Physical Therapy May Help for Vertigo

 Disorienting corridorSteve Haake, PT, DPT

Vertigo, or dizziness, causes a person to feel as though their surroundings are spinning about them. Luckily, physical therapy may help for vertigo.

Vertigo is a more common problem than you might think.  As many as 35% of adults 40 years and older in the US have experienced vertigo.  Your chances of having vertigo increase with age as 80% of adults 65 and older have experienced dizziness.  Causes of vertigo range widely and include, but are not limited to, things like changes in blood pressure, drug side effects, anxiety, vertebrobasilar insufficiency, TMJ dysfunction, neck pain, central nervous system dysfunction, and vestibular dysfunction.  The most common cause of vestibular dysfunction is BPPV (benign paroxysmal positional vertigo).  Up to 66% of all vestibular cases are BPPV.  In addition, 50% of individuals over 65 will have BPPV at some point.  BPPV is a transient vertigo that is induced by head position changes.  People with BPPV typically experience brief episodes of dizziness when rolling over in bed, lying down or sitting up, or when looking up or down. 

To understand how BBPV causes symptoms of dizziness you need to know some basic inner ear anatomy.   The inner ear has three semicircular canals:  anterior, posterior, and horizontal.  These semicircular canals contain fluid called endolymph.  Vestibular organsThe inner ear also consists of two other vestibular structures, the saccule and utricle, which contain small crystals of calcium carbonate called otoconia.  Together, all of these structures help us to sense head movements in all directions.  Problems arise when the otoconia (crystals) become displaced into one of the three semicircular canals.  This is what causes the feeling of spinning or vertigo.  There are two types of BPPV, cupulolithiasis and canalithiasis.  Cupulothiasis is when the otoconia adhere to one of the semicircular canals.  Canalithiasis is when the otoconia are freely floating in one of the semicircular canals.  Canalithiasis is the most common form of BPPV.  The posterior canal is the most commonly affected at 85% of all cases of BPPV. 

Fortunately, BPPV can be effectively treated by a physical therapist.  The main goal of treatment is to get the otoconia (crystals) out of the affected semicircular canal.  Just like one of those ball-in-a-maze toys, the physical therapist places the patient into various positions to move the crystals out of the affected semicircular canal.  The success rate of this repositioning maneuver is 80-90% with one treatment session and increases with more treatment sessions.  Balance exercises and gaze stability (eye) exercises are often used in conjunction with the repositioning maneuver.  The physical therapist may also prescribe repositioning exercises to be done at home.  The recurrence rate of BPPV can be up to 20%.