Is Your World Spinning?

Chances are you’ve expe­ri­enced dizzi­ness at some point in your life. That sen­sa­tion of light­head­ed­ness can be a symp­tom of many things — med­ica­tion, heart and/​or neu­ro­log­i­cal con­di­tions and head trau­ma. But what hap­pens when that dizzi­ness does­n’t go away, lasts for days and makes the room seem like it’s spin­ning even when you’re not moving?

It may be a sign that you’re expe­ri­enc­ing ver­ti­go, a vestibu­lar dys­func­tion that can be a debil­i­tat­ing in some cases.

Our bod­ies main­tain bal­ance with sen­so­ry infor­ma­tion from three sys­tems: vision, pro­pri­o­cep­tion (sen­so­ry recep­tors in the skin, mus­cles and joints) and the vestibu­lar sys­tem (inner ear — pro­vides infor­ma­tion about motion, equi­lib­ri­um and spa­tial orientation).

The vestibu­lar sys­tem is locat­ed in your inner ear and made up of the utri­cle, sac­cule and three semi­cir­cu­lar canals. When the vestibu­lar sys­tem isn’t func­tion­ing prop­er­ly, a per­son may experience:

• Dizzi­ness (light­head­ed­ness, faint­ness, unsteadiness)
• Ver­ti­go (per­ceived move­ment, spin­ning of self or surroundings)
• Dis­e­qui­lib­ri­um (unsteadi­ness, imbal­ance, disorientation)
• Spa­tial dis­ori­en­ta­tion (not know­ing where your body is in space)
• Lack of concentration
• Visu­al disturbance
• Hear­ing changes

If you’re expe­ri­enc­ing any of these symp­toms, you should see your pri­ma­ry care provider. You may be referred to a spe­cial­ized ther­a­pist for vestibu­lar reha­bil­i­ta­tion ther­a­py (VRT). Vestibu­lar phys­i­cal ther­a­pists can per­form fur­ther eval­u­a­tion to help deter­mine the cause of your symp­toms. They can also pro­vide you with an indi­vid­u­al­ized treat­ment plan to address your needs, includ­ing cas­es of inner ear dis­or­ders. Patients under­go­ing phys­i­cal ther­a­py with these con­di­tions per­form exer­cis­es that retrain the vestibu­lar sys­tem to reduce or elim­i­nate dizzi­ness or imbal­ance relat­ed to posi­tion changes and movement.

Com­mon Vestibu­lar Disorders

Benign Parox­ys­mal Posi­tion­al Ver­ti­go (BPPV): The most com­mon vestibu­lar dis­or­der is BPPV. With BPPV, oto­co­nia (cal­ci­um car­bon­ate crys­tals) locat­ed in the inner ear sys­tem are dis­placed from the utri­cle into the semi­cir­cu­lar canal. While mov­ing with­in the canal, groups of crys­tals can cause ver­ti­go (room-spin­ning dizzi­ness) that lasts approx­i­mate­ly 20 – 30 sec­onds. This usu­al­ly occurs with posi­tion change such as mov­ing from lying to sit­ting, bend­ing for­ward or tilt­ing your head back. Imbal­ance and light head­ed­ness are also com­mon symptoms.

There are 3 canals in which the crys­tals can be dis­placed in each ear. Your vestibu­lar ther­a­pist can iden­ti­fy the canal and per­form the appro­pri­ate head move­ments, such as the Epley maneu­ver, to move the crys­tals back into the utricle.

Vestibu­lar neuritis/​labyrinthitis: This is anoth­er com­mon dis­or­der caused by inflam­ma­tion in the inner ear or nerves con­nect­ing the inner ear to the brain, dis­rupt­ing the trans­mis­sion of sen­so­ry infor­ma­tion from the ear to the brain. Symp­toms can include mild dizzi­ness to severe room-spin­ning ver­ti­go, which can occur at rest or with move­ment, nys­tag­mus (abnor­mal move­ment of the eyes) which can cause prob­lems with eye sta­bi­liza­tion, nau­sea, vom­it­ing, dif­fi­cul­ty con­cen­trat­ing, unsteadi­ness and hear­ing loss (more com­mon with labyrinthitis).

Vestibu­lar reha­bil­i­ta­tion can help sta­bi­lize your eyes, con­nect head and eye move­ments, improve depth per­cep­tion and increase tol­er­ance to move­ment in the sur­round­ing area.

Post-con­cus­sion syn­drome: Fol­low­ing head trau­ma, such as a con­cus­sion, you may expe­ri­ence dizzi­ness, imbal­ance, headache, neck pain, whiplash, and/​or dif­fi­cul­ty con­cen­trat­ing. A vestibu­lar phys­i­cal ther­a­pist can assess your vestibu­lar sys­tem, cer­vi­cal spine (neck) and response to activ­i­ty to iden­ti­fy which sys­tems have been affect­ed by head injury. An indi­vid­u­al­ized ther­a­py pro­gram may be planned to help you return to dai­ly and recre­ation­al activ­i­ties. This may include eye and head move­ment exer­cis­es, strength­en­ing and bal­ance exer­cis­es and man­u­al therapy.

What to expect dur­ing your vestibu­lar phys­i­cal ther­a­py evaluation:

A spe­cial­ized phys­i­cal ther­a­pist will meet with you to dis­cuss your symp­toms. Your vestibu­lar sys­tem will then be eval­u­at­ed, which includes obser­va­tion of your eye move­ments while sit­ting and when mov­ing between posi­tions. Your eval­u­a­tion may include a bal­ance screen­ing, mus­cle strength test­ing and obser­va­tion of dai­ly activities.

Your ther­a­pist may rec­om­mend that you attend phys­i­cal ther­a­py (PT) 1 – 2 times per week as long as your symp­toms remain present, how­ev­er this will be mod­i­fied based on the cause of your symp­toms and abil­i­ty to per­form exer­cis­es with­out PT super­vi­sion. Depend­ing on the cause of your dizzi­ness (for exam­ple, BPPV vs. vestibu­lar neu­ri­tis), you may improve after 1 – 2 vis­its or your symp­toms may slow­ly improve over the course of 6 – 8 weeks. Fol­low­ing your eval­u­a­tion, your phys­i­cal ther­a­pist will cre­ate an indi­vid­u­al­ized a treat­ment plan to address your symptoms.

If you’re expe­ri­enc­ing dizzi­ness or spin­ning that impacts your dai­ly life, see your pri­ma­ry care physi­cian right away and ask if vestibu­lar reha­bil­i­ta­tion ther­a­py is a treat­ment option for your con­di­tion. Our vestibu­lar phys­i­cal ther­a­pists can pro­vide you with treat­ments to help get your world back in alignment.