Feeling off balance or dizzy after getting off of a ride at the local fair may be normal but if you are experiencing these symptoms in everyday life it may signal a problem with your inner ear, or vestibular system, and you may benefit from vestibular physical therapy.

1. VESTIBULAR PHYSICAL THERAPY SERVICES
OFF BALAN CE? DIZZY? VES TIBU LAR PT CAN H ELP
Feeling off balance or dizzy after getting
off of a ride at the local fair may be
normal but if you are experiencing these
symptoms in everyday life it may signal a
problem with your inner ear, or vestibular
system, and you may benefit from
vestibular physical therapy.
Symptoms of dysfunction in the
vestibular system can include vertigo, or
room spinning dizziness, disequilibrium or
feelings of being off balance, motion
sensitivity, loss of balance or falls,
bouncing or blurred vision, nausea,
feelings of floating or lightheadedness.
If you have been experiencing these
symptoms, read on to determine if a
referral to a vestibular-specialist physical therapist may help.
WH AT EX ACTLY IS TH E VES TIBU LAR S YS TEM?
Deep inside the inner ear lie what are called the vestibular organs. These organs are
part of the vestibular system that gathers sensory information about the position and
movement of the head and plays an important role in balance and stability. Inside each
inner ear lie 5 small organs–3 semicircular canals that provide information about
angular acceleration (head rotation) and 2 otolith organs that are sensitive to linear
(straight line) acceleration.
When the head and body move, viscous fluid inside the organs in each ear is displaced
which triggers sensory receptors and sends information via the vestibular nerve into
the brain to update the nervous system about how the body is moving so it can fire the
proper muscles to keep you balanced and stable. Typically, the signals in each ear
balance one another. Certain medical conditions can cause a sudden imbalance in
vestibular input between the ears or a reduction in function in both ears. When this
system is not functioning optimally symptoms like vertigo, dizziness, and unsteadiness
result.
WH AT IS CAU S IN G MY S YMPTOMS ?
Symptoms such as dizziness, motion sensitivity, or disequilibrium, for example, can
often be treated with vestibular physical therapy, but it is important to first identify the
underlying cause of your symptoms. While in some cases the underlying cause may be
relatively benign, in other cases it can signal a more serious condition or even a medical
emergency. Strokes or TIAs, Multiple Sclerosis, cardiac conditions, brain tumors, or
infections are examples of serious conditions that can cause these symptoms.
If you are experiencing symptoms of a vestibular problem along with any of these other
symptoms it is essential to seek urgent medical care:
• Weakness, especially on one side of the body or face
NOVEMBER 25, 2022
FEELING DIZZY? YOU MAY NEED VESTIBULAR
THERAPY
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2. • Loss of coordination
• Changes in vision
• Severe headache
• Changes in sensation
• Abnormal eye movements
• Confusion
• Changes in speech
• Vomiting
• Chest pain or pressure
• Unrelenting vertigo or dizziness
At the onset of new symptoms your doctor may recommend imaging studies such as
MRIs or CT scans to rule out some of these more serious causes of dizziness and
imbalance. In some cases you may be referred to an ENT or audiologist for specialized
testing of the vestibular system. Some medications can also be damaging to the
vestibular nerve or vestibular organs so it is important to discuss your medications with
your doctors as well.
As long as more serious conditions like a stroke or tumor have been ruled out, or have
been addressed medically, physical therapists can also perform clinical testing during
their evaluations to help determine the cause of your symptoms and guide treatment.
Below you will find a list of some of the conditions that can benefit from treatment by a
vestibular physical therapist:
Vestibular hypofunction: This is a term that refers to a reduction in the function of the
inner ear in one or both ears. It can have many causes including ototoxic medications,
brain tumors such as acoustic neuromas, a brain injury affecting one side of the brain,
autoimmune diseases that affect the inner ear over time, weakening of the structures
of the inner ear due to aging, and as a result of conditions such as Meneire’s Disease
or Labyrinthitis.
BPPV: Benign Paroxysmal Positional Vertigo is characterized by brief episodes of room-
spinning vertigo that are triggered by changes in position. BPPV occurs when small
crystal-like otoconia which normally exist inside the otolith organ called the utricle are
displaced into the semicircular canal. When the head changes position, these otoconia
drift through the canals causing an increase in signaling from the affected ear and
results in the sensation of vertigo.
Concussion: While a concussion injury does not show up on an MRI or CT scan, it can
damage or affect the inner ear and vestibular system to cause lasting symptoms of
dizziness, motion sensitivity, or imbalance.
Vestibular migraine: In persons with migraine headaches, spells of vertigo, nausea and
imbalance may occur even without the accompanying headache pain. These spells can
last seconds, minutes, hours, or days. Many people do not know about this type of
“atypical” migraine.
Cervicogenic Dizziness: In persons with a history or whiplash, neck pain, or
degeneration of the cervical spine, sometimes the symptoms of dizziness, nausea,
headache, imbalance or feelings of unsteadiness may arise from problems in the neck.
Neck pain, stiffness, or limited range of motion may accompany these other
symptoms.
Persistent Postural Perceptual Dizziness (3PD): Symptoms of vague dizziness or
lightheadedness that increases with movement or in busy or crowded places and
improves with sitting or lying down and which persists for more than three months
may be 3PD. It may be triggered initially by a sudden inner-ear event during which the
body becomes more reliant on visual input.
H OW CAN VES TIBU LAR PH YS ICAL TH ERAPY H ELP?
Vestibular physical therapy techniques will be prescribed based on the underlying
cause(s) of your symptoms. This is why it is important to undergo screening or testing
for these conditions at either a doctor’s office or at the physical therapy clinic.
Depending on causes, here are some physical therapy treatments you may experience
during vestibular therapy:
Canalith Repositioning Maneuvers: If your vertigo is caused by BPPV (see above), your
therapist will take you through a series of head and body positions called canalith
repositioning maneuvers to move the crystals out of the semicircular canals which
should improve the vertigo symptoms.
Habituation exercises: In many cases the vestibular system has become oversensitized
to movement and symptoms of dizziness, imbalance, or unsteadiness can occur with
daily tasks. Habituation exercises involve performing symptom-inducing movements in
a controlled fashion to help habituate and desensitize the vestibular system to these
triggers
Gaze stabilization: The inner ear is intimately connected to the eyes and poor gaze
stabilization can contribute to many of the symptoms outlined above. Gaze stabilization
exercises can be performed in the clinic and at home to improve or compensate for the
loss of stability.
Neck physical therapy: If there is a cervicogenic component to your symptoms your
physical therapist may perform manual hands on techniques like joint mobilization or
soft tissue mobilizations to improve neck pain and stiffness. You may perform
strengthening and stretching exercises for the neck and work on the joint position
sense of the neck called proprioception.

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Cardiovascular training: If your symptoms are triggered by an increase in heart rate then
a graded cardiovascular training program on a treadmill or bike will be prescribed to
train the body to work at increasing intensities without symptoms.
Balance exercises: balance training may be needed if you are experiencing
unsteadiness, falls, or losses of balance.
VES TIBU LAR PH YS ICAL TH ERAPY CAN H ELP
As you can see, though there are many causes of symptoms like dizziness and
disequilibrium, there are also many ways that vestibular physical therapy can help. If
you have been experiencing these symptoms recently or for some time, call and
schedule an evaluation at Evolve PT so we can get to the bottom of your symptoms
and create a program to help you recover.
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