"My crystals are loose."
"I've lost my marbles."
"I'm dizzy."
Approximately 40 percent of people will experience vertigo at some time in their lives. People describe their symptoms as spinning, whirling, or feeling dizzy, light headed and unsteady. If you've never experienced vertigo before, the sudden onset of dizziness can be very scary. People often think they are having a stroke or experiencing something more severe, leading them to seek care in the emergency room or urgent care.
Vertigo is a symptom, not a disease.
And those symptoms can often be easily treated by a physical therapist. There are multiple causes for dizziness, but they generally fall into four main categories — each with very different treatments. Once the cause of dizziness is diagnosed, it can be quickly resolved by a physical therapist who specializes in vestibular rehabilitation.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most commonly reported cause of vertigo, accounting for 33 to 50 percent of vestibular diagnoses. It's also the most commonly diagnosed cause of vertigo we see in physical therapy.
BPPV is characterized by brief periods (usually less than one minute) of vertigo when you change the position of your head. People describe the sensation as a sudden onset of a "room-spinning" sensation. It's due to your head's position relative to gravity, so it most commonly happens when you roll over in bed, get in and out of bed, bend over or make quick head movements. The spinning sensation may be accompanied by an overall feeling of fatigue and nausea or vomiting. People who experience dizziness getting out of or rolling over in bed are 4.3 times more likely to have BPPV.
There's not always a specific cause of BPPV.
Head injuries cause 17 percent of BPPV cases and nerve damage accounts for 15 percent. But in 50 percent of cases, there is no specific reason for the onset of symptoms. Small crystals of calcium carbonate, called otoconia, can become dislodged and travel into one of the three semicircular canals (posterior, anterior and horizontal) in the inner ear.
Therefore, there are three types of BPPV, with the most commonly diagnosed type occurring in the posterior canal. A physical therapist can help distinguish the cause and the type of BPPV based on your history and the results of positional testing.
Don't try BPPV treatments at home.
With the convenience of technology, it's easy to find videos of BPPV treatments — like the Epley maneuver — by doing a simple Google search. However, treatments are specific to the ear and canal affected, and misdiagnosis can cause complications if the maneuvers are applied to the incorrect ear or canal. You should always be properly diagnosed before trying self-treatment. Once diagnosed, BPPV can be resolved typically within one to four treatments, with a physical therapist performing the correct maneuvers to help move the crystals out of the ear canal.
Vestibular Hypofunction
Vertigo can be caused by a one-sided weakness in your inner ears, often due to inflammation. This imbalance, known as vestibular hypofunction, causes an eye impairment because the eyes have trouble adapting after head movement. Vestibular hypofunction can also be caused by:
- Viral or bacterial infections that attack the nerve that connects to your inner ear
- Weakness in the structures of your inner ear due to aging
- Toxic reactions to medications
- Blood clots, tumors or brain injuries that impact the inner ear
With vestibular hypofunction, you might feel dizzy every time you move your head — like your eyes cannot keep up with your head movement. Other symptoms include poor balance, difficulty walking, blurry vision and nausea or vomiting. They may appear suddenly or gradually and may be accompanied by mild, one-sided hearing loss.
A physical therapist can do a full assessment of your visual system, gait and balance. They'll also perform other activities to relieve symptoms and promote a faster recovery, including gaze exercises to improve the coordination of head and eye movements and balance and gait activities. These forms of vestibular rehabilitation are more effective than medication or general exercises.
Central Vestibular Loss
Brain injuries, tumors and conditions can also cause dizziness. Unlike problems in the inner ear, symptoms usually develop slowly — you may not remember a specific time of onset. Symptoms may differ based on the location of the tumor or problem within the brain.
Central vestibular loss, meaning the issue stems from the brain, can be caused by multiple sclerosis, neoplasms, traumatic brain injury, vascular disease or stroke. Gaze exercises and balance activities can help relieve the dizziness and vertigo.
Cervicogenic Vertigo
Let's face it — we're all stressed. And that stress causes a lot of problems, vertigo included.
Tightness in your shoulders and neck can bring on dizziness that is usually noticed with head movements or prolonged time in one position. This type of dizziness is usually accompanied by neck pain and headaches. Physical therapy treatments primarily aim to decrease tightness in the muscles and joints of the spine. Mobility and strength exercises can also help relieve symptoms.
Dizziness doesn't mean you've lost your marbles. But the ones in your ears might be loose. Vestibular rehabilitation is a proven way to treat your vertigo, no matter the type or the cause. If these are issues you've been experiencing, visit a physical therapist with expertise in vestibular rehab to stop your head from spinning.