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Vestibular Physical Therapy
The Many Faces of Vestibular Dysfunction
While all humans have a vestibular system, most will never know it is there unless they develop a vestibular system disorder. The vestibular system, like most of our body systems, typically hums along in the background doing its job without much notice and no active participation from its owner. This system does play a very important role in normal human movement, however, and when it is not operating optimally can cause significant symptoms like dizziness and imbalance. Physical therapists are healthcare providers that can help treat the symptoms of a vestibular disorder and improve overall patient function.
THE WHO, WHAT AND WHERE OF THE VESTIBULAR SYSTEM
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 gaze 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, these organs send 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 or a reduction in function in both ears. When this system is not functioning optimally symptoms like vertigo, dizziness, and unsteadiness result.
THE MANY FACES OF VESTIBULAR DYSFUNCTION
Dysfunction and disorder of the vestibular system comes in many forms. Sometimes our patients will come to the clinic with a diagnosis of a vestibular condition and other times they come to the clinic with symptoms of a vestibular disorder but no diagnosis. In either case, physical therapy can often help to identify the cause (when needed) and treat the symptoms. Symptoms that can indicate a vestibular disorder include:
Feeling off balance or unsteady when you turn your head, change position, walk or are in a space with a lot of visual stimuli like a grocery store or busy airport
Feeling like the environment around you or words on a page are bouncing up and down or oscillating back and forth
Room-spinning vertigo that occurs in response to a position change such as rolling over in bed or bending down to clean out the dishwasher
Feeling of unsteadiness in low light conditions or on uneven terrain
Dizziness when turning your head or changing position
Dizziness or vertigo when bearing down
Nystagmus (abnormal movements of the eye)
Some common vestibular disorders encountered by physical therapists include:
Meniere’s Disease
Vestibular Neuritis
Vestibular hypofunction
Concussion
Labyrinthitis
Cervicogenic Dizziness
Persistent Postural Perceptual Dizziness
Vestibular migraine
In addition to symptoms like imbalance or dizziness, vestibular disorders can be accompanied by other symptoms such as neck pain or stiffness, loss of or changes in hearing, tinnitus, nausea/vomiting and hearing your own heartbeat or footsteps more loudly than usual. Symptoms can develop following a concussion or brain injury or a recent upper respiratory, gastrointestinal or other viral infection.
It is important to recognize that many of these symptoms can overlap with other serious medical conditions and seeking treatment from a medical provider is always recommended. If you are experiencing symptoms of a vestibular problem along with any of these other symptoms it is essential to seek urgent medical care:
Weakness, especially on one side of the body or face
Loss of coordination
Changes in vision
Severe headache
Changes in sensation
Abnormal eye movements
Confusion
Changes in speech
Vomiting
Chest pain or pressure
Unrelenting vertigo or dizziness
At the onset of new symptoms your doctor may recommend imaging studies such as MRIs or CT scans to rule out some of these more serious causes of dizziness and imbalance. In some cases you may be referred to an ENT or audiologist for specialized testing of the vestibular system. Some medications can also be damaging to the vestibular nerve or vestibular organs so it is important to discuss your medications with your doctors as well.
VESTIBULAR EVALUATION
The vestibular evaluation is intended to identify an underlying cause for your symptoms, determine if physical therapy is indicated and if a referral to another provider like an ENT or Neurologist is needed. During this evaluation your physical therapist will be looking closely at how your eyes move as they are closely linked to the vestibular system through several reflexes. In some cases they may ask you to wear a set of special goggles called Frenzel lenses that allow the therapist to see your eyes magnified on a screen, watch a playback of eye movements and even briefly occlude your vision with a goggle screen cover. They will observe your eyes under several conditions such as:
Following a moving object
Looking back and forth between two points
Following an object as it approaches your nose
Maintaining gaze on a stable target while turning your head back and forth
Gazing in different directions
Moving your head quickly one direction or another while looking at a fixed point
Changing positions
Your therapist will be observing for things like gaze stabilization, nystagmus, convergence of the eyes, and so forth while asking you about the presence of symptoms like double vision, blurry vision, dizziness, vertigo, nausea, imbalance, etc. The vestibular evaluation also often includes an assessment of balance, gait, strength and coordination and possibly other assessments depending on the exam findings.
VESTIBULAR PHYSICAL THERAPY CAN HELP
While vestibular physical therapy is not indicated for every single vestibular condition, in many cases it can be very helpful to reduce and sometimes eliminate symptoms and improve overall function. How do physical therapists treat the vestibular system? Well, it depends on the cause of the symptoms. In the case of BPPV the use of canalith repositioning maneuvers like the Epley Maneuver are used to remove calcium carbonate crystals from the semicircular canals. In the case of other vestibular conditions, vestibular therapy often focuses on facilitating adaptation of the vestibular system or helping the body compensate for a loss of vestibular function. Reducing motion sensitivity, addressing any neck-related conditions, improving balance and walking ability are all aspects of vestibular physical therapy that can help patients immensely. Educating patients on how to manage their conditions is another important role of physical therapy.
As you can see there are many ways that physical therapists can help individuals experiencing vestibular-related symptoms and it starts with scheduling an initial evaluation. Call Evolve Physical Therapy today to schedule an appointment with one of our vestibular physical therapists today.
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Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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