Physical Therapy Vertigo Treatment

Vertigo can dramatically affect your quality of life and ability to perform daily activities. Vertigo involves a false sense of motion, a sensation in which the individual feels that they or their environment are spinning even when sitting or standing still. Vertigo is most commonly caused by BPPV, a displacement of inner ear crystals that results in balance issues and a spinning sensation. Physical therapy can reduce and eliminate the symptoms of vertigo, assess and treat the underlying cause of vertigo, retrain the brain to adapt to vestibular dysfunction, and help individuals regain balance and coordination safely.

What is Vertigo?

Vertigo is a false sense of motion, a sensation in which the individual feels that they or their environment are spinning even when sitting or standing still. Movement of the head or the body can worsen the symptoms of vertigo. Symptoms of vertigo can last a few minutes to a few hours or come and go.

Symptoms of vertigo can include:

• Spinning, rocking, tilting, or swaying sensation when standing or sitting still

• Nausea

• Vomiting

• Sweating

• Headache

• Loss of hearing

• Abnormal eye movements

• Ringing in one or both ears

• Difficulty walking due to imbalance

There are two types of vertigo: peripheral and central vertigo. Peripheral vertigo accounts for 80% of cases and is normally due to BPPV. Central vertigo accounts for 20% of vertigo cases and results from lesions on the brain stem or other issues affecting the brain, such as a migraine or multiple sclerosis.

Common causes of vertigo include:

• Inner ear infections or disorders

• Vestibular Migraines

• Meniere’s disease

• Vestibular neuritis or labyrinthitis

• Tumors (an acoustic neuroma)

• Surgery that removes or injures the inner ear or its nerves

• BPPV, or benign paroxysmal positional vertigo

• Head injury or concussion that causes injury to inner ear

• Hole in inner ear

• Stroke or neurological conditions like multiple sclerosis

Benign paroxysmal positional vertigo, or BPPV, is one of the most common causes of vertigo. BPPV occurs when calcium carbonate crystals in the ear (called canaliths) come loose and move into one of the fluid-filled canals of the ear. The crystals interfere with the normal movement of fluid in the canals. The fluid’s purpose in the ear is to sense movement; however, a disturbance like the crystals can cause false signals to be sent to the brain, tricking the brain into thinking that the person is moving even if they are not. The false signal contradicts what the other ear is sensing and eyes are seeing, leading to the spinning sensation of vertigo.

Physical Therapy for Vertigo

Physical therapy can reduce and eliminate the symptoms of vertigo, assess and treat the underlying cause of the vertigo, retrain the brain to adapt to vestibular dysfunction, and help individuals regain balance and coordination safely. The physical therapist completes a thorough evaluation to determine the cause of the individual’s vertigo and performs the Dix-Hallpike test to determine if the vertigo is due to BBPV. This test is done through simple head movements and watching the individual’s eyes for involuntary movements which indicate where crystals are loose in the inner ear.  

If the vertigo is BPPV-related, the physical therapist will perform canalith repositioning maneuvers, which are head movements that work to reposition and move the displaced crystals back to the utricle of the inner ear. This can take a few sessions but works to eliminate BBPV-related vertigo 90% of the time.

Physical therapy treatment for vertigo can also include:

• Vestibular rehabilitation therapy: an exercise-based program designed to reduce vertigo and dizziness and address gaze instability, imbalance issues, and fall risk.

  • Gaze stabilization: these exercises improve eye movement control to improve vision clarity when the head moves, e.g. individual practices fixating on an object while repeatedly moving the head.

  • Habituation exercises: these exercises aim to reduce dizziness by repeated exposure to visual stimuli and specific movements that normally provoke dizziness. Over time, the intensity of the dizziness decreases as the brain learns to ignore the abnormal inner ear signals that create dizziness.

  • Balance training exercises: these exercises involve coordinated movement, completion of dual tasks, and transitioning from stationary to dynamic positions to reduce falls risk and improve steadiness and postural stability when walking, standing, turning, and bending.

• Canalith repositioning maneuvers are specific head movements performed by a physical therapist to reposition displaced crystals to address BBPV-related vertigo.

• Manual therapy is used to alleviate myofascial restrictions and tightness in the neck that may be contributing to migraines that cause vertigo.

• Strength training to improve strength and muscular support in the neck, back, and core muscles for improved balance and to reduce any referred pain from the neck to the head.

Vertigo can dramatically affect your quality of life and ability to perform daily activities. Work with our physical therapists to address the underlying cause of your vertigo and find relief!