PHYSICAL THERAPY
Did you know that Physical Therapists treat Vertigo? Many of my patients are surprised when they hear that in addition to their musculoskeletal conditions, I can work with them to reduce their dizziness and vertigo.
A typical evaluation for vestibular patients goes as follows: First, a physical therapist will review your medical history with you and ask questions regarding your head position during the onset and duration of symptoms. Then they will perform an examination which may involve changing body positions, eye tracking assessments, balance assessments and head turning while performing activities. Depending on the type of vestibular disorder you have, treatment will vary.
There are many types of vestibular disorders that can cause dizziness and vertigo. Vestibular disorders commonly seen in the clinic include Benign Paroxysmal Positional Vertigo (BPPV) and Unilateral Vestibular Hypofunction (UVH).
BPPV is a common vestibular condition where patients have dizziness when their head is in a certain position and typically resolves quickly (1). Patient may say: “Every time I roll over in bed, I get dizzy for a few seconds.” This is caused by displaced calcium carbonate crystals in the inner ear. Treatment involves therapist directed movements to encourage the crystals to move to a position where they are no longer causing dizziness.
UVH is a condition where patients report dizziness with head movement (2). Patient’s may say: “Every time I bend over to tie my shoes I get dizzy.” With this condition, certain organs in your inner ear are not functioning properly. (These are the same organs that are related to motion sickness during travel.) Treatment can involve therapist directed habituation exercises during which patients perform activities that are symptom provoking in order to exercise the organs that are not working properly. An example of this type of treatment is when a person prone to sea sickness joins the Navy and their seasickness disappears in a few weeks. Being on the boat for many days exercises the inner ear organs which are no longer overstimulated by the movement of the boat.
Most patients will be prescribed a home exercise plan specific to their condition to improve the speed of recovery. The home exercises will change over time as symptoms improve.
There are many other vestibular conditions and treatment interventions than those listed here. Depending on your medical history and the results of your physical examination, your therapist may determine that you need further medical testing before proceeding with physical therapy. This article is not intended to be medical advice, but rather to introduce concepts in vestibular physical therapy. Consult a medical professional if you have vertigo or dizziness.
1. Herdman S. Benign paroxysmal positional vertigo (BPPV). APTA. https://www.apta.org/patient-care/evidence-based-practice-resources/clinical-summaries/benign-paroxysmal-positional-vertigo-bppv. Published October 25, 2011. Accessed April 25, 2023.
2. Callahan J ML. Unilateral vestibular hypofunction (UVH). APTA. https://www.apta.org/patient-care/evidence-based-practice-resources/clinical-summaries/unilateral-vestibular-hypofunction-uvh. Published June 28, 2017. Accessed April 25, 2023.
