inner ear are Meniere's disease, vestibular neuritis and labyrinthitis. Vestibular neuritis and labyrinthitis are caused by inflammation of the vestibular nerve and inner ear. These conditions are often preceded by a viral or bacterial infection and develop suddenly. Often vertigo is severe in these conditions and can last several days to weeks. Nausea and vomiting are not uncommon due to the severity of spinning sensations. If the labyrinth of the inner ear is inflamed, hearing loss and a ringing in your ear (tinnitus) may develop but often resolve within a few weeks. A person may feel unsteady and have difficulty balancing and walking due to the vertigo. 

Meniere's disease is thought to be caused by an abnormal amount of fluid in the inner ear. It is unclear exactly what the underlying cause is, but certain factors may predispose one to Meniere's. Similar to the other conditions outlined above, vertigo is characteristic of Meniere's disease. Episodes are often unpredictable and are not preceded by a change in position. They can last from 20 min to 24 hours. Hearing loss, tinnitus and feeling of fullness in the ears is present in this condition and some of these symptoms may be permanent. 

When being evaluated for vertigo, it is important for healthcare providers to rule out more serious causes of vertigo such as a stroke or TIA (transient ischemic attack), multiple sclerosis, vestibular migraine or tumor. The presence of weakness (especially on one side of the body), loss of coordination, changes in vision, severe headache, confusion, changes in speech and certain abnormal eye movements can indicate one of these conditions and it is essential to seek urgent medical care. 

HOW CAN PHYSICAL THERAPY HELP MY VERTIGO?

Once the underlying cause of vertigo is determined, it is time to begin treating it. The physical therapist approach to treating vertigo will vary based on its cause and any other symptoms you are experiencing. If someone has been experiencing vertigo for some time, they may develop problems with their balance that should also be addressed during treatment. 

If you are suffering from BPPV, the therapist will first use a series of head and body positioning to determine which canal the otoconia are located and then will typically prescribe a series of precise changes in position that will help the otoconia leave the semicircular canal. You will likely experience vertigo during the treatment and possibly some nausea but it should improve significantly once the treatment is complete or shortly after. You may be prescribed some of these movements as homework and might experience relief in as little as one treatment. 

If you have been diagnosed with Meniere's Disease, you may have been prescribed medications by your physician to help control nausea and motion sickness. Your physical therapist will likely educate you on lifestyle modifications that can help reduce the likelihood of another Meniere's attack. Limiting salt intake, taking in a steady amount of fluids throughout the day versus all at one time, and limiting caffeine, tobacco and alcohol use can help maintain a more appropriate fluid level in the inner ear. The vertigo experienced with vestibular neuritis and labyrinthitis will decrease as the inflammation subsides. In any of these three conditions, you may experience some residual dizziness with head movements or feelings of imbalance. Your PT may prescribe a series of head and eye exercises to strengthen the vestibular nerve and a series of balance exercises to help you feel more steady and reduce your risk of falling. 

If your vertigo was caused by something like a stroke or multiple sclerosis, it is important that you receive the right medical care to treat the underlying conditions. If you continue to experience feelings of vertigo, dizziness or unsteadiness, a physical therapist may be able to lessen these symptoms with exercises to habituate the body to motions that cause dizziness, to improve your balance, strengthen the vestibular nerves when possible, or help the body adapt to a vestibular system that is not functioning optimally. 

DON’T WAIT TO SEE A PT

Whatever the cause of your vertigo is, don’t wait to seek treatment. While it is essential to identify serious underlying causes that require emergency medical care, even the “benign” causes of vertigo can disrupt your daily life. Schedule an appointment with a physical therapist today to help identify the cause of your vertigo and get you on the road to feeling better!

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