We treat many causes of vertigo and dizziness. Many times vertigo and dizziness can be reduced or eliminated with vestibular rehabilitation. Rehabilitation in balance disorders focuses on vestibular exercises and orthopedic exercise to maximize results. Physical therapy can help diagnose and determine your best course of treatment.

Understanding Vertigo

Vertigo is a common ailment that affects a large number of people every year. Although it isn’t life threatening, it can substantially affect quality of life. Vertigo is a sensation of spinning, rocking, or moving, even if sitting still. Symptoms are worse with moving the head or body, such as rolling over in bed or bending over to pick something up. If aggravated, vertigo can also be associated with lightheadedness, nausea, or even vomiting.

Common Causes of Vertigo

• Inner-ear infection
• Vestibular neuritis
• Meniere’s disease
• Vascular impairment
• Strokes
• Tumors
• Neck (cervical spine) issues
• BPPV (Benign Paroxysmal Positional Vertigo)

Vertigo Symptoms

Patients suffering from vertigo may experience the following symptoms, often with quick movements or when sitting still:

• Dizziness
• Feeling “off-balance”
• Loss of balance
• Blurred vision
• Trouble focusing the eyes
• Light-headedness
• Spinning sensations
• Sweating
• Ringing in the ears or hearing loss in one or both ears
• Nausea and/or vomiting
• Unexplained loss of balance with position changes and during functional activities

The Vestibular System

The vestibular organs of the inner ear provide the brain with information about changes in head movement. If the vestibular system is not functioning properly, dizziness, vertigo, imbalance, and spatial disorientation can occur.

Key components include:

• Semicircular canals – anterior, posterior, and horizontal canals respond to angular position changes of the head
• Otoliths – lined with hair particles that have spontaneous firing rates that respond to gravitational orientation changes
• Vestibular nerve – last link in the pathway ascending and descending into the vestibular nuclei
• Vestibular nucleus – located in the brain stem, provides information to the brain
• Labyrinth and cochlea – help the inner ear maintain equilibrium for the body

Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and is due to a mechanical change in the inner ear. “Crystals,” or particles in the inner ear, can be dislodged and travel into one of the semicircular canals, creating a false sense of movement. This is why alterations in head position can produce symptoms.

A physical therapist can determine if BPPV is causing an individual’s symptoms using balance testing and specific movement tests. The most common test is called a Dix-Hallpike test, which uses simple head movements to provoke symptoms. The physical therapist looks for nystagmus (involuntary movement of the eyes) that can help determine which canal the problem is in.

Treatment for BPPV typically includes canalith repositioning procedures, which move the particles out of the way, most commonly known as the Epley Maneuver. This treatment typically resolves symptoms in 1-2 visits, but a small percentage of patients will have persistent symptoms that require additional treatment that may include a different repositioning procedure known as the Semont Maneuver or habituation exercises to correct symptoms. Even after symptoms have resolved, your physical therapist may provide additional balance training tailored for inner ear problems.

How We Treat Vertigo

Not all vertigo comes from BPPV. Western Pennsylvania Sports Medicine & Rehabilitation Clinic has specially trained physical therapists who will complete a comprehensive evaluation to determine the underlying cause of your vertigo and tailor an individualized program to meet your needs.

Treatment Options

Treatment for vertigo may include:

• Eye-tracking exercises
• Balance exercises on various surfaces
• Walking exercises with various head movements
• Habituation (Brandt Daroff) exercises
• Canalith repositioning procedures
• Balance training to assist in preventing falls during daily activities
• Stretching and strengthening exercises designed to improve balance during standing and walking