The vestibular system

is made up of two main parts: the central vestibular system and the peripheral vestibular system.  The central vestibular system is highly complex and includes structures within the brainstem and cerebellum.  The peripheral vestibular system is amazingly small, but has many important jobs.  It includes the vestibular nerve, the labyrinth and the vestibule. 

Dizziness coming from a problem with the central vestibular system is much more difficult to fix and can represent a serious life threatening problem.  Dizziness coming from a peripheral vestibular problem is often times more benign and is easier to correct.  Some individuals can experience dizziness from both peripheral and central vestibular disorders.

Both central and peripheral vestibular problems must be stable (controlled) in order for physical therapy to help most.

How Does Physical Therapy Treat BPPV?

Those who move a lot are more likely to correct BPPV on their own.  Of course, the individuals who move a lot may also experience more intense vertigo.  BPPV is treated by either accidentally or intentionally moving the head in special ways at the right time to reposition lose calcium carbonate crystals. 

Those who treat BPPV call this intentional skilled movement of the head "canalith repositioning." 

Do you have to feel spinning to have vertigo?

Vertigo is not a diagnosis it is a symptom.  The Vestibular Disorders Association uses the following terminology to define vertigo: Spinning or whirling sensation; an illusion of movement of self or the world. 

I have witnessed individuals with intense nystagmus describe their dizziness as other sensations than spinning.  The presence of nystagmus often represents either a central or peripheral vestibular disorder.    I see people all the time who have vestibular disorders (with nystagmus) and they describe their dizziness as lightheadedness, off balance, funny in the head, etc.  Many clients I see who have been told they have vertigo do not truly have vertigo. 

I have had clients with the diagnosis of Benign Paroxysmal Positional Vertigo present with typical BPPV nystagmus and describe their dizziness as lightheaded...not vertigo. 

"Go Green" when dizzy!

No, I don't mean get sick when you are dizzy.  What I mean is learn to be energy efficient when you are dizzy.  Only use the muscles you absolutely have to use when you are dizzy.  Since dizziness causes the unconscious to become conscious, we often try to take voluntary control over involuntary balance needs.  This causes us to tense way too much.  When we are more tense than we need to be, we use more energy than necessary...It's like leaving the lights on upstairs when you are spending your time downstairs.  So, it is important to relax any joint/muscle you are not using so that you are not exhausted by the end of the day.

Why should I exercise?

While practicing Physical Therapy in Canton, Ohio, I have had the opportunity to work primarily with clients who have dizziness and balance disorders.  One special type of therapy that I have used with this population is Vestibular Rehabilitation.  Many individuals who benefit from Vestibular Rehabilitation also have a problem with tension and stiffness.  In fact, I have learned that tension and stiffness are often a primary problem for individuals who had dizziness and balance disorders.  Because I have been immersed into this type of population, I have become more focused on the impact of tension and stress on our ability to move and our overall health.

The normal reaction when we are stressed is to want to fight or run away.  Any perceived threat causes our bodies to tense up.  Many of us have issues that cause stress that we carry with us all day long.  Then, we go and try to get a good hard intense workout it.  Sometimes our workouts stress us out because we didn't perform the way we had hoped or we didn't make as much progress as we had planned on making.  Even worse, sometimes our workouts stress us out because we really didn't want to be doing it in the first place! 

What if we were to change the reason we exercise?  What if our primary reason for exercise became to learn how to relax when we move?  What if we "went green" or tried to use our own physical energy more wisely during the day?

Why is it good to be dizzy?

Dizziness often causes the unconscious to become conscious.  In other words, things that occur in our bodies that do not require our attention, suddenly are brought to our attention.  We never thought about how we felt when we moved before, but with the presence of dizziness, we think about it all the time.  Reflexes that allowed us to move (without thought) are now being drowned out by our need for control. 

Green light dizziness is benign dizziness that we must feel in order for it to go away.  As long as an individual has been diagnosed and has been told "it's good to be dizzy" then it truly is good to be dizzy.  There are psychological and physical reasons why it is "good to be dizzy."  When we welcome "green light" dizziness into our lives, we decrease it's relevance in our lives.  Our body gets the stimulation it needs to heal and our sense of movement can then return to the reflexive/unconscius level. 

(There are rules that should be followed when it is good to be dizzy.  Do not practice these concepts without the guidance of a medical professional who has experience working with green light dizziness.)

What can I do to battle my dizziness mentally?

I have many clients who battle anxiety and depression with dizziness.  I once heard it said that we are born with two innate fears: loud noises and fear of falling.  I don't have a source to confirm this information, but I find it interesting that both fears have to do with the inner ear.

I recently had a client, who is hypersensitive to sensory input (touch, sound, images/light and movement) ask what she could do to battle her dizziness mentally.  I was so happy she asked.  Without mental and spiritual training it is very difficult to successfully battle dizziness. 

In short, because I knew the cause of her dizziness, I was able to instruct her that she first needed to transform her way of thinking about her dizziness.  She needed to welcome the dizziness instead of try to hide from it.  She needed to convince herself that it was good to be dizzy.