How Physical Therapy Can Treat Dizziness

A man discusses his symptoms with his doctor.
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If you’ve ever had an occasional dizzy spell, you know the uneasy (and sometimes queasy) feeling of the world spinning around you. If this happens here and there, you might not think it’s anything to worry about, but if it starts happening on a regular basis, it could mean something more.

Dizziness (including vertigo) affects a significant part of the population; up to 20% of adults, in fact. For many, dizziness stems from a disease or imbalance of the vestibular system within the inner ear, and benign paroxysmal positional vertigo (BPPV) is the most common type.

It’s important to be aware of the symptoms because undiagnosed, vestibular problems can lead to an increased risk for falls and fall-related injuries. In specific populations, such as older adults, this can have a severe impact to whole health and quality of life.

AdventHealth Sports Med and Rehab Vestibular Rehabilitation ImPACT Trained Physical Therapist and Board-Certified Neurologic Clinical Specialist, Dr. Samantha Corkwell, explains common reasons for vestibular problems, as well as effective physical therapy solutions to heal them.

The Vestibular System

“The vestibular system is part of the inner ear. It is a small, powerful structure that aids balance by detecting motion,” Dr. Corkwell says.

When it comes to vestibular problems, Dr. Corkwell notes, “Benign paroxysmal positional vertigo (BPPV) is one of the most common conditions that we treat. It happens when calcium carbonate crystals fall out of their correct space within the inner ear and float freely. This changes the way fluid naturally travels in the inner ear, which alters signals to the brain. This can give the brain the perception that your head is moving in a direction that it really is not, causing the illusion that your environment is spinning around you.”

This feeling can last a couple of seconds, but it can feel severe and cause people to lose their balance and fall.

What many people don’t realize is that this can often be diagnosed and treated by a trained physical therapist, like Dr. Corkwell.

“BPPV is very easily treatable, usually a physical therapist can correct it within one to two sessions.”

Dr. Corkwell explains that it’s important to report any new symptoms of dizziness or balance problems to your doctor as soon as possible, because if it is BPPV, it can be corrected quicker the faster you get to a physical therapist for treatment. The longer you wait, the longer it could take to fix.

Risks and Symptoms of BPPV

Dr. Corkwell advises that BPPV is more common in people as we age. It can also occur after a sudden injury or accident that results in a significant bump to the head.

Other risk factors for BPPV include:

  • Osteoporosis
  • Vitamin D deficiency
  • Migraines

Symptoms of BPPV include:

  • Vertigo (feeling like the world is spinning as you change positions)
  • Nausea or vomiting when changing positions
  • Feeling off balance as you walk or turn your body or head
  • Having more frequent falls

Diagnosing BPPV

“As a starting point, we assess each patient’s complete medical history, as well as the onset, history and frequency of their symptoms. For example, in BPPV, dizziness may last seconds, but dizziness due to an infection of the ear tends to last minutes to hours,” explains Dr. Corkwell.

She continues, “Then, we conduct a series of tests to assess a patient’s eye movements. If the eye system alone is working properly, we might consider referring the patient to a neurologist for the evaluation of other neurological conditions. If we detect alterations in eye movements, however, it leads us down the path of a possible BPPV diagnosis.”

Testing for BPPV can be done by a series of exams that assess the nerves of the inner ear, head movements, and the ability to stabilize vision after that movement.

Dr. Corkwell describes, “Patients may read an eye chart standing still, and then we have them turn their head in a certain direction and try to read it again. If they can’t read the chart the same way each time it tells us that they might have an issue with nerves in their ear.”

The Epley Omniax System

Another state-of-the-art diagnostic and treatment tool for BPPV at AdventHealth Sports Med and Rehab is the Epley Omniax System.

Dr. Corkwell notes, “There are few Omniax Chairs in the U.S. and our clinic in Celebration is home to one of them.”

It’s a painless experience for the patient, who is secured in the chair and positioned in a dark room, similar to an eye exam. The patient wears video goggles to record their eye movements through a series of tests performed by an audiologist. The test takes about 30 minutes.

Dr. Corkwell states, “With the Omniax System, we can look for BPPV by measuring vestibular ocular reflex, or how the ears, eyes and brain are interacting. The eyes use the vestibular ocular reflex constantly as we’re moving, and it allows us to keep our vision stable. If we see nystagmus (uncontrolled jerking movement of the eyes) during the test, it could indicate BPPV or another vestibular nerve disorder.”

While this sophisticated technology can help identify the cause of a patient’s dizziness, it can also assist in treatment.

How to Treat BPPV

“We treat BPPV by doing repositioning maneuvers. With a series of specific movements to the head, we can help the crystal get back into the correct position within the inner ear,” explains Dr. Corkwell.

These movements can be done alone or with the help of the Omniax System chair, when appropriate.

“We can spin the Omniax System chair to specific positions to help reposition the displaced crystals in the inner ear or get them into a position where the body can just absorb them. It can be a very helpful treatment tool.”

Treatment for BPPV usually only takes one to two sessions with repositioning maneuvers. If a patient has balance issues as well, more balance training and strengthening may be added to the treatment plan.

Dr. Corkwell’s Message to You

“Many patients don’t realize that we are here as a resource to help diagnose and treat dizziness and balance issues. Patients may experience dizziness and bring it up to their doctor, and sometimes medications are offered as a treatment, but it’s also important to see a trained team, including a physical therapist, who can help diagnose and solve the vestibular problem in the long-term.”

We’re here to support your whole health in body, mind and spirit. Learn how AdventHealth Sports Med and Rehab’s comprehensive Vestibular Program can help you or a loved one with dizziness or balance-related disorders.

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