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Positional Vertigo:  The Lowdown on Dizziness

Despite our own familiarity or experience with dizziness–whether it be a game of Dizzy Bat or lightheadedness when quickly rising from bed–there is still great misunderstanding in regard to different kinds of dizziness and what may be the physiological cause of each.  In other words, it is common for such symptoms to be placed under the same broad umbrella, thus making accurate diagnosis and the ensuing treatment a murky process.  Perhaps the most misunderstood or misused term associated with this feeling is “vertigo,” which is often used as a generic diagnosis to put a name to what the patient is experiencing.  However, in reality, “vertigo” is not a diagnosis at all, nor should it be used as a blanket term for dizziness, regardless of what may be causing it.

In reality, vertigo is described as a SYMPTOM rather than a diagnosis or disease.  What differentiates the vertigo symptom from that of more generalized non-descript dizziness is that of a very profound spinning sensation of the patient’s body and/or the room they are in at the time.  Once it is confirmed that a patient is indeed experiencing vertigo, it becomes the task of us therapists to determine the source via our specialized assessment and testing.

Among the most treatable of these diagnoses within the Physical Therapy scope of practice is that of Benign Paroxsymal Positional Vertigo, simply known as BPPV.  BPPV is characterized by a pathology in the canals of our inner ear, or the balance center of our nervous system.  More specifically, it is the displacement of calcium crystals that line the inside of the utricle–or the area located at the base of the canals–that causes the symptoms we have come to associate with “vertigo.  These crystals, known as canaliths, are tasked with telling our brains the position of our head, thus allowing it to send signals to the proper muscle groups that help us maintain balance.

However, these crystals may occasionally become dislodged from their proper place, whether it be from a high-impact trauma or natural degradation due to aging.  Once displaced from the inner wall of the utricle, certain movements or postures may cause the crystals to migrate into one of the three canals where they don’t belong.  This improper migration causes misleading signals to overwhelm the brain, eliciting a strong spinning sensation accompanied by rapid involuntary movement of the eyes TOWARD the problematic ear, known as nystagmus.  By intentionally placing patients in these problematic positions, we as therapists can confirm or rule out issues with the inner ear–or vestibular system–as the cause of a patient’s symptoms.

In confirmed cases fitting these criteria, a corrective maneuver can be done, in which the patient is placed through a specific sequence of postures in order to move the displaced crystals out of the canal that they’re stuck in and BACK to their proper home–the utricle.  If done correctly, this sequence should result in nearly immediate cessation of the patient’s dizziness.  Comprehensive patient education on proper posture and correct body mechanics can help minimize or eliminate recurrence of episodes going forward.

Warren Rodrick, DPT, is a Physical Therapist and Site Supervisor of our new Wallingford location.  Warren has worked with Amity PT since graduating from University of Hartford with his Doctorate of Physical Therapy in 2015.  Working with patients of all ages and ability levels, Warren prides himself on his commitment to their goals and providing the individualized care they need.  To set up an appointment to see if your Glutes are up to par, contact us at 203-626-5330 or visit amitypt.com.

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