Physical Therapist's Guide to Vertigo
Vertigo usually is described as a spinning sensation, whereas dizziness usually is described as "lightheadedness." Often, they have different causes and different treatments.
If you have vertigo accompanied by one or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:
- Double vision
- Difficulty speaking
- A change in alertness
- Arm or leg weakness
- Inability to walk
What is Vertigo?
Vertigo is the sensation of spinning—even when you're perfectly still, you might feel like you're moving or that the room is moving around you. Most causes of vertigo involve the inner ear ("vestibular system"). A number of conditions can produce vertigo, such as:
- Inner ear infections or disorders
- Tumors, such as acoustic neuroma
- Surgery that removes or injures the inner ear or its nerves
- Head injury that results in injury to the inner ears
- A hole in the inner ear
You also might have:
- Abnormal eye movements
One of the most common forms of vertigo is benign paroxysmal positional vertigo, an inner-ear problem that causes short periods of a spinning sensation when your head is moved in certain positions.
How Is It Diagnosed?
Your physical therapist will use your answers to the following questions to help identify the cause of your vertigo and to determine the best course of treatment:
- When did you first have vertigo (the sensation of spinning)?
- What are you doing when you have vertigo (turning your head, bending over, standing perfectly still, rolling in bed)?
- How long does the vertigo last(seconds, minutes, hours, days)?
- Have you had vertigo before?
- Do you have hearing loss, ringing, or fullness in your ears?
- Do you have nausea with the spinning?
- Have you had any changes in your heart rate or breathing?
Your physical therapist will perform tests to determine the causes of your vertigo and also to assess your risk of falling. Depending on the results of the tests, your therapist may recommend further testing or consultation with your physician.
How Can a Physical Therapist Help?
Based on your physical therapist's evaluation and your goals for recovery, the therapist will customize a treatment plan for you. The specific treatments will depend on the cause of your vertigo. Your therapist's main focus is to help you get moving again and manage the vertigo at the same time. Treatment may include specialized head and neck movements or other exercises to help eliminate your symptoms. Conditions such as benign paroxysmal positional vertigo have very specific tests and treatments.
If you have dizziness and balance problems after your vertigo has stopped, your physical therapist can develop a treatment plan that targets those problems. 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
- Exercises to help the brain "correct" differences between your inner ears
- Exercises to improve your ability to focus your eyes and vision
In addition, 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 people with dizziness. 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 vestibular rehabilitation focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurological 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 vertigo. 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.
Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2011;16;(2):CD005397. Systematic Review. Article Summary on PubMed.
Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review.Phys Ther. 2010;90:663–678. Free Article.
Scherer MR, Schubert MC. Traumatic brain injury and vestibular pathology as a comorbidity after blast exposure. Phys Ther. 2009;89:980-992. Free Article.
Cohen HS, Sangi-Haghpeykar H. Canalith repositioning variations for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2010;143:405–412. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Melissa S. Bloom, PT, DPT; Bob Wellmon, PT, PhD, NCS; and APTA's Neurology Section. Reviewed by the MoveForwardPT.com editorial board.
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