Understanding Vertigo

Vestibular rehabilitation is a specialized form of physical therapy designed for people who have vertigo and dizziness symptoms which are impacting their daily life. You may experience vertigo for a variety of reasons. Vertigo is defined as a whirling or spinning sensation which results in imbalance. The vestibular system is an organ deep in your inner ear, behind your ear drum. It is encased in the bone of your skull, surrounded by fluid and is also filled with fluid.

The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV). This is a type of dizziness which is caused by crystals called "otoconia" in your inner ear. These crystals are supposed to reside in one part of your inner ear called the "utricle" and "saccule". The problem arises when these crystals move from that location into the semi-circular canals. Once these crystals enter into the fluid filled semi-circular canals, your brain misinterprets the crystals moving the fluid as rotational movement of the body. In response, your brain tells your eyes to move to compensate for the rotational movement; however, your body is not moving but your eyes are - so you see your environment whirling or spinning and you feel dizzy. Through a series of movements and positions, your vestibular physical therapist can help to move the crystals out of where they are located and your symptoms are typically alleviated in 1-2 sessions.

The second most common group of vestibular problems are vestibular hypofunction and age-related changes to the vestibular system. The vestibular system declines in function as you age, and if you are over the age of 20, you fall into this group. Typically, the function declines slowly and equally in your right and left ears. Sometimes, however, something might happen which causes one side to decline in function more quickly than the other side. When this happens, your brain perceives rotational movement, but your other systems which maintain your balance and sense movement tell your brain that movement is NOT occurring. This mis-match of information coming into your brain results in a feeling of dizziness and can also result in a nauseated feeling in your stomach. Through sessions with your vestibular physical therapist, exercises can assist your body in learning that this difference in function between your left and right vestibular system is your "new normal". Once that happens, your symptoms decrease to the point you can resume your normal life. This can take from 4 – 8 weeks depending upon the severity of your condition.

The third most common group of vestibular problems is related to your neck. When you experience dizziness or vertigo, you tend to avoid moving your head and neck. If this continues for a period of time, your neck can become stiff from decreased movement. This stiffness can then also become a cause of dizziness when your head/neck is moved. Oftentimes discerning whether your neck stiffness caused your dizziness or vice versa can be challenging. The end result is the same – the vestibular physical therapist works on your neck movement as well as head movement to decrease your symptoms and allows you to return to your normal daily activities, usually in 4 – 6 weeks.

The final group of vestibular problems is related to strokes, traumatic brain injuries, concussion and Meniere’s disease. Dizziness and vertigo is a common side effect of each of these diagnoses. Vestibular rehabilitation for people in this group focuses upon returning the person to their normal daily activities while minimizing or eliminating the impact of their vertigo or dizziness. This process can take from 6 – 12 weeks.

Vertigo and dizziness are not pleasant symptoms, and you don’t have to "just put up with it". Talk to your doctor about your symptoms and ask to see a physical therapist who can help you get back to your life instead of watching your life happen without your participation.

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