I was seeing a patient after he had a rotator cuff repair. He had to wear a sling so he slept on the same side night after night for several weeks. One day in the clinic, he was laying on his side, facing the wall, doing strengthening exercises for his shoulder, when he asked me if it was normal for the electrical outlet on the wall to be spinning around. He went on to describe how for the last day, he would get very dizzy when rolling in bed. After a thorough vestibular evaluation, I determined that my patient had Benign Paroxysmal Positional Vertigo (BPPV). With one easy maneuver, I treated his dizziness, and it hasn’t returned.
Let’s break down BPPV. Benign= not life threatening. Paroxysmal= comes in sudden brief spells. Positional= triggered by certain head positions or movements. Vertigo= False sense of spinning/rotation. People will complain of dizziness, imbalance, lightheadedness, spinning, head fullness, difficulty w/ vision, nausea & vomiting. Symptoms generally come on with looking up/down, rolling, head rotation or lying down or sitting up from lying. Symptoms generally only last a few seconds. Some people will have a constant sense of not feeling right, along with the positional symptoms.
Treatment consists of going to a trained physical therapist for canalith repositioning. What are canalith and why do they need to be repositioned you say? Canalith are microscopic crystals inside canals in your inner ear that can become dislodged. When they no longer rest in the correct area, they cause dizziness. Trained physical therapists can evaluate to determine which ear is involved, and which of the 3 canals in each ear is the problem. Then very specific maneuvers can be performed to get the canalith back where they belong. When done correctly, the symptoms can resolve in as few as 1-2 days.
What not to do? Medications don’t cure the problem, and tend to only make people sleepy. Self-help videos aren’t specific to which ear or which canal is involved. Home exercises aren’t about repositioning as much as they are getting your brain habituated or used to the dizziness signals it’s receiving. Chiropractic care doesn’t reposition the crystals. Activity modification won’t reposition the crystals. Neither will time. An expensive & time consuming consult with a neurologist or ear nose & throat doctor is often not needed either. A simple referral to physical therapy can treat the problem effectively & efficiently.
There are other sources of dizziness besides BPPV. Other inner ear disorders can cause dizziness. Blood pressure changes can mimic positional dizziness. Some neurologic disorders can have associated dizziness- which generally isn’t positional. The 2nd biggest cause of dizziness we see in physical therapy is the cervical spine. A thorough evaluation should be able to pinpoint the area involved, so treatment can progress from there.
I enjoy treating dizziness a lot. There aren’t too many PT diagnosis that I can cure in a visit or 2 without having to prescribe a home exercise program, or having to discuss pain. I find I can make a big impact in someone’s life in a very short amount of time.
Bethany Jacobsen PT, ATC, CCCE