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How Physical Therapists Treat Dizziness and Vertigo

Causes and Treatments
 Nov 8 2019

What causes dizziness? Maybe a recent injury left you feeling unbalanced, a stroke or other brain trauma caused episodes of vertigo, or a medication you’re taking lists dizziness as a potential side effect.

But what if you suddenly start to experience dizziness or vertigo and see no obvious cause? Feeling unsteady on your feet can be frightening, especially if you’re not sure why it’s happening. Even if you know the root cause, unexpected dizziness can make you feel unsafe and keep you from the activities that matter to you.

While consulting your physician about new symptoms is always a good place to start, your physical therapist can also help provide answers! Let’s look at some of the ways physical therapists can help diagnose and treat the causes of dizziness.


What Causes Dizziness and Vertigo?

Your physical therapist is equipped to diagnose some of the most common causes of dizziness and vertigo, including:


Inner Ear Issues

When you’re experiencing dizziness or vertigo, inner ear issues are the most likely culprit. One inner ear issue you may have already heard of is Benign Paroxysmal Positional Vertigo, or BPPV. It’s the most common cause of vertigo in older adults. Crystals in the inner ear help you sense your head’s position against gravity (so you can tell up from down). When these “crystals” get displaced in the inner ear canal, you’ll have trouble sensing your head’s position and feel dizzy.  Many patients describe feeling like the room is spinning around them, especially when changing head positions such as lying down or getting up. The good news is, BPPV is one of the easiest causes of dizziness to treat! A trained physical therapist can treat BPPV in just 1-4 visits. See more information on treatment below.

Another common inner ear issue, Meniere’s Disease, occurs when there is abnormal fluid build up in the inner ear. Similar to BPPV, you may suddenly feel like your head is spinning, with episodes of vertigo that can last minutes or even hours. Patients with Meniere’s disease will also usually experience other symptoms like ringing in the ears, partial deafness, or a feeling of fullness in the ears. Unlike BPPV, there is no direct treatment or cure available for Meniere’s disease, so physical therapy will focus on symptom management and returning to activities that matter to you.


Concussions and Head Injury

Concussions and other head trauma can result in symptoms like dizziness and vertigo, even long after the original injury occurs. A physical therapist can provide holistic treatment to get you back on your feet after a head injury, including treating any dizziness or associated vertigo. Read more about baseline testing and concussion treatment at Compleat Rehab here.


Blood Flow Restrictions

Conditions that cause blood flow restrictions in the brain, such as stroke, migraines, or other vascular diseases, may be accompanied by dizziness and vertigo. Physical therapists are trained to recognize symptoms of dangerous conditions that require a doctor’s attention, and we will refer you accordingly. On the other side of treatment, if you have recently had a stroke or been diagnosed with a vascular condition that causes dizziness, physical therapy can help treat the symptom while improving your overall health.


Issues with Back and Neck Muscles

Many people don’t realize it, but inflammation or degeneration of the muscles around the upper spine and neck can actually cause dizziness! It’s called cervical vertigo or cervicogenic dizziness (cervical refers to the spinal vertebrae in your neck). This inflammation can be cause by trauma, injury, surgery, or the body’s natural aging process. If you have cervical dizziness, you may experience a spinning sensation when you move your neck, especially when turning your head. The muscles in your neck and upper back have nerves that send signals to your brain about where your head’s location, so conditions that mess with these nerves can therefore mess with your balance! Luckily, a physical therapist can both prevent and treat cervical dizziness.


How Can a Physical Therapist Help?

Physical therapy treatment for dizziness will vary based on the cause, and may include:


Direct Treatment (Canalith Repositioning)

One of the most common sources of dizziness comes with a simple solution. BPPV is caused by dislodged inner ear crystals; to treat it, we just shake them back into place! Ok, so it’s not as crazy as it sounds. Essentially, your physical therapist will direct or move you through carefully ordered positions in order to help move the crystals back where they belong. There are 6 evidence-backed ‘positioning maneuvers’ that we use. Which variation works best for you will depend on your symptoms and level of comfort. For instance, the “Gans Repositioning Maneuver,” one of the less intensive options, has you repeatedly roll back and forth and then gently tilt your head to the side. It may seem like a fruitless exercise, but the technique is backed by real results – in one study, 95% of patients had no dizziness or vertigo symptoms after just 2 treatments using the Gans Repositioning Maneuver.

Your physical therapist might try a couple of different maneuvers before finding the one that works for you, but most instances of BPPV can be treated in just 1-4 therapy visits!


Vestibular Rehabilitation

For some causes of vertigo, direct treatment is not an option. Some chronic conditions can be managed with medication or therapy but will never actually go away, such as Meniere’s disease, vascular disease, and other conditions. The good news is: physical therapy can still treat the symptoms of these conditions, including dizziness or vertigo.

To help patients manage dizziness symptoms, we use vestibular rehabilitation. Vestibular rehabilitation focuses on ‘rehabbing the brain’ as opposed to treating the underlying cause of the dizziness itself. Your physical therapist will have you perform exercises that require balance and coordination, while providing strengthening and conditioning as well. They may also recommend alternative ways you can move or perform certain tasks to avoid triggering vertigo. The exercises train your brain to work with the changes in your body, whether that’s inflamed nerves or inner ear fluid levels. You are essentially relearning up from down! It may sound difficult, but your brain is an amazing organ! And a trained physical therapist can help you achieve rehabilitation quickly, with treatment averaging from 4-8 weeks.


Manual Therapy

Issues with the muscles in and around your neck, or cervical muscles, can wreak havoc on your vestibular system, leading to dizziness and vertigo. A physical therapist can address these issues with manual therapy and corrective exercise to help reduce or completely treat symptoms of dizziness.

Your physical therapist will use hands-on techniques to massage the affected muscles, alleviate tension, improve blood flow, and provide myofascial release. They may also directly manipulate your head, neck, shoulders, and arms in order to work or stretch the affected muscles. Your musculoskeletal system is complex, and a problem in one muscle group can cause problems in its neighbor. A trained physical therapist can find the source!

Corrective exercises to improve strength and range of motion may also help relieve pain and associated dizziness. We create unique treatment plans for each patient, but for less involved cases, effective treatment may require as little as two weeks of therapy.


Strengthening, Conditioning, and Awareness Training

Regardless of the cause of your vertigo, strength and conditioning training can help you manage the symptoms and get back to living. We work with patients to pick the goals that matter to them. For a lot of patients who have symptoms like dizziness and vertigo, regaining independence and movement is one of their primary goals. Physical therapy helps these patients improve their physical strength and coordination, equipping them to handle bouts of vertigo and feel less out of control when dizziness occurs.

Your physical therapist can also train you to be aware of your body, to notice signs that an episode could occur, and to avoid activities that trigger vertigo. Training may include leg, core, and arm strengthening; gait training to reduce fall risk; and balance and reaction testing.


Are you struggling with dizziness, or do you know someone who is? Physical therapy can help! Contact us today to schedule a free consultation.


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You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint

You may contact our Privacy Officer at (704) 824-7800 for further information about the complaint process.

This notice was published and becomes effective on August l, 2011.