The vestibular system is a group of sensory organs that provide feedback to the brain regarding spatial orientation, movement, and head positioning. These sensory organs are located in the inner ear and are on both the left and right side of the skull. It helps keep us steady as we move throughout the day. Along with our vision and touch, the vestibular system is important to assist with our ability to balance.
Just like our musculoskeletal system, the vestibular system can be injured or in some cases not work as effectively or efficiently as it should. There are a variety of reasons as to why this occurs, but there are a few that are certainly more common.
We can experience a dysfunction in our vestibular system secondary to head trauma, inner ear diseases, viral insults to the vestibular nerve, a stroke event, an infection, or even tumors. These different events require different treatments. Some, not all, can be successfully managed by physical therapy. I want to talk more specifically about some of the most common vestibular dysfunction that responds well to physical therapy.
Benign paroxysmal positional vertigo, or BPPV for short, is the most common vestibular disorder. What does BPPV stand for? Benign means not harmful. Paroxysmal is recurrent, sudden intensification of symptoms. Symptoms are brought on by position and vertigo is a sense of imbalance, spinning, or dizziness. Essentially, BPPV, is non-harmful dizziness with short duration of symptoms brought about by changes in body position.
How, and why, does BPPV occur? In our vestibular system there are organs called the utricle and saccule. It is important because it helps us detect gravity and linear accelerations, like jumping. In these organs there are calcium crystals called otoconia. These otoconia can become loose and start shifting out of these organs. This shift can happen because of age related degeneration, mild to severe head trauma, car accidents, surgery and subsequent trauma to the ear, or inactivity.
Once these crystals start moving around due to the above causes, they migrate into 1 of 3 semicircular canals connected to the utricle and saccule. The horizontal canal, posterior canal, and an anterior canal exist on both the left and right side of your skull. While the utricle and saccule help detect linear acceleration, the semicircular canals help detect angular acceleration. If the crystal deposits enter your canals, they impact the canal’s ability to appropriately detect angular acceleration. This causes the dizziness and vertigo associated with BPPV.
If you have a history of BPPV, you may experience symptom provocation after:
- Rolling or sitting up in bed
- Reaching for object on floor, under cupboard or top shelf
- Washing hair
- Working under the car
- Changing a light bulb
- Dental chair
- Diagnosis procedures involving head dependency (ct, MRI, surgery)
Notice that all of these causes have some sort of head movement (rolling in bed), or having your head in a dependent position (sitting in a dentist chair). In these movements or periods of immobility, the crystal deposits are moving in your canals impacting your ability to appropriately sense your angular acceleration. So, even if your body is no longer moving, your brain is receiving signals from your semicircular canals telling it that you are. This is when the dizziness occurs.
So, what can you do about BPPV? Physical therapy plays a large role in addressing the cause of BPPV. If you have experienced dizziness in the past you may have been prescribed diazepam, lorazepam, dramamine, meclizine, or some other type of medication. While appropriate in some instances, these medications will not address the underlying cause of your dizziness if you are truly in fact experiencing BPPV.
As BPPV is a positional issue, using different positions by your physical therapist can treat your dizziness. Your therapist will take you through testing called the Dix-Hallpike, sidelying test, or roll test to help determine the kind of treatment you need. Depending on what type of BPPV you are experiencing and which 1 of the 3 semicircular canals are impacted, your physical therapist can provide an effective treatment as well as specific exercises to perform at home. Most of these movements involved some sort of rolling combined with different head movements to help reposition the crystals into the utricle and saccule. While this sounds slightly comical, these are effective treatments for treating BPPV. This, in conjunction with education on positions to avoid at home have shown to have a significant impact on your symptoms in just a few visits.
Dizziness can impact your daily activities and limit your quality of life. However, physical therapy can help! Contact The Fit Institute to schedule an appointment with our vestibular therapist.