One of the more challenging yet rewarding disorders to treat as a physical therapist is complaints of dizziness. Did you know that dizziness can be such a debilitating condition that it is the number one reason for an adult over the age of 65 to visit a physician? After pain; dizziness and unsteadiness are the next most frequent medical complaints. Some of these symptoms, are often associated with reports of loss of balance and falls, revealing the significance of the problem to the sufferer.
Patients with complaints of dizziness can be classified into one of three subtypes.
1. Vertigo
2. Presyncope
3. Dysequilibrium
Vertigo is a false sensation of movement of either the body or the environment, usually described as a sensation of spinning, which suggests a vestibular system dysfunction.2 Vertigo can be peripheral or from a central lesion. The most common peripheral vestibular disorder is benign paroximal positional vertigo.
Benign paroximal positional vertigo (BPPV) can occur when sedimentous material is released into the endolymphatic fluid or through disruption of the flow of free floating endolymphatic material within the ears semicircular canals. This is hypothesized to result from trauma; such as from a motor vehicle accident or degenerative changes. When this material is released it is sensitized to gravity and head positioning. With (BPPV) a nystagmus or involuntary eye movement is present, this occurs in a unidirectional pattern, and is never vertical.
This disorder can often occur in combination with cervicogenic dizziness, or vertigo originating from the cervical spine. It can be effectively diagnosed and treated by using the Dix Hall-pike test and Epley maneuver.
Presyncope differs from other forms of dizziness in that it is a feeling of faintness that lacks the feeling of movement. This results from a compromise of oxygen, blood or glucose to the individual’s brain. Common conditions may be arrhythmia, carotid stenosis, or postural hypotension
Dysequilibrium is the sense of altered balance that is experienced without an associated vertigo present. This is often present when standing or walking, or may be present with eye, head or body movement.
Two forms of disequilibrium are: VBI or vertebral basilar artery syndrome, and cervicogenic dizziness; or originating from the cervical spine.
Many individuals with complaints of dizziness report worse complaints with cervical motion than whole body movement.4,9 These people have associated signs and symptoms of nystagmus, neck pain, suboccipital headaches and altered cervical mobility.
Manual therapy is a recommended treatment for cervicogenic dizziness. This type of hands on therapy is directed at restoring joint mobility, decreasing muscle spasms and trigger points of pain in the cervical musculature. These techniques are useful when dizziness or other signs are provoked with neck movement.10
Many of the top physical therapists skilled in treating this form of dizziness can be contacted at THERAPEUTIC REHAB SPECIALISTS located in:
Pinellas Park (727) 470-6070 or Lakeland and Brandon, Florida. (813) 876-8771 for more information.
Anthony Pribila PT, DSc, CMPT, CMP, CEAS can be reached at (813) 876-8771.
