Treating Vertigo with Physical Therapy

If you’ve ever felt dizzy, off balance, or like the world is spinning, you could be experiencing vertigo. I’m Lauren Masi, Doctor of Physical Therapy and board-certified Orthopedic Clinical Specialist. I’m also the owner and Clinical Services Director here at Bay Area Physical Therapy and Lafayette Physical Therapy. Today, we’re going to talk about treating vertigo with physical therapy. 

What Is Vertigo?

Vertigo by definition is the sensation that the room is spinning. This is not necessarily what you’re feeling within your body, but the feeling when you’re sitting still that the room around you is literally spinning. When this happens, some people might also even notice a sensation of their eyes twitching in their head, and that’s called nystagmus. 

Now, I have a lot of patients who come in and they might tell me that they have vertigo, but upon further discussion I find out they’re frequently falling, or they’re tripping or stumbling, or that they’re dizzy. Can those descriptions of how they’re feeling be due to other balance disorders? Of course, but by definition, that is not exactly vertigo. 

The Basics of Balance

In physical therapy, we do a very thorough assessment to get to the root cause of what might be causing your unsteadiness, your dizziness, or even possibly your vertigo. When you come in, I often will start by explaining what is balance. In our bodies, there are three main systems that contribute to our body knowing where we are:

1. The Vestibular System – that includes the inner ear and the crystals that are in our inner ear called otoliths. 

2. The Visual System –what you see with your eyes.

3. The Nervous System – specifically proprioception, which is knowing where our body is in space. We have proprioceptive nerve endings in all of the joints in our body that give us feedback to tell us whether we’re standing on a sideways hill, based on if one of our joints feels more compression on one side or we’re leaning one way or the other.

Proprioception, your vision and those crystals in your inner ear all need to tell your brain the same thing so that your body can figure out first, where are you? And second, are you in balance or out of balance? 

How We Assess Balance and Vertigo in Physical Therapy

During a physical therapy assessment, not only am I going to do a subjective discussion to hear what your symptoms are, but I’m also going to put you through tests. This can include: 

• Challenging your visual system with eye tracking tests. 
• Having you try to balance on one foot on flat or unstable surfaces. 
• Testing your inner ear system by moving your head in different positions to see if the movement of those inner ear crystals reproduces any of your symptoms. 

The Basic Anatomy of the Inner Ear

Our vestibular system, one of those three systems that I mentioned earlier, has to do with the canals and the crystals that are in our inner ear. We have three canals in our ears, and each one has fluid that normally travels in them along with little hair cells. As we move our head, the fluid whooshes past those hair cells, and those hair cells tell our brain what direction we’re moving in. 

We have little crystals that sit in there too, and those crystals are not intended to be moving. But sometimes after a fall, or if you hit your head or get a concussion type injury, those crystals can shift out of place and lead to vertigo. Also, as we age, those crystals essentially dehydrate, and they break loose even faster. This is another reason why it’s so important to drink water, because hydration plays a part even in this vestibular system.

How Physical Therapists Treat Vertigo Caused by Loose Inner-Ear Crystals

If I suspect that you have vertigo due to these crystals moving around, one of the treatments for that is to take you through very specific maneuvers to try to put those crystals back in the appropriate canal. That involves the physical therapist helping you through some movements; and then if and when appropriate, we can teach you how to do those maneuvers at home. 

One thing I do caution people against is that you can go on the internet and find everything nowadays. I have a lot of patients who come in and they say, “Oh, I looked up this maneuver and I just did it at home, and it’s not getting better.” And I do caution people against this because there are multiple canals in each ear, meaning there are multiple different directions that these crystals can get thrown into which will put your vestibular system out of whack. That’s where having the skill of a physical therapist really comes into play.

How Physical Therapists Treat Other Types of Vertigo

If after my assessment, I decide it’s not coming from this vestibular system and those crystals, you could have what we call vestibular hypofunctioning, which for a lot of people just means you haven’t challenged your vestibular system enough. 

Sometimes people might be afraid of falling, maybe they’ve fallen before and now they’ve narrowed down their lifestyle to avoid it happening again. Maybe they’re not walking on uneven surfaces anymore, they’re not crossing that grassy field. We tend to see this as people age, but it can happen in anyone if you aren’t stimulating the nervous system in those ways; and then if you do happen to step on something uneven, your body’s reaction to that could be much more severe in making you feel unsteady and off balance or dizzy.

The treatment for that diagnosis is a graded exposure to those things. Your physical therapist is going to hone in on which balance exercises and activities you would need to do the most. We’re going to set you up in a very safe environment to do them with us here and push those boundaries a little bit until you start to feel strong enough to withstand those challenges. That will help you feel much more comfortable in the world. 

Call Bay Area Physical Therapy for Vertigo or Balance Treatment

Physical therapy is an amazing, amazing help when it comes to vertigo, and a lot of people don’t know that we can be a source of relief for this condition. If you need help with vertigo, unsteadiness, or dizziness, please reach out to us today at (925) 284-3840 for a complimentary consultation because we want you to be safe in your daily life.