Do you have dizziness or “spinning” symptoms when moving in bed, or when turning your head?

Do you have loss of balance with day-to-day activities?

Do you suffer from dizziness or lightheadedness with associated nausea or vomiting?

Do you have difficulty with walking or completing everyday tasks due to dizziness?

Do you have extreme sensitivity to motion?

If you answered yes to any of the above questions, you may have trouble with your vestibular system. A Physical Therapist trained in vestibular rehabilitation may be able to help!

What is the Vestibular System?
The vestibular system is a complex structure that is composed of sensors in both sides of the inner ears. This vestibular apparatus is a fluid filled system of tubes and "canals" which provides input to the brain to let us know when we are moving up and down, side to side, or in circles (or a combination of movements). The sensors of the vestibular system work closely with nerve fibers, which supply movement input to the eyes (vestibulo-ocular nerve). For example, if the vestibular system reads that the head is moving in a diagonal direction it prepares the eye movement to keep up with the head movement. This sensory input loop is one of the many crucial components that keep us balanced, whether when standing or sitting.

If the vestibular system becomes inflamed or compromised, it can send signals to the brain that the head is moving even though it actually is not. This can lead to vertigo,
dizziness and decreased balance. This deficit in the vestibular system can often
be retrained to function well again with physical therapy.


Vertigo and Dizziness
Vertigo and dizziness are often confused to be the same. True “vertigo” is when you feel the sensation that you are spinning, or that the world is physically spinning around you while you are actually sitting still or moving just slightly. This type of vertigo is often provoked with head movement or rolling in bed and resolves temporarily on its own. However, it often returns within days or weeks, and is typically treated successfully with specific physical therapy techniques.

"Dizziness" or "lightheadedness" describes the feeling like you may faint or fall due to feeling unsteady. Dizziness is also often associated with headache, nausea, and giddiness. Causes of dizziness can vary greatly including use of certain medications, dehydration, or sensory overload (for example amusement rides or even playing modern video games). Other physical conditions which may lead to dizziness are neuritis or labyrinthitis occurring in the inner ear (often precipitated by a virus or cold). In some cases people who suffer from regular bouts of dizziness can be helped with specific exercises to work on training eye and head coordination.


Benign Paroxysmal Positional Vertigo:
“There are rocks in my ears!?”
Benign Paroxysmal Positional Vertigo (BPPV) is a disorder that causes vertigo, dizziness, and other symptoms due to debris that has collected within the wrong part of the inner ear. This debris, called otoconia, is made up of small crystals of calcium carbonate (sometimes referred to as “ear rocks”). The otoconia are normally located within a specific part of the inner ear’s vestibular system, but at times may slip out into one of the semi-circular canals, which are designed to house fluid only. With head movement, these displaced otoconia shift with gravity, sending false signals to the brain from the vestibular system. These signals can make the brain sense that the body is moving when it is not. When the brain becomes confused by the input of movement that is not actually happening it can cause eye movement to compensate with associated symptoms of true vertigo.

Symptoms of BPPV, such as spinning, vertigo, dizziness, imbalance and nausea are almost always precipitated by a change in head position with respect to gravity. Getting out of bed and rolling over in bed are two common "problem" motions. Some people feel dizzy and unsteady when they tip their heads back to look up. An intermittent pattern of these
symptoms is typical.

Treatment of BPPV with physical therapy techniques is often quite successful. The treatment involves a series of movement tests to determine which ear and which canal is involved. Once the source of BPPV is determined, your therapist will take you through various controlled movements to correct the position of the otoconia.


Decreased Balance
The ability to maintain balance depends on information the brain receives from three different sources: input from the eyes, input from muscles and joints, and input from the vestibular organs in the inner ears. All three of these sources send information from sensory receptors via nerve impulses to your brain.

When a person is suffering from decreased balance, physical therapy can often help through exercise training. Vertigo or dizziness is not always present when balance is limited.

How can Physical Therapy help me with dizziness, decreased balance, or BPPV symptoms?

If you are suffering from symptoms of dizziness, lightheadedness, decreased balance, or vertigo it is always ideal to check with your doctor first. Make sure that your medications and diet are appropriate and that there have been no sudden changes that may have contributed to your symptoms. At this time, physical therapy treatment may be recommended. Your first session will consist of an evaluation by your therapist to assess and determine the physiological causes of your symptoms. Depending on the findings, your therapist will then treat you with possible canalith repositioning procedure (repositioning of your “ear rocks”), balance training, eye/gaze stability exercises, and/or
stretching and strengthening of involved musculature.

For your first and following physical therapy appointments please wear clothes that you can comfortably move in. For safety, having a driver is highly suggested for those with vertigo.