You wake up, leap out of bed – and suddenly, the world tilts and spins around you. You’re well-rested, you didn’t have a wild night out, so what’s going on? That unsettling sensation might well be a classic case of vertigo.
Vertigo affects millions worldwide, leaving them dizzy, disoriented and struggling to find their balance. It’s more than just a fleeting spell of lightheadedness – it can turn simple movements into a challenge.
“Vertigo is a broad classification that includes people who suffer from dizziness, imbalance, and vestibular dysfunction or pathology,” said Jim Newton, physical therapist with Sunshine Physical Therapy. “The vestibular refers to the vestibular system, which is the part of the inner ear responsible for balance and spatial orientation.
“Vertigo is a common condition that comes with the aging process. The classic scenario is usually an older person will get up out of bed and all of a sudden their room starts spinning. The sensation lasts anywhere from 10 seconds to several minutes and the individual has no idea what is going on. Often, they end up going to the ER which starts the process of looking for a cardiac or neurological issue and they end up going through a series of tests. When it’s all said and done, it’s a simple thing called benign paroxysmal positional vertigo (BPPV).”
According to Mayo Clinic, BPPV causes brief episodes of mild to intense dizziness and is usually triggered by specific changes in your head’s position. It’s rarely serious except when it increases the chance of falling.
“There are crystals in the inner ear that have come loose and gone into a different part of the inner ear, disturbing the individual’s balance system,” Newton continued. “Their brain starts spinning and they literally can’t even walk while it’s happening. Generally, the patient is diagnosed with vertigo from either the hospital ER or a primary care physician and referred to us for treatment, although we do accept patients without a referral as well.”
The American Medical Association states that most vertigo is caused when crystals inside the inner ear are dislodged from their normal position. With BPPV, there are tiny calcium carbonate crystals called otoconia that detach from the inner ear and move into the semicircular canals instead. The little crystals help you sense the pull of gravity and acceleration and deceleration. If the stones shift when you turn your head, it induces a sense of spinning.
Fortunately, there is an effective treatment that helps patients manage and often overcome vertigo by using a combination of exercises and rehabilitation techniques.
Vestibular therapy, also known as vestibular rehabilitation therapy, is a customized exercise program that aims to improve the function of the vestibular system. The exercises focus on enhancing gaze stability, improving postural control and reducing symptoms of dizziness.
“The first thing we do is test the patient for a phenomenon called nystagmus, which is an involuntary eye movement,” Newton explained. “I tilt their head one way or the other and I extend and lay it over a table and their eyes start moving, rotating or clicking back and forth.
This is how we determine where the crystals have dislodged and where they are now. That determines the ear that’s involved and which canal is involved.
“We use a simply physical therapy maneuver called the Epley maneuver to treat vertigo.” he continued. “We put the head in four different positions which causes gravity to float the crystals out of one part of the inner ear and back to where they belong. We also work on balance therapy and on habituation therapy, which is getting a patient used to moving their head and going from lying down to sitting and from sitting to standing.
“The goal is to get the nervous system used to moving as it did before the onset of vertigo. Once we resolve the issue, we give the patient instructions on how to treat themselves if it recurs.
Generally, it only takes two or three sessions to cure the condition.”
Newton also treats patients who have recently experienced a fall with the goal of improving their balance. Dizziness can cause imbalance, which leads to falls. Environmental factors and medication can contribute to imbalance, too. Low blood pressure is another condition that can lead to falls.
“Balance is based on three sensory components in our balance system,” Newton explained. “The senses we intake to keep our balance include our vision, our inner ear, and the balance system that detects where we are in space with our head, arms and body movements. Balance training helps the patient regain that balance skill set that was lost.
“I advise my patients to slow down when getting up from lying or sitting down. Wait two to three minutes, because it can take that long for the body’s autonomic nervous system to re-regulate the blood pressure. Once standing, wait a minute or two, move your head and march in place a few steps. Then when it’s safe to do so, proceed.
“Resist the impulsivity that is inherent in humans to jump out of bed and start walking immediately [if you are having problems with vertigo]. Just a few extra minutes may save you from a debilitating fall.”
Vestibular therapy not only reduces vertigo episodes and improves balance and coordination, but also enhances visual stability through gaze exercises that enable patients to move their heads without experiencing blurred vision or dizziness.
Patients often experience greater independence in their ability to perform daily activities with confidence after treatment. As a non-invasive and drug free treatment, vestibular therapy has been shown to be a safe and effective cornerstone in managing vestibular disorders and offers hope for those struggling with vertigo and balance issues.
Jim Newton has a master’s degree in physical therapy and public health from Hunter college in New York. He can be reached at Sunshine Physical Therapy, 1705 17th Ave., Vero Beach. The phone number is 772-562-6877.
