You may have heard friends or family use a lot of different names for their dizziness – vertigo, head swimming, lightheadedness, disequilibrium, unsteadiness, or even just feeling “off”. It’s a very common report to be dizzy, in fact it is one of the most common complaints to Primary Care Doctors. But not all dizziness is created equal, presents with the same symptoms, or has the same underlying cause. Your Primary Care Doctor or ENT Doctor may choose to rule out cardiovascular issues, blood pressure changes, kidney issues, medication side effects, or a list of other things that can be causing your dizziness prior to PT if you have a medical history that includes these risk factors. That said, many patients are appropriately sent to a qualified PT immediately so that we begin to correct your symptoms.
Vertigo, or the sensation of spinning even when you’re perfectly still, is typically the fault of a vestibular system dysfunction. The vestibular system is the part of your inner ear that is responsible for balance. Common vestibular issues that can cause vertigo include BPPV (benign paroxysmal positional vertigo), vestibular neuritis, Meniere’s disease, or a bilateral vestibular hypofunction. BPPV is by far the most common cause for vertigo, but an evaluation by a qualified provider to look at some of the competing diagnoses, and others, should be performed prior to any treatment. At Focus, every PT in the company has spent extra time beyond their educational training to evaluate and treat Vestibular disorders.
BPPV is caused when the crystals in the inner ear are misplaced within one or more of the semi-circular canals of the inner ear. When the crystals break loose out of their home (the utricle) and fall in to one of the canals, it stimulates the inner ear nerve, and the brain believes you are spinning in circles. This usually occurs in only 1 canal and in only one ear, but it can occur in both at the same time, or in multiple canals. Over the years, the PTs at Focus have seen and treated successfully combinations of all sorts of BPPV. Outside of the room spinning sensation, patients with vertigo complain of nausea, a loss of balance, and prolonged dizziness. Your evaluation consists of specific questions to understand your symptoms, what provokes it, and how long it has been going on. Next, your Physical Therapist will perform a hands-on evaluation to look at your balance, eye movements, and vestibular system. Evaluation of your vestibular system is a critical component and will include the Dix-Hallpike Assessment or a similar modification, commonly followed by the Epley Maneuver if a positive finding is present. PT intervention for BPPV usually consists of the initial treatment visit, followed by 1-2 more follow-up appointments prior to full resolution of vertigo symptoms.
If you are having vertigo or other dizziness symptoms and we find that it doesn’t align with a BPPV diagnosis, we may choose to do a more specialized evaluation including some Infrared goggles, called Frenzel goggles. We may also perform a dynamic visual acuity exam, and other special tests. This helps us rule in a vestibular hypofunction, a central processing issue, or other vestibular dysfunctions. Many of these diagnoses would necessitate a vestibular rehab program where we perform specific exercises to help with your dizziness.
Have questions or want a further explanation of the topics above? We would love to sit down with you to answer your questions and evaluate the root cause of your dizziness. Each of our PTs at Focus are trained in up to date vestibular rehab evaluation and treatment techniques. Please reach out to us if you’ve been dealing with dizziness and don’t know where to go next, or if you just wake up one day and feel that sensation of spinning. Thanks for allowing us to serve you.