Today I’m going to write about a topic that many people don’t realize is covered by physical therapists. It’s a particular area of interest for me, and I believe an area of concern that is widely under-treated in general. It’s called VESTIBULAR or BALANCE THERAPY, and it has to do with helping those who feel dizzy, off balance, and/or are falling down.
First of all, there are many reasons why people get dizzy, nauseous, and light headed. Similarly, there are many causes that can lead a person to fall or have balance problems. The first step, before diagnosis, is recognizing the symptoms and knowing when to seek help.
THE FOLLOWING ARE A LIST OF SYMPTOMS THAT SHOULD LEAD ONE TO VISIT THEIR DOCTOR:
• Dizziness, including spinning (vertigo), nausea, light headed sensations, and difficulty focusing the eyes
• Frequent falling or tripping, with or without provocation
• Difficulty focusing the eyes on the computer for long periods without getting headachy, dizzy, or noticing trouble reading
• Difficulty staying upright while walking in crowds
• Difficulty focusing your eyes while driving
• Recent hearing loss or ringing in the ears
• Recent head trauma, concussion, or suspicion of concussion
The list could go on from there, but essentially the gist is this: falling, dizziness, and post-concussive confusion can get better! THE FIRST STEP IS SO SEEK HELP.
When you go to your primary care physician, the process is often multi-layered. Make sure you ask about physical therapy. Some will refer you to vestibular physical therapy right away. Others will recommend you go see a specialist first, either a neurologist or an ENT that focuses on vestibular disorders. Eventually, you may end up in the care of a PT.
At Thrive, it is a core value amongst the staff that we treat all our patients as individuals and do a thorough evaluation to determine the cause of their symptoms. This is true if you’ve sprained your ankle, or woken up with the spins. When a person comes in for a vestibular or balance evaluation, it is our job to weed out what their specific goals and needs are based on their presentation. I first like to know why my patient’s have come: are they dizzy, do they seem to be tripping often, or have they bumped their head and are now struggling to focus at work? The way the patient presents helps form a hypothesis as to what might be wrong.
AS STATED BEFORE, THERE ARE LOTS OF REASONS PEOPLE MIGHT COME IN FOR BALANCE AND VESTIBULAR THERAPY. SOME REASONS PEOPLE FALL ARE:
• Sensation loss associated with age or diabetes that make it hard to feel where you step
• Weakness of the muscles that hold the trunk upright
• Joint motion loss
• Nerve changes in the inner ear, often but not always associated with aging, that signal to the brain where your body is in space
• Balance impairments related to a concussion, stroke, or neurologic impairment like Parkinson’s Disease
SIMILARLY, PEOPLE GET DIZZINESS AND VERTIGO FOR MANY REASONS. THOSE REASONS ARE:
• Inner ear dysfunction having to do with loose calcium deposits. This condition is called Benign Paroxysmal Positional Vertigo (BPPV)
• Nerve changes in the inner ear, often but not always associated with aging
• Fluid imbalance in the inner ear, called Meniere’s Disease
• Strokes in the part of the brain called the cerebellum
• On rare occasion, tumors
As surprising as it may seem, most of these things can be made better. While we may not be able to fix sensation loss in your toes, for example, we can improve your strength and positional sense to compensate for that loss. Similarly, while BPPV feels like sea-sickness on steroids, there is actually a very effective way to treat it. The most important thing to do is call your doctor or PT and get the ball rolling! If you are already a patient at Thrive and have been noticing some of the things discussed in this post, be sure to ask your PT about it. We treat many vestibular disorders in house. And, if your problem is beyond our scope, we will be happy to refer you to the appropriate professionals.
Looking forward to helping you stay upright and moving in the future!
Elizabeth D’Annunzio Shah, PT, DPT, OCS works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)