Here’s a troubling statistic: It’s been estimated that more than half of adults over age 60 experience dizziness or a loss of balance.
For some people, dizziness is an occasional annoyance…but it can also be chronic and severe and lead to other problems, such as fatigue, depression and difficulty walking and driving. Even worse: Falls due to dizziness or imbalance are a leading cause of disability—and death—in older adults.
Some people think they just have to live with dizziness and limit their activities out of fear of falling. Or they try meds, such as meclizine (Antivert) or diazepam (Valium), but end up with side effects, including blurred vision and drowsiness.
An Underutilized Solution: A form of physical therapy called vestibular rehabilitation therapy (VRT) can often treat the underlying cause of dizziness and give long-lasting relief that’s as effective as medication but without side effects.
ARE YOU A CANDIDATE FOR VRT?
The vestibular system is a collection of structures in the inner ear that helps give us our sense of balance. Your brain integrates information from the inner ear with other sensory information from the eyes and joints and muscles to coordinate balance.
Vestibular disorders include benign paroxysmal positional vertigo (BPPV), which is marked by brief episodes of a mild-to-intense sensation of spinning, usually triggered by specific changes in the position of your head…and Ménière’s disease, in which vertigo is accompanied by hearing loss or tinnitus (a ringing in the ears) that comes and goes.
Other causes of vestibular disorder are aging…brain injury…acoustic neuroma (a benign tumor on the nerve leading from the inner ear to the brain)…stroke…an ear infection…and medication, including certain antibiotics, diuretics and chemotherapy drugs.
If you suffer from unexplained dizziness or imbalance, see your doctor promptly for a comprehensive evaluation to determine if the underlying cause is due to vestibular dysfunction or another problem.* Be prepared to describe your symptoms in detail and explain what makes them worse—for example bending over, riding in a car or turning your head.
Helpful: When explaining your symptoms, try to differentiate between dizziness (a feeling of light-headedness or faintness)…disequilibrium (a loss of steadiness due to imbalance or spatial disorientation)…and vertigo (the perception of spinning or whirling).
Other possible symptoms of vestibular disorders: Blurred or double vision, eyestrain, headaches, difficulty concentrating or reading, nausea, physical fatigue, difficulty walking and falls. (These symptoms can be experienced with or without dizziness.)
In addition to evaluating your symptoms, to confirm appropriate treatment, a doctor may do tests such as an electronystagmogram (ENG), which checks eye movements…or rotary chair testing, which determines if a problem with the inner ear or the neurological system is the cause of dizziness. In this test, a patient wears infrared goggles that record eye movements while sitting in a computerized chair that rotates. Other tests may include hearing tests or an MRI. If your symptoms are found to be due to vestibular dysfunction, you may benefit from VRT.
HOW VRT WORKS
VRT is a specialized form of physical therapy designed to help patients develop new ways to coordinate signals between the brain, inner ears and eyes so they can feel better and resume their regular activities.
Whether the main symptom is dizziness and/or a balance problem, a typical regimen includes working with a physical therapist one to two times weekly for six to 12 weeks, plus daily exercises you do on your own at home. Once symptoms are alleviated, the exercises are done less frequently for maintenance.
VRT consists of three main types of exercises—habituation, gaze stabilization and balance training. Specific exercises are customized to address an individual’s particular vestibular weakness and involve placing your head, neck and/or body in different positions for short periods of time to challenge balance and/or vision. See below…
- Habituation exercises. Best for: Those who experience dizziness when they move around, make quick head movements or change positions. Habituation reduces dizziness through repeated exposure to specific movements or visual stimuli that provoke a patient’s dizziness. Because these exercises are designed to bring on symptoms of dizziness, most people will feel worse initially. However, over time the brain “learns” to ignore the noxious stimuli, and the symptoms become less noticeable.
- Gaze stabilization exercises. Best for: Those who experience blurred or double vision, difficulty focusing or visual disturbances associated with movement of the head. Gaze stabilization exercises improve control and coordination of eye movements.
- Balance training. I generally incorporate balance exercises into all my patients’ regimens, no matter what their specific symptoms are, to improve steadiness and safety with movement.
In addition: VRT may also include some strengthening, stretching and/or aerobic exercises, since people with vestibular dysfunction often decrease their activity levels and become sedentary, which can lead to reduced stamina, muscle strength and flexibility.
FINDING A PHYSICAL THERAPIST
While all physical therapists have some training in treating patients with dizziness, it’s best to look for one who is a board-certified clinical specialist in neurology (NCS)…has completed a residency or fellowship in neurological physical therapy…and/or has advanced training in vestibular therapy. A physical therapist who regularly does VRT is a good alternative.
To find a physical therapist in your area with specific clinical expertise, consult the American Physical Therapy Association (at APTA.org, click on “Find a PT”).
*If you experience vertigo or dizziness accompanied by one or more of the following symptoms—blurred or double vision, difficulty speaking, a change in alertness, arm or leg weakness or numbness, inability to walk—call 911 immediately. You could be suffering from a stroke or other serious condition.