• Dr. Karen Fernandez, PT, DPT, Cert. VRT

What can physical therapy do for vertigo?

To follow up on our original post about vestibular disorders and dizziness, we wanted to bring you a series of posts to teach you about a couple of these conditions.

One of the most common diagnoses and the easiest to treat is BPPV, or Benign Paroxysmal Positional Vertigo, more commonly known as vertigo. According to Neuhauser et al., of the patients with dizziness reffered to neurotology or otolaryngology, BPPV is the most common diagnosis, especially in the elderly. Additionally, in a systematic review by Hanley et al., it was reported that 17-42% of patients with vertigo symptoms had a BPPV diagnosis.

The Name Explains What the Condition Entails

Benign = non-malignant

Paroxysmal = recurring and sudden, meaning it can happen repeatedly and without warning

Positional = dependent on ear position

Vertigo = sensation of spinning or rotation

This condition may make you feel symptoms of imbalance, dizziness, nausea, double or blurry vision, or lightheadedness as a result of positional changes. Some of the most common triggers are: rolling in bed, getting out of bed, turning your head, bending over, or looking up.

BPPV occurs when otoliths, or calcium carbonate crystals that are housed in our inner ear (within our otolith organs), become displaced. Common reasons for an otolith to become displaced are aging, infection, or trauma. Watch this video from the University of Pittsburg Medical Center, explaining this condition:

Vertigo can be very scary as it often occurs suddenly and without warning. However, it can be treated relatively quickly. Most cases range from 1-6 physical therapy treatments depending on the type of BPPV. Some cases are more complex than others, and can require lengthier assessment.

BPPV has Several Variations

In order to distinguish the type of BPPV, a vestibular trained physical therapist will take a patient through a series of positional tests, in which the head is manipulated against gravity. If the patient has BPPV, symptoms such as dizziness, nausea, and nystagmus, amongst others, may occur during the testing.

Nystagmus is defined as a repetitive, uncontrolled eye movement, that can occur in a horizontal, vertical, rotational, or mixed direction (American Academy of Ophthalmology). The key in classifying the type of BPPV is the pattern, latency, and duration of the nystagmus observed during the positional movements. The eye patterns tell us which ear is involved, what semicircular canal is involved, and if the otolith or "crystal" is free floating in a semicircular canal or stuck in the cupula (a gelatinous mass, within the ampulla which is an expanded area within the semicircular canal).

Obviously, this is a very complex system, as was demonstrated in a video on our first article, linked here. Therefore, your vestibular trained physical therapist will carry out numerous other tests before performing the positional testing to rule out RED FLAGS or other conditions.

Other conditions that may cause dizziness are: strokes, concussions, cervicogenic dizziness, headache/migraine, and vestibular hypo-function. These conditions can also be treated by a physical therapist, but may take longer than BPPV.

Sources:

Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65(6):898–904.

Hanley K, O’Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract. 2001;51:666–671.

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