What do frozen shoulder and some forms of BPPV have in common?

Just like frozen shoulder occurs in stages (freezing, frozen and thawing), I believe some forms of BPPV occur in stages.  Stages for some forms of BPPV seem to be dumping, dumped and recovery.  Based upon what I see in the clinic, timing of when clients receive repositioning treatments seems to impact the success of the maneuvers for some individuals.   I believe some forms of BPPV suddenly occur.  In other words, if 100,000 pieces of otoconia are going to fall out, they all fall out at once. These clients seem to reposition fairly easily.   I believe there are others who dump a few thousand out every day or week for a period of time.  If we try to reposition otoconia when the person is in the dumping phase, we will need to continue repositioning periodically until the client reaches the dumped or recovery phase.  I believe the dumping stage represents BPPV at an unstable level.

Many forms of vestibular dysfunction seem to occur in stages.  Depending upon whether or not vestibular rehab works will depend upon which stage the individual is in.

Is Benign Paroxysmal Positional Vertigo Really Benign?

I believe there are times when Benign Paroxysmal Positional Vertigo is truly benign and I believe there are times when it is not even close to benign.  Whether or not we agree that benign paroxysmal positional vertigo is benign depends upon our definition of benign.  If the term benign means not cancerous or malignant, then BPPV is truly benign.  However, if benign means not life-threatening, not recurrent, not progressive or of no danger to health, then there are times when benign paroxysmal positional vertigo is not benign at all. 

When is BPPV not benign?  I suggest the following examples:
1.  When BPPV is caused by circulatory problems.  In this case, BPPV may be a result of a lack of blood flow to the inner ear.  This could be a sign of more ischemia to come in more important life sustaining places like the brainstem or cerebellum.  In this case, BPPV is a sign of life-threatening problems that may soon occur. 
2. When an individual falls to the floor and injurs something (fractures, head injuries, sprains and strains).  In this case, BPPV is of danger to health and can be life-threatening.
3.  When an individual develops movement phobias because of the intense sensations they experience when they move.  This is of danger to health because individuals often become "scared stiff" and develop disuse dysequilibrium. 
4.  Many cases of BPPV recur frequently.  That is opposite of what some define as benign.

The Unpredictability is a Killer!

Many individuals perceive their vestibular problems to be unpredictable.  One of my clients stated, "The unpredictability is a killer!"  My client was not referring to a life threatening problem.  However, dizziness can be a sign of a life threatening problem.  Individuals with undiagnosed dizziness should either call their Medical Doctor or go to the Emergency Department.   Clients who make these types of comments are referring to the terrible, controlling and inconvenient nature of dizziness.  I think what clients mean by "unpredictable" is the way vestibular dysfunction may come and go at any time for no reason. This part of vestibular dysfunction is definitely unpredictable.  That aspect of vestibular dysfunction can be terrifying for many.  Over the years, however, I have noticed that the unpredictability of the problem seems to be more predictable than one might recognize. 

With many of my clients (not all), the way their problem returns is fairly predictable.  For instance, the spells usually last about the same amount of time.  The intensity seems to either stay the same or even become less.  The nausea, over time, may actually become less.  The movements that cause the problem remain consistent.   It even seems that I notice patterns of when the problem may return and when it may go away on it's own.  If vestibular rehab worked once for an individual, it seems as though it is likely to work again should their problem return.

We have to be careful not to give more power to vestibular dysfunction than it deserves.  I know that in the moment, the problem is horrendous.  However, the greater our brains perceive vestibular dysfunction as a threat, the greater our sympathetic nervous systems will respond.  This will cause a stronger response in our bodies.  We must be honest about how "unpredictable" these spells actually are so that we do not have as intense of a response when the problem returns.

Christmas Lights and Dizziness

Some individuals have told me they become dizzy looking at christmas lights...especially in stores.  Why does this happen?  I think it depends on the individual.  Here are a few possible reasons.

1. For people who have a predisoposition toward visual dependence and/or motion sickness, they tend to rely more on their eyes for balance.  For these individuals, they may be light sensitive.  Seeing several different lights at different depths can confuse the brain because their is not a consistent pattern.  This can cause a sense of dizziness.
2. For people with vestibular problems, looking at lights at varying levels (depths, heights) can cause the brain not to be able to focus the eyes as well.  When this occurs, if an individual has a vestibular dysfunction, nystagmus can occur.  When nystagmus occurs we usually become dizzy. (spinning, off balance and/or a sense that things are moving, etc).

Amazing Balance!

This gentleman has an outstanding ability to focus and remain relaxed:

What do individuals battling Migraines, Fibromyalgia and Motion Sickness

all have in common?  I have noticed that these problems all involve a tendency toward hypersensitivity.  Many clients with these problems also report being hypersensitive to light, movement, sound and touch.  It is as if their sympathetic nervous systems are overpowering their parasympathetic nervous systems and causing them to be in a constant state of fight or flight.