Physical Therapy to Address Dizziness

By profession, I am a Physical Therapist working with primarily a neurological population. At my specific clinic this can range from spinal cord injury to traumatic brain injury to amputees to dizziness to fall risk patients--truly a melting pot of so many different diagnoses! I love what I do, and I wanted to write this post to help create a little more awareness on Vestibular Rehabilitation. YES!! A Physical Therapist can help patients with dizziness and motion sensitivity and NO! you don't always just have to "live with it." It is a population I, personally, began treating about 6 months ago! This population is very difficult to treat in comparison to other diagnoses because each patient is SO different and unique in their onset, frequency, duration, and sensation. There is no cookie cutter patient, but there is a plethora of research to support Vestibular Rehabilitation and how much it can truly improve a patient's quality of life! I mean, who in the world wants to be dizzy?

Most of my patients had no idea a Physical Therapist can do anything to help their symptoms. That was my main inspiration for writing this post. The sad part is that many of these patients were dealing with dizziness for 10-15 years assuming nothing could be done to address it. Some of these very patients (dealing with dizziness for 10-15 years) were alleviated in ONE VISIT! It blows my mind that due to lack of awareness these patients dealt with dizziness for all of those years! There is a lack of awareness in the medical field that can be easily fixed to help patients like this! Why deal with dizziness for THAT long if there could possibly be a way to address it?

Vestibular research is fairly new compared to other patient populations in the physical therapy world and, honestly, not many medical professionals even know what a Physical Therapist can do to address dizziness. Within the hospital system I work for, we have "spread the word" and educated many Physicians and various departments (such as the ED) about what Vestibular Rehabilitation consists of. Since then, our referrals have increased and we have been able to see so many patients for their dizziness---some which were evaluated and deemed appropriate for Physical Therapy and others who were not appropriate (it really just depends on a patient's specific diagnosis, medical history, and comorbidities).

Many hospitals are keeping Physical Therapists in the emergency department to help differentiate between stroke and vertigo. The special tests used by Physical Therapists to evaluate vestibular patients are very sensitive and specific (meaning they can help to accurately differentiate between the two conditions) in the first 48 hours of onset of symptoms unlike imaging (MRI, CT).

Benign paroxysmal positional (BPPV) vertigo is the most common cause of vertigo and the number one diagnosis we are referred for. However, out of all dizziness patients BPPV only comprises of about 20% of that patient population. Many medical professionals refer to this vertigo/dizziness as a result of a crystal or rock being out of place. In the simplest explanation possible BPPV

physiologically occurs when otoconia--which are typically referred to as crystals-- become dislodged from their home in the utricle and migrate into one or more of the 3 fluid-filled semicircular canals. BPPV by nature is sensitive to change in position. Many of my patients report symptoms when turning over in bed, lying down or sitting up, looking up or down, or with head turns. The intensity of vertigo is extremely variable in BPPV patients depending on the cause. This is why it is essential to go see a Physical Therapist that specializes in vestibular treatment in order to get thoroughly evaluated and treated the correct way! Patients with BPPV can be a "one and done" fix depending on the patient's medical history and comorbidities as Vestibular Physical Therapists are trained to treat this crystal being out of place with a variety of maneuvers.It my opinion, patients with straight forward BPPV are the easiest population to treat. In my experience, some treatments can be a "one and done" and patients feel better within 24 hours (of course this is best case scenario but it does happen more often than not!). Dizziness in these patients is usually brief. It typically ranges from mild to intense intensities and is most commonly described as "the world spinning". Some patients are more complex and require multiple treatments prior to feeling back to their norm. Below is an illustration of what a typical treatment conducted by a licensed Physical Therapist would look like for a patient with right BPPV. When done properly, this maneuver has about an 80% cure rate.

These maneuvers are conducted specifically based off of information gathered from the evaluation that a Vestibular Physical Therapist conducts which is essentially to diagnose/discover the reason behind the dizziness. However, DPT's address many more forms of dizziness. Some of my patients have had impairments such as motion sensitivity, symptoms secondary to concussions, visual vertigo, migraines, Meniere's disease, etc which all differ from one another in the way that it is evaluated, treated, and progressed. Some are much more complex while others may be more straight forward.

Honestly, without doing a thorough evaluation and examining a patient's medical history and comorbidities it is impossible to know whether a patient can benefit from Vestibular Rehabilitation. SO many factors can contribute to a patient feeling dizzy but not all factors can be addressed by a Vestibular Physical therapist. BUT, why not take a shot at it? It can be so beneficial in improving a patient's quality of life and helping them return back to their activities of daily living! In this way, DPT's (Doctors of Physical Therapy) are the detectives analyzing the scene and all of its components prior to making a plan of care. A plan of care mostly consists of adaptation, substitution, or habituation exercises to alleviate symptoms of dizziness while, also, addressing static and dynamic balance, gait, and strength.

If you can relate to any of the things mentioned in this blog post find a Vestibular Rehabilitation clinic near you and see if they can help improve your quality of life! :)