Physical Therapist's Guide to Dizziness
Dizziness is a common problem, especially among older adults. In fact, for people over the age of 65, dizziness is one of the most common reasons for physician visits and hospitalizations. Regardless of the cause of dizziness, the sooner you get help, the better.
Dizziness—and the balance problems that may come with it—can be caused by a number of factors:
- Inner ear disorders ("vestibular disorders") such as benign paroxysmal positional vertigo
- Injury or trauma to the inner ear
- Diseases such as arthritis or diabetes
- Brain disorders such as Parkinson disease or stroke
- Conditions such as low blood pressure
- Use of certain medications
How Does it Feel?
Some people have a spinning sensation ("vertigo,") which happens when you change the position of your head). Others have a general feeling of unsteadiness, a rocking sensation as if on a boat, or as “lightheadedness.” Dizziness can result in:
- Difficulty walking
- Feeling tired
- Decreased ability to concentrate
Above all, dizziness can increase the risk for falls, which can be a serious health concern among older adults.
The earlier you get treatment, the better. That's because your brain and inner ears are more likely to be able to work together during the early stages, so that’s when you have your best chance for full recovery.
How Can a Physical Therapist Help?
The good news: most dizziness and balance disorders can be successfully treated—and they are not an "inevitable" part of aging. Your physical therapist can perform tests to determine the causes and also to assess your risk of falling. Often, there is more than one reason for dizziness and falls in the same person. Depending on the results of the tests, your therapist may recommend further testing or consultation with your physician.
Based on your physical therapist's evaluation and your goals for recovery, the therapist will customize a treatment plan for you. Your therapist's main focus is to help you get moving again and manage the dizziness at the same time. Exercise and new ways to perform daily activities are the primary treatments.
During your recovery, your physical therapist will teach you strategies to help you cope with your symptoms:
- Do certain activities or chores around the house cause you to become dizzy? Your therapist will show you how to do those activities in a different way to help reduce the dizziness.
- Have simple activities become difficult and cause fatigue and more dizziness? Your therapist will help you work through these symptoms right away so you can get moving again and return to your roles at home and at work more quickly.
Physical therapy treatments for dizziness can take many forms. The type of exercise that your therapist designs for you will depend on your unique problems and might include exercises to improve your balance, to improve your ability to focus your eyes and vision, and to "correct" differences between your brain and your inner ears. The inner ears tell the brain how the body is moving in relation to gravity. They also communicate information about head motion, which is used to coordinate eye motion.
In addition to those exercises, your physical therapist might prescribe exercises to improve your strength, your flexibility, and your heart health—with the goal of improving your overall physical health and well-being.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat dizziness and balance problems. You may want to consider:
- A physical therapist who is experienced in treating people with neurological problems. Some physical therapists have a practice with a neurological or vestibular rehabilitation focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with inner ear injury.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence about physical therapy treatments for dizziness. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Alrwaily M, Whitney SL. Vestibular rehabilitation of older adults with dizziness. Otolaryngol Clin North Am. 2011;44:473-96. Article Summary on PubMed.
Authored by Bridgett Wallace, PT, DPT; Laura O. Morris, PT, NCS; Bob Wellmon, PT, PhD, NCS; and APTA's Neurology Section. Reviewed by the MoveForwardPT.com editorial board.
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