Treatments for Vertigo Often Easy and Effective

Most reasons for vertigo can be treated and improve balance

By Deborah Jeanne Sergeant

Jamie McKinstry
Jamie McKinstry

Do you frequently feel like the room is spinning? It may be vertigo. 

The differences between vertigo and dizziness are how they present and what causes them. Colloquially, the terms are used interchangeably. However, vertigo involves a feeling of the room spinning and can include nausea. It comes mostly from inner ear issues. Dizziness can include lightheadedness, fogginess and lack of balance.

Few people think of a physical therapy office as a source of help for vertigo.

James Wallace, physical therapist and director of clinical rehabilitation services at Charles T. Sitrin Health Care Center in New Hartford, said that most of his patients come to him as referrals.

“The fact of the matter is true vertigo can be very alarming and most people don’t hesitate to get emergent care,” he said. “So, most of the time these folks end up in urgent care or emergency rooms. For the dizzy patient, they often see their primary care providers.”

Issues with the brain, hearing and vision can also contribute to vertigo, which is why patients seen for vertigo may be referred to other providers. Some audiologists and neurologists treat balance issues. Many vertigo issues have to do with the vestibular area of the inner ear.

“The appropriate tests are determined with a thorough patient history,” Wallace said. “Our therapists are highly skilled and educated and certified to treat vestibular problems efficiently and effectively.”

Eye movement tells care providers about the inner ear, since the inner ear controls eye movement and sends messages to the spine to adjust the person’s position. His office performs numerous types of tests until arriving at a diagnosis and also refers people to other professionals as needed.

Benign paroxysmal positional vertigo (BPPV) is one cause of dizziness which Wallace’s office treats. BPPV is caused by displaced calcium carbonate crystals in the semicircular canals.

Dale J. Buchberger
Dale J. Buchberger

Jamie McKinstry, physical therapist with additional education in BPPV, treats patients diagnosed with BPPV at Warner Physical Therapy in Oswego.

“If it is BPPV, I put them in positional testing,” she said. “When you do that, you’ll illicit the symptoms. I hope their symptoms happen so we know it is BPPV. Then I can put them in the correct positional treatment.”

By tilting, moving and holding the head in specific, strategic sequences, she can reposition the crystals. McKinstry said some patients receive misdiagnoses and ineffective treatments for months before learning about BPPV at her office and receiving just one to five treatments that bring relief.

“They’ve dealt with dizziness much longer than they’ve needed to,” she said.

Some patients with BPPV have concurring conditions contributing to dizziness, so it is important to rule out or treat other sources of dizziness.

McKinstry sends patients home with a handout so they can reposition their crystals as needed, but they are also welcome to return to the office.

In addition to treating BPPV, Robert Berkley, doctor of physical therapy at Robert Berkley Physical Therapy in Oswego, may recommend strategies for patients whose dizziness is caused by other issues, such as ocular nerve issues.

“You have to teach the nerve to focus on a point,” he said. “It can be disturbed during car sickness as you watch trees go past, but if you focus on one tree, and another tree. Ice skaters focus on one point like the judge. We may have a smiley face or large dot and we have them focus on that as they move.”

At the therapy office and at home, a few easy exercises can help improve balance, such as learning to walk while blindfolded to improve proprioception (the sense of where one’s body is located).

“With other balance issues, it’s training you to do the things that cause you to lose your balance,” Berkley said. “If you are dizzy when you look up, or look to your left, we train you to walk while looking to the left. On average, it takes two weeks before they start feeling better and within a month back to normal.”

Medication may cause dizziness and lightheadedness, although that is not necessarily vertigo. This especially affects older people who likely have numerous medication needs. Combined with other factors like polypharmacy and reduced proprioception, muscle tone, and inner ear function, many older adults have high risk of falls. For a younger person, a fall may not be serious. But, it can be life-altering for an older adult, according to Dale Buchberger at Active Physical Therapy Solutions in Auburn, a physical therapist, doctor of chiropractic, certified strength and conditioning specialist, diplomate of the American Chiropractic Board of Sports Physicians.

“When they have a break, they’re immobile and at high risk for blood clots,” Buchberger said. “It becomes a complicated situation.”

Months of immobilization reduces muscle tone, bone density, cardiovascular health and overall wellness. To prevent falls, he recommends improving staying active to keep strength and balance optimal.

“Walking and resistance training are what you need,” he said. “One good device for most people is a Total Gym. I don’t get any money from Chuck Norris for that. For older people, it’s a safe, effective method of strengthening.”

He also recommends exercises classes for older adults at places like the YMCA or other gyms.

Balance exercises can also help, such as modified squats and bridges. To squat more safely, Buchberger said to stand in front of the kitchen sink and hold on to the edge of the counter. Squat down as far as safely possible and stand.

“If you struggle to get up, your arms can help pull you up,” he said.

For bridges, lie on the back in bed, push in the heels and lift the bottom.

“My oldest patient was 97,” Buchberger said. “You still make gains with these folks so they can stay independent.”