Physical Therapy for Vestibular Issues
Going to see a physical therapist for vestibular issues is almost always balance related. There are three main components of balance: vision, proprioception, and the inner ear.
Vision is pretty straight forward, being able to see, not only in focus but to be able to process that information for tracking and pursuit. Proprioception is the body’s ability to sense the environment through pressure and stretch receptors in the joints and skin. The most complicated system is the inner ear. which maintains your body’s position in space similar to a bubble level.
A change in any of these systems can cause major balance issues. Sometimes the changes are irreversible, and the goals are around adapting and up training the working components. Other times the prognosis is in line with musculoskeletal injuries, where progression and resumptions of normal function is possible. There are many other factors involved in balance, age, medical complications, history of falling, a psychological component or fear of falling. The best type of treatment is one that starts with a thorough evaluation and understanding of these component parts. This is why seeking a Physical Therapist with advanced certifications is always recommended.
By large, the most common diagnosis seen for vestibular therapy is an issue with the inner ear itself, also known as vertigo. The inner ear works similar to a bubble level, and as the head moves in different positions, the bubble level will shift and give input to the brain on where the body is in space. The most common dysfunction that can arise is an issue and one of the canals, or bubble levels, is benign positional proximal vertigo, or BPPV. This is a diagnosis that is mostly treated with physical therapy, but sometimes an ENT will assist.
The fluid inside the canal has receptors that sense the change in direction and intensity of motion, which are like little hairs. The fluid has crystals in it, and one of the common ways someone gets vertigo is after an upper respiratory infection. The theory is that inflammation causes some of the crystals to clump together, which can cause them to get stuck, or make the bubble level move slower when a movement happens. This can cause competing signals, with a result of dizziness. When the crystals get so clumped that they have a hard time navigating the canal, they can get somewhat stuck. This causes the brain to register rapid movement, whichever canal is affected. The most common canal is the posterior, and a common complaint is when someone rolls over in bed they feel like they keep rolling even though they’re not moving.
Treatment for BPPV can be somewhat uncomfortable, since the treatment involves inducing the symptoms to help clear the dysfunction. This is why it is always recommended to see a Physical Therapist or ENT who specializes in this type of treatment. The good news is BPPV is extremely well managed, and although it can come back, treatment is highly effective.
Click here to find out more information about physical therapy for the vestibular system
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