What kind of dizzy am I?

Fri, 31 Mar 2023 18:21:16 GMT

Yes, you read that question correctly!

The question when it comes to treating dizziness is not how dizzy you are, but what kind of dizziness are you experiencing. The term “dizzy” can mean a multitude of things. Is the room spinning (Vertigo)? Do you feel like fainting (Lightheadeness)? Does your stomach feel like it is turning over and over (Nausea)? In the sea of different questions surrounding dizziness, it can be difficult to specify what is leading to your symptoms. To help single out which predicament you are dealing with, search through the following statements to determine if physical therapy may be of benefit in treating your dizziness.

“I get dizzy/spinning when I lie down, get up from bed, or roll in bed.”

This is a common complaint for many vestibular patients with BPPV (benign paroxysmal positional vertigo). A physical therapist can help with this issue by repositioning the misplaced otoconia (crystals) within the inner ear. Once this is corrected there is a 15% reoccurrence rate per year. If your symptom is more dizziness than spinning, asymmetries in the cervical spine may be influencing your dizziness. The upper cervical spine has a high density of proprioceptors and has direct input to the vestibular processing center in the brainstem. If there are asymmetries present in your neck, this can lead to the neck providing poor input to the brain regarding where your head is in space. Once again a skilled PT who specializes in treatment of the cervical spine can help determine if this is the cause of your dizziness and provide appropriate care.

“I get dizzy when I look a certain way”

Although this seems similar to the previous question, this phrasing implies eye or neck movements may be causing dizziness. As mentioned above, the proprioceptors in your neck may be sending faulty information, leading to a sense of movement when you are not actually moving. Another reason for this dizziness could be an impaired VOR (vesibulo-ocular reflex). Your VOR is responsible for coordinating your head and eyes while you are moving. If your VOR is not calibrated correctly, every time you move your head, your eyes will be unable to provide a steady field of view, leading to increased dizziness. A skilled PT will be able to determine whether the eye movements or neck movements are leading to your symptoms.

“When the ringing in my ears gets louder, I get more dizzy.”

Hearing l oss with dizziness may indicate a pathology affecting the structures of the inner ear. A condition known as labyrinthitis can cause tinnitus (ringing in the ears), imbalance, vertigo, nausea, and dizziness. Labyrinthitis is an inflammation of the structures within the inner ear, including the semi-circular canals (balance organs) and the cochlea (hearing organ). Labyrinthitis usually follows a viral infection such as the cold or flu. During an acute episode of labyrinthitis, you may experience a rapid onset of spinning (vertigo) that develops over the course of an hour and may remain severe for several days before beginning to taper off. A physical therapist can perform VNG testing and other balance testing to help determine if labyrinthitis may be contributing of your symptoms.

“I get dizzy when I move from lying down to sitting, or from sitting to standing upright.”

This scenario differs from the previous question because of head position. When we change from lying down to sitting up, or from sitting to standing, our head usually doesn’t turn. If you experience a moment of unsteadiness/lightheadedness/dizziness immediately after you stand up, but this feeling goes away quickly on its own, you may be experiencing Orthostatic Hypotension (OH) or Positional Orthostatic Tachycardic Syndrome (POTS). OH is a sudden drop in blood pressure following a change in position, which usually resolves within 2-3 minutes. POTS is an abnormally rapid heart rate increase with positional changes and activity. If left untreated, OH or POTS may lead to an increased risk of falls and an early sign of other cardiac conditions.

In other cases, your body simply may not be accustomed to a specific motion (i.e. bending forward at the waist, or leaning to your right). Dizziness or unsteadiness with specific motions may be related to a lack of exposure to the problematic motion. If your brain and/or vestibular system adapts to not experiencing a specific motion, a physical therapist can help work you through a progression of habituation exercises to help retrain the brain to respond normally to this motion.

As mentioned above, the joints and tissues of the neck may contribute to unsteadiness/dizziness with position changes. If there are asymmetries or imbalances with the structures of the neck, certain motions may result in increased “dizzy” sensations. PT may be indicated to address abnormalities in the spine to correct these issues.

“I only get dizzy when I close my eyes.”

If you have difficulty walking at night, standing in the shower washing your hair, or standing with your eyes closed, you might be experiencing vestibular hypofunction. In this case, your balance centers within one or both of your ears may not be producing the proper signals to your brain. Vestibular Hypofunction may present as a variety of symptoms including but not limited to: increased dizziness with walking or movement, “swimminess”, difficulty of the eyes keeping up with head motion, veering or listing to one side with gait, and difficulty focusing. Your body relies on 3 main systems to balance: vision, vestibular, and sensation. When you close your eyes, you are only left with sensation and your vestibular system. When these two systems are sending different messages to your brain (because either your vestibular system isn’t working correctly or your neck joints/muscles are providing incorrect information), you may experience dizziness/unsteadiness. A trained physical therapist can help correct this problem through retraining the vestibular system.

“I get dizzy, but the real problems are my headaches.”

A large percentage of headaches we see stem from the neck. These are known as Cervicogenic Headaches, and may be caused by improperly aligned joints, excessive tension in neck muscles, or a combination both. These abnormalities may be a result from a past trauma, such as car crash, or simply poor posture over time. PT is often the right choice to treat these headaches and impairments.

Headaches accompanied with symptoms such as increased vertigo, intolerance to movement, and “brain fog” may be a result of Vestibular migraine. Vestibular Migraines differ from traditional migraines because they do not always present as headaches. While headaches may be present, vestibular migraines more commonly present with imbalance, dizziness, and/or motion sensitivity. Vestibular migraines may be activated by a specific stimulus, and may be identified by the pattern and frequency of symptom onset. A skilled therapist can help decrease the frequency and intensity of these migraines, as well as collaborate with other medical professionals if you require further intervention beyond a PT’s scope of practice.

In conclusion:

Physical therapy can be a part of the solution for your dizziness and vertigo. At minimum, physical therapists will get you connected with the proper medical professionals for your specific situation. Physical therapists in Ohio are direct access professionals, meaning you are able to visit them without a referral. If you have any questions regarding evaluation/treatment of your condition, feel free to call the office and speak to a therapist.

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What kind of dizzy am I?

Yes, you read that question correctly!