Vertigo & Dizziness
Symptoms of dizziness can result from many conditions such as; (vestibular) inner ear disorders, neck injuries or muscle tightness, neuropathy, central nervous system problems, metabolic issues, or psychological disorders. Our therapists are trained to screen for more serious conditions (such as neurological and cardiovascular disorders) as well as effectively evaluate and treat conditions which are appropriate for physical therapy intervention.
Dizziness is a common symptom reported during doctor and emergency room visits. Dizziness is subjective and can be described in many different ways. Describing dizziness accurately is helpful for successful diagnosis. Dizziness can be described as a sensation of fogginess, spaciness, haziness, lightheadedness, faintness, or unsteadiness. Unlike dizziness, vertigo is the illusion of movement or spinning. Vertigo is described as either the spinning or movement of the room or surrounding objects, or self-spinning. Disequilibrium means unsteadiness, imbalance, or loss of equilibrium, which typically occurs when one is standing, moving or walking.
Balance Solutions therapists specialize in the evaluation and treatment conditions resulting in complaints of dizziness. Common conditions treated at Balance Solutions include, but are not limited to:
- Vestibular Disorders
- Cervicogenic Dizziness & Vertigo
- Post Concussive Syndrome
- Multi-factorial Balance & Gait Deficits
- Orthostatic Hypotension
- Postural Orthostatic Tachycardia Syndrome (POTS)
Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is the most common type of vestibular disorder. Approximately 50% of individuals over the age of 65 will experience an episode of BPPV at some point in their lives. With BPPV, vertigo occurs as you change the position of your head. The vertigo may be mild to severe, normally lasting less than one minute. Positions and activities which commonly result in a bout of vertigo include; lying down, sitting up, bending forward, looking up and rolling over.
BPPV occurs when small calcium carbonate crystals detach from the part of the ear that senses gravity and become trapped in one of the canals that control the muscles of your eyes while your head is moving. Normally, when the crystals detach they are dissolved in part of the ear that senses gravity; however, they may migrate into one of the canals that controls the muscles in your eyes. The stones cause the canal to become gravity sensitive, sending incorrect signals to your central nervous system resulting in the sensation of vertigo or dizziness.
The stones may have detached following a bump on the head or rapid head movement, or degeneration of the hair cells they rest upon. As we age, we have increase degeneration of the hair cells, therefore, more stones floating around. This increases the occurrence of BPPV.
BPPV may eventually resolve on its own, however advances in medical technology have made it an easy disorder to diagnose and treat. Proper treatment may be vital; individuals who suffer from BPPV are at increased risk for balance disorders and falls. Skilled physical therapy intervention can be very effective at alleviating symptoms of BPPV. Specialized training, equipment, and experience is required for proper evaluation and treatment of this condition by a physical therapist.
To read more about vestibular rehabilitation click here.
Vestibular neuritis typically results from a viral infection in the inner ear but may result from a lack of blood supply to the vestibular nerve. Vestibular neuritis may be preceded by a systemic infection such as an upper respiratory or gastrointestinal infection. These infections may occur several weeks prior to the onset of vestibular neuritis. Vestibular neuritis may also be caused by viruses such as the herpes virus, which can lie dormant in your system for years. The herpes virus causes other conditions such as; cold sores, chickenpox, or shingles.
A viral infection in the inner ear results in inflammation of the vestibular nerve. The vestibular nerve is responsible for conveying information from your vestibular system (inner ear) to your central nervous system (brain) and oculomotor system (eyes). Inflammation of this nerve disrupts the transmission of this information, resulting in decreased vestibular nerve function. This can result in symptoms of vertigo, dizziness, disequilibrium, difficulty focusing your eyes, decreased concentration, nausea, headache, and neck pain.
Skilled physical therapy intervention can be very effective at alleviating acute or chronic symptoms associated with vestibular neuritis. Specialized training and experience is required for proper evaluation and treatment of this condition by a physical therapist.
To read more about vestibular rehabilitation click here.
Vestibular Labyrinthitis typically results from a viral infection in the inner. Vestibular labyrinthitis may be preceded by a systemic infection such as an upper respiratory or gastrointestinal infection. These infections may occur several weeks prior to the onset of vestibular labyrinthitis.
A viral infection in the inner ear may results in inflammation of the vestibular and cochlear nerves. The vestibular nerve is responsible for conveying information from your vestibular system (inner ear) to your central nervous system (brain) and oculomotor system (eyes). Inflammation of this nerve disrupts the transmission of this information, resulting in decreased vestibular nerve function. This can result in symptoms of vertigo, dizziness, disequilibrium, difficulty focusing your eyes, decreased concentration, nausea, headache, and neck pain. The cochlear nerve is responsible for hearing; therefore, labyrinthitis is associated with hearing loss.
Skilled physical therapy intervention can be very effective at alleviating acute or chronic symptoms associated with vestibular labyrinthitis. Specialized training and experience is required for proper evaluation and treatment of this condition by a physical therapist. Physical therapy intervention does not restore hearing loss; however, decreases associated dizziness and improves balance.
To read more about vestibular rehabilitation click here.
Meniere’s disease, also known as endolymphatic hydrops, is associated with abnormal endolymphatic fluid pressures in the ear. Meniere’s is considered a syndrome as there are multiple causes with a typical presentation of symptoms. A Meniere’s episode usually consists of at least 2 of the following 4 characteristics; roaring tinnitus (ringing in the ear), ear pressure & fullness, vertigo, and hearing loss. A Meniere’s episode can last for hours, and may be preceded by an aura. Many individuals may experience mild residual symptoms for a few days with return to normal several days after the episode.
Meniere’s is a progressive disease which can be challenging to diagnose and treat. Subjective history regarding the onset, duration and frequency of vertigo and/or dizziness is important for diagnostic purposes, as the symptoms typically last for hours and resolve before the individual undergoes testing. It may take several years before Meniere’s results in residual vestibular nerve or hearing loss, making it difficult to diagnose based on test results.
Individuals with Meniere’s are highly likely to experience cervicogenic dizziness or benign paroxysmal positional vertigo (BPPV) at some point in their lives, and often mistake this for more frequent Meniere’s episodes. BPPV and cervicogenic dizziness can be easy to resolve with specialized physical therapy intervention. A qualified therapist can educate you regarding the differences between Meniere’s, BPPV and cervicogenic dizziness; helping you to better manage your condition.
To read more about vestibular rehabilitation click here.
Cervicogenic dizziness may occur in the absence of an injury, or may occur weeks to years after a head or neck injury. Approximately 20-50% of people who have sustained a whiplash injury will experience symptoms of dizziness. Cervicogenic dizziness may also occur as a result of: arthritic changes, herniated disc, hyper mobility, muscle spasm, poor posture, or scoliosis. Cervicogenic dizziness may occur gradually with continual worsening of symptoms or onset may be rapid.
Symptoms related to cervical dizziness can range from mild to severe and last minutes to hours. Many individuals describe their dizziness as fogginess, spaciness, haziness, heavy headed, disconnected…etc. Symptoms are often worse with over-head activities, prolonged neck rotation, bending forward for long periods such as with reading or gardening, using the computer, looking up, and arm activities. Symptoms will often improve with lying down or supporting the head. Cervicogenic dizziness may be associated with pressure or pain in the cervical region and/or headaches
At Balance Solutions you will be evaluated by a skilled licensed physical therapist to determine factors contributing to your cervical condition, such as; upper cervical spine mechanics, passive intervertebral mobility (segmental movement of each vertebrae), range of motion, muscle strength, joint mobility, soft tissue mobility, postural alignment, body mechanics and your quality of movement with normal daily activities. Evaluation for cervicogenic dizziness will also include vestibular screening (oculomotor & videonystagmography exam) to rule out vestibular (inner ear) involvement. Following a thorough evaluation, a personalized plan of care with goals will be constructed specifically to meet your individual needs.
Treatment for cervicogenic dizziness may consist of the following interventions;
- Manual therapy
- Therapeutic exercise
- Neuromuscular re-education
- Posture and body mechanic training
- Cervical kinesthetic and proprioceptive exercises
- Balance therapy (if needed)
Balance Solutions therapists have been trained in many types of manual therapy techniques to effectively treat patients with cervicogenic headaches and dizziness. Manual therapy is used in conjunction with therapeutic and neuromuscular re-education exercises to achieve the best possible outcomes. Manual therapy techniques can used to improve the mechanics of your cervical spine and alleviate symptoms of dizziness as well as decrease pain and muscle guarding when present. Effective manual therapy intervention is used to speed up the heeling process and promote proper mechanics throughout the body. Click here to read more about manual therapy.
- Schenk R. An Integrated Approach to Examination and Treatment of the Upper Cervical Spine- Physical Therapy for the Cervical Spine and Temporomandibular Joint: Home study course.
- Wrisley D, Spataro P, Whitney S, Furman J. Cervicogenic Dizziness: A Review of Diagnosis and Treatment. Journal of Orthopedic and Sports Physical Therapy. 2000; 30(12): 755-766.
- Meadows JJ and Magee DJ: An overview of dizziness and vertigo for the orthopedic manual therapist. In Boyling, J.D., and N. Palastanga (eds.): Grieve’s Modern Manual Therapy: The Vertebral Column, 2nd Ed. Edinburgh, Churchill 1994.
- Borg-Stein J, Rauch SD, Krabak B. Evaluation and management of cervicogenic dizziness. Critical Reviews in Physical and Rehabilitation Medicine 13(4) 255-264, 2001
Post Concussive Syndrome
A concussion is a mild traumatic brain injury that typically occurs after a blow to the head. It can also occur with violent shaking and movement of the head or body, such as in a whiplash injury. The initial injury does not have to be severe, and you don’t have to lose consciousness to get a concussion or post-concussion syndrome. In many individuals, post-concussion syndrome is a complex disorder in which many symptoms appear within 7-10 days and last for weeks and sometimes months after the injury occurs. Symptoms can sometimes persist for a year or more.
Persistent post-concussion symptoms may be caused by structural damage to the brain or disruption of the signal within the nerves or may be related to psychological factors, as the most common symptoms (headache, dizziness and insomnia) are similar to those often experienced by individuals diagnosed with depression, anxiety or post-traumatic stress disorder. In most cases, physiological effects of brain trauma and emotional reactions to these effects play a role in the development of symptoms.
The goal of treatment after a concussion is to effectively manage your symptoms. Post-concussion symptoms may include;
- Loss of concentration and memory
- Ringing in the ears
- Blurry vision
- Noise and light sensitivity
Post-concussion headaches can vary in frequency, intensity and duration. Headaches may be associated with a neck injury that occurred at the same time as the head injury and may result in tension type headaches or cervicogenic headaches and dizziness. If you have experienced a head injury severe enough to cause confusion, even if you have never lost consciousness, you should seek medical attention so that you don’t risk worsening your injury.
Skilled physical therapy intervention can be very effective at alleviating acute or chronic symptoms associated with post-concussive syndrome. At Balance Solutions you will be evaluated by a skilled licensed physical therapist to determine factors contributing to your condition, such as; oculomotor exam, videonystagmography, upper cervical spine mechanics, passive intervertebral mobility (segmental movement of each vertebrae), range of motion, muscle strength, joint mobility, soft tissue mobility, postural alignment, body mechanics, sensory integration and balance assessment. Following a thorough evaluation, a personalized plan of care with goals will be constructed specifically to meet your individual needs.
Multifactorial Balance & Gait Deficits
Dizziness that only occurs only when standing or walking may be secondary to a problem with someones balance. Many factors play a role in keeping balance, such as; vision, the inner ear, proprioceptive awareness/sensation, strength, and range of motion. Balance disorder may result from simple conditions such as having a fear of falling or lacking strength, to more complex conditions such as having peripheral neuropathy (loss of sensation in the feet and legs).
Posture also plays a significant role in maintaining your balance. Poor posture affects your ability to use proper ankle and hip strategies, which help to control your balance. It is common for people with osteoporosis or postural changes to stand at their posterior limits of stability (stand with more weight on their heels instead of their toes) resulting in increased sway and poor ankle strategies & gait mechanics
At Balance Solutions you will be evaluated by a skilled licensed physical therapist to determine factors contributing to your balance condition, such as; sensation, reflexes, the ability to turn your head when walking (cervical spine mechanics), joint mobility, functional strength, soft tissue mobility, postural alignment, body mechanics and your quality of movement with normal daily activities. Following a thorough evaluation, a personalized plan of care with goals will be constructed specifically to meet your individual needs.
Orthostatic Hypotension (OH) is a sensation of dizziness or lightheadedness that can occur for a few moments due to a sudden drop in blood pressure. OH typically occurs when first getting out of bed, standing in one position for a long period of time, squatting down or bending forward then standing back up quickly.
The sensation of dizziness or lightheadedness is caused by blood pooling in the lower extremities after a change in body position. OH is common and can occur briefly in anyone, although it is more common among the elderly, and those with low blood pressure. Other symptoms that can be associated with OH include; distortions or temporary decrease in hearing, nausea, headaches, blurred or dimmed vision, generalized numbness/tingling and fainting.
Postural Orthostatic Tachycardia Syndrome (POTS)
Postural orthostatic tachycardia syndrome (POTS) is a condition that affects your circulation (blood flow). With POTS, the majority of their blood stays in your legs when you go to stand up or are standing in one position for a longer period of time. This is called blood pooling, and this makes your heart beat faster to try to get the blood back up to your brain. This increase in heart rate can go up to 30 beats or more per minute and your blood pressure can drop. This change in heart rate and blood pressure is a form of orthostatic intolerance, symptoms that come on when standing up from lying down, that may be relieved by sitting or lying back down.
The primary symptom of an orthostatic intolerance may include;
- Feeling lightheaded, dizzy or faint
- Blurry vision
- Nausea and/or vomiting
- Rapid increase in heartbeat
- Diaphoresis (sweating)
- Spacy, foggy, hazy sensation
- Feeling extreme fatigue
- Feeling as though you just ran a race
Other symptoms may include:
- Chest pain
- Feeling hot or cold
- Feeling anxious, nervous, or jittery
- Headaches and neck pain
An episode of POTS is more likely to occur when you rapidly change from lying down to sitting, when you’re in the shower, standing in line, suddenly stop an exercise or a strenuous activity and then stand still, or when you are feeling stressed. You also may have POTS symptoms after a large meal as your intestines need more blood flow for digestion.
Women between the ages of 15 and 50 years old are more likely to have POTS. Several diseases and conditions appear to make someone more likely to develop POTS. Conditions which may be related to POTS include but are not limited to;
- Anemia (when you don’t have enough red blood cells)
- Autoimmune diseases, such as Sjogren’s, multiple sclerosis or lupus
- Chronic fatigue syndrome
- Diabetes and prediabetes
- Ehlers-Danlos, a muscle and joint condition
- Mononucleosis, Lyme disease, or Hepatitis C
- Mitral valve prolapse
At Balance Solutions you will be evaluated by a skilled licensed physical therapist to determine factors contributing to your condition. Following a thorough evaluation, a personalized plan of care with goals will be constructed specifically to meet your individual needs. Focus is placed on education, lower extremity strengthening, and cardiovascular conditioning.