Learn about your dizziness and how physical therapy can help.

Dizziness is one of the most common reasons people seek medical care in the United States. Dizziness can have a variety of causes, some benign and some more serious. Delay in identification and management of dizziness can complicate care and lead to unnecessary medical expenses. Individuals with complaints of dizziness can seek evaluation and treatment for their dizziness from physical therapists. This post discusses potential causes for dizziness and how a physical therapist can help diagnose, treat, or refer clients for additional treatment or assessment.

1. What exactly is Dizziness?

The language used to describe/discuss “dizziness” can be confusing or complicated to to start out we will establish some operational definitions. For the purposes of this article dizziness will refer to the sense that someone is unsteady, unsteadiness will refer to the actual disruption of or inability to balance, and vertigo will refer to the sensation of the room spinning. Those are brief definitions and there is a lot to be explored there, but for the sake of simplicity we will leave it at that and explore three main ideas about dizziness and vestibular rehabilitation.

2. The Vestibular System

The vestibular system is one of our three systems of balance that work together to keep us upright against gravity. Since we do not just sit still all day, we need different systems to regulate our movement. This helps us maintain stability without requiring too much conscious effort. If we had to devote constant conscious effort to maintain balance, it would be very difficult to accomplish anything during movement because we would need to spend more devoting conscious effort just to staying upright. Thankfully, we have systems in place that, in healthy individuals, run in the background and regulate posture/balance. This discussion will focus on an overview of the vestibular system today but it should be noted that there are two other systems that work with the vestibular system. The other main systems are known as our proprioceptive or somatosensory systems and our vision. A good analogy to understand how these systems work is to think of them as feet on a camera tripod where the combination of those three feet on the camera tripod keep the tripod well-balanced. In the same way, our three systems of balance all keep us upright by working together.

Our vestibular system is the system of wiring between our brain and our peripheral vestibular organ (located in our inner ear) that detects head movement and, through reflexes, automatically contracts postural and ocular muscles based on the direction our head is moving. This helps us keep our gaze stable and our center of mass oriented safely during movement. To understand this very complex system, it is convenient to think about it in terms of a system that both receives information about our head and body movement (inputs), processes that information, and then contracts muscles to orient our gaze or adjust our posture (outputs).

Location of the Vestibular System

A crucial part of the vestibular system is an organ in our inner ear (vestibular organ) which is neurologically connected to different parts of our brain. A problem with our peripheral vestibular or our central vestibular function can cause feelings of dizziness or vertigo. The key to understanding their dizziness lies in understanding whether it is caused by central vestibular dysfunction or peripheral vestibular dysfunction. Is it an input problem, a processing problem, or an output problem?

An office examination by a physical therapist who is well trained can help determine the source of your problem and identify if it is something that requires referral or can be treated in a physical therapy office. A physical therapist will typically perform a comprehensive exam where they will have you perform certain head and eye movements to assess your problem.

3. BPPV

A very common cause of dizziness is called BPPV which stands for benign paroxysmal positional vertigo. It is very common in older individuals and can cause vertigo with head movements such as bending over or turning in bed. It is often under-diagnosed or misdiagnosed but is very quickly and easily assessed by a physical therapist performing a vestibular examination. I am not going to go into the details of what BPPV is because it is a rather lengthy explanation, but I did want to emphasize that it is a very common cause of dizziness and it can be very quickly addressed if it is correctly identified.

If you are having any issues with dizziness, you should reach out to your physical therapist first. Here at Robbins Rehabilitation East, we offer free evaluations to see how we can help you.


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