Do you ever feel the room around you is moving or spinning? If so, you may be experiencing vertigo. Dizziness and vertigo are amongst the most common symptoms leading individuals to seek medical attention. In fact, one study found that in 2011 alone, approximately 3.9 million individuals went to the emergency department complaining of these symptoms.1
Vertigo is often a result of dysfunction to our vestibular system. Our vestibular system is a sensory system which works closely with our visual and musculoskeletal systems to provide our brain with information on motion, head position, and spatial orientation. The main component of our vestibular system is found within the inner ear. It is made up of three semicircular canals as well as otolith organs designed to detect head movements. The semicircular canals contain fluid and tiny hair-like cells that detect when we are rotating our head. Whereas, the otolith organs contain calcium carbonate crystals that sense when we are moving our head in a linear motion. This sensory information is signaled to the brain which results in positional or eye movements to maintain orientation. If there is a disruption to this system, our body has difficulty maintaining gaze and head stabilization, postural control, and balance.
There are a number of conditions which may disturb our vestibular system resulting in feelings of unsteadiness, disorientation, or the room-spinning sensation. Fortunately, the majority of causes of vertigo are treatable with vestibular rehabilitation. These conditions include, but are not limited to, Benign Paroxysmal Positional Vertigo (BPPV), Ménière’s disease, vestibular neuritis, and migraine-associated vertigo. Patients with a history of stroke or those at a higher risk of falls would benefit from vestibular rehabilitation as well.
BPPV is the most common diagnosis given to patients with vertigo. This condition is defined as sudden, intense vertigo that occurs with certain head positions. BPPV occurs when one of the crystals from our otolith organs dislodges and becomes displaced in a semicircular canal. Vestibular rehabilitation for this diagnosis includes canal repositioning maneuvers with the intent to relocate the crystal back to its appropriate place.
Ménière’s disease is a chronic disorder of the inner ear resulting in symptoms which include ringing of the ear (tinnitus), hearing loss, fullness or congestion of the ear, balance deficits, and intense vertigo attacks. The vertigo attacks are often preceded by warning symptoms, which include lightheadedness, sound sensitivity, increased tinnitus, or headaches. These symptoms are believed to be caused by an abnormal build-up of endolymph fluid in the inner ear, called the labyrinth.
Vestibular neuritis is a disorder resulting from infection to the inner ear leading to inflammation of the vestibular nerve. The vestibular nerve is responsible for transmitting information to the brain that assists with maintaining balance. The inflammation disrupts the transmission of sensory signals and incorrectly notifies the brain that the individual is moving, which contradicts signals from our other senses. This sensory mismatch can lead to onset of vertigo, dizziness, balance deficits, and vision impairments.
Migraine associate vertigo is characterized as severe, progressive head pain with accompanying dizziness, vertigo or balance deficits. Occasionally, the individual may also experience motion sensitivity, nausea, vomiting, or postural instability. Precipitating factors have been identified, which include food sensitivities, stress, hormonal changes, physical activity, environmental changes, or sensory stimuli.
During your initial visit, your physical therapist will review your symptoms and medical history. Following, your therapist will perform an examination to assess your vestibular, visual, and musculoskeletal systems. This will include gait analysis, balance, posture, musculoskeletal function, visual stability and mobility, as well as positional testing. Based on the examination findings, your clinician will develop an individualized plan of care designed to meet your specific needs and achieve your personal goals. This will include a home exercise program and extensive patient education to ensure optimal results.
Your physical therapist will implement vestibular rehabilitation to treat your vertigo, dizziness, visual disturbance, and balance dysfunction. Vestibular rehabilitation typically includes manual therapy and an exercise-based program which promotes compensation of your sensory systems. Depending on the examination, your clinician will prescribe exercises which promote habituation, gaze stabilization, and balance training. Habituation works toward reducing dizziness through repeated exposure of specific movements or visual stimuli. Gaze stabilization focuses on improving eye control for visual fixation during head movements. Balance training will focus on improving steadiness for increased safety as the patient goes about his/her daily activities.
1 Saber Tehrani AS, Coughlan D, Hsieh YH, Mantokoudis G, Korley FK, Kerber KA, et al. Rising annual costs of dizziness presentations to U.S. emergency departments. Acad Emerg Med. 2013 Jul. 20 (7):689-96.