Vestibular Therapy – Vertigo: What is it? Can it be treated?

By: Jennifer E. Lane, PT, MPT

Vertigo, or more specifically Benign Paroxysmal Positional Vertigo (BPPV), is the most common vestibular (inner ear) disorder. Crystals that are in the inner ear become displaced into a semicircular canal. When you move your head into very specific positions it stimulates the crystals and it creates faulty information to your eyes and brain. True vertigo is defined by a severe spinning sensation that lasts for less than 1 minute. People complain of vertigo when they turn over in bed, bend over, or reach up. In addition to a spinning sensation, people might also feel lightheaded, off-balance, nauseous, or have a feeling of floating lasting for hours or days after a BPPV episode. There is no hearing loss with BPPV.

BPPV’s most common cause in people under 50 years old is a head injury; I can attest to this. A number of years ago, I was hit by a car while on my bike, hit my head against the road, and couldn’t see straight for all the spinning. Obviously, I had sustained a concussion as well. When those symptoms resolved, I continued to experience a horrible spinning sensation with certain head positions. I was told that nothing could be done to help me, so I started avoiding certain activities. I lived with the spinning for more than 2 years. One day while sitting in class in my physical therapy program, the instructor told us we would be learning about BPPV and how to treat it. I eagerly raised my hand to volunteer as a “for real patient” and was treated during class. My symptoms resolved immediately. I was amazed and thankful and knew I had to learn more. Living with BPPV is debilitating and I was so relieved to be cured of it. In people over 65 years of age, it can occur for unknown reasons and can seem to happen spontaneously. There is evidence that states that more than 50% of >65 year olds may have BPPV. Sometimes it can resolve on its own, but other times treatment is required. Physical therapy can help. As readily as the crystals can wash into the canals, they can also wash out. With specific techniques, a physical therapist can effectively treat BPPV. The patient can resume normal activity and not have to avoid certain positions. There is a 30% relapse rate, but the relapse can also be treated effectively.

If BPPV is left untreated, patients will adopt avoidance behaviors, which may lead to hypersensitivity of the vestibular system. In other words, if you avoid certain positions, your inner ear will become increasingly sensitive to the most benign stimulation. Driving in a car, swiveling in an office chair, and swinging on a swing set with your kids can all cause motion sickness, or vestibular hypersensitivity. And most importantly, BPPV left untreated could lead to falls. In the aging population, falls causing broken wrists, hips or head trauma can severely affect that person’s independence.

There are other causes of dizziness that can also be treated effectively with physical therapy. The key is to be diagnosed properly either by your doctor or by a trained physical therapist so that the correct treatment can be administered.