How can physical therapy help vertigo?

Do you experience vertigo that causes you to have nausea, a fear of falling, or reluctancy to go out in public because these symptoms might occur? Vertigo can be a very debilitating condition which can affect many aspects of a person’s life.  Vertigo is defined as the illusion of movement or the illusion that the world around you is moving.  Most commonly, vertigo is associated with benign paroxysmal positional vertigo, acute vestibular neuritis, and menieres syndrome.  Benign paroxysmal positional vertigo or BPPV is a common cause of vertigo that can be treated by physical therapists. Benign means that there is no malignancy, paroxysmal means that the symptoms are sudden and intense, position means that the symptoms are related to a specific position, and the main symptom is vertigo.

The inner ear is made up of three canals; a posterior, horizontal, and anterior canal.   BPPV occurs when the free floating calcium carbonate crystals, called otoconia, in the canals of the inner ear are displaced and send false signals to the brain about the relation of your body in space. Vertigo is the main symptom of BPPV which is often associated with nausea.  Typically, symptom-provoking positions will include rolling over in bed, looking up, washing hair, turning your head to look to the side, and reaching for an object on the floor.  Episodes of vertigo tend to last for less than one minute with BPPV.

There are tests that physical therapists can use to determine if you have BPPV, which will guide the treatment.  The tests for BPPV will often bring on your symptoms of vertigo and nausea that may last for up to several minutes.  During the test, the physical therapist will be examining both eyes for nystagmus.  Nystagmus is involuntary rapid eye movements that will give the physical therapist information about which canal of the inner ear may be affected. If the test is positive for BPPV, the treatment can be implemented to relocate the otoconia to their correct location using the Canalith Repositioning Maneuver, also known as the Epley maneuver. If the patient does in fact have BPPV, their symptoms should be significantly decreased or resolved after treatment.  There are also maneuvers that the physical therapist can teach patients to do at home that will help resolve the symptoms associated with BPPV.

In a study from the Journal of Neurology, Neurosurgery, and Psychiatry, it was found that in a group of 35 patients that had posterior canal BPPV, 28 of the 35 patients did not have symptoms of positional vertigo or nystagmus 24 hours after the treatment.1 The long-term outcomes of BPPV using a Kaplan-Meier estimation were that 18% had reoccurrence at 12 months, 30% at 36 months, and 37% at 60 months.2 Your physical therapist will instruct you on what to do if you experience a reoccurrence of BPPV.  The therapist will also assess a patient’s balance and balance training exercises may also be indicated.  Patients that are being evaluated for vestibular disorders should have someone to drive them home and need to sit in an upright chair for 20 minutes after the treatment.  Some therapists may also recommend that patients sleep in a recliner at a 45-degree angle for one night after treatment. BPPV is just one of many causes of vertigo; if you are experiencing any of these symptoms, discuss them with your physician to determine if physical therapy is appropriate for you.

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Jennifer Davis, DPT

Jennifer is a Physical Therapist at TheraSport Physical Therapy in Eden, North Carolina.

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