Vertigo and Balance

Vertigo and Balance Blog


I have been working as a vestibular (balance) therapist for almost 20 years and it still amazes me how mismanaged dizziness and balance conditions are.

First, I will address balance.  According to the CDC (Center for Disease Controls) falls are a leading cause of mortality and morbidity among adults age 65 and older.  More than ¼ older people fall each year but less than half tell their doctor.  Falling once doubles your chances of falling again. Fear of falling is an indicator of a future fall. With all of this being said, has your doctor asked you about your balance at your annual physical? Did you receive a balance screen at that time?  If you told your doctor you fell what advice did he /she give to you?  I can’t tell you how many patients who I have seen who have had multiple falls, and came to me not by the recommendation of their doctor but of a friend!  Falls are a serious issue and need to be addressed immediately and effectively.

If you have fallen, let your doctor or physical therapist know, because you can reduce the risk of a future fall by doing exercises to address the reason for your fall.  Physical therapists, especially those with vestibular training ( like all of our therapists at Willow Grove and Hatboro Physical Therapy) are experts in balance and how to keep your  bodies moving and avoiding future falls.

It is my firm belief that anyone over age 65, or who has had a history of a fall should have an annual balance screen.  This screening is so important, because many people do not realize they are at an increased risk of falling. Balance is our 6th sense, and I would argue one of our most important senses. Balance is the key to our independence. Take the time to learn how to keep your balance system up and running.

The balance system is plastic, meaning it can change and improve if worked on.  It is comprised of our eyes (which allow us to see in space), ears (which houses the vestibular organs that tell us where our head is in space), and our feet (which contact the ground and tell us where our feet and lower body is in relation to the ground). These 3 sensors all report to the brain which synthesizes the data from our sensors and makes necessary corrections to keep us upright.  An issue with any of these sensors can affect our balance.  Obviously, if we were blind and were without vision this would affect our balance.  This is a great example of how we can adapt, have you ever seen a blind person walking… of course you have, they utilize their other sensors to get around. They will use their hands or a walking stick to make up for their lack of vision.  Someone who has numbness in their feet from neuropathy can have difficulty with balance, but they need to learn how to rely on their other sensors for balance (ears/ eyes) to make up for this loss.  Finally, someone who has  weakness in their inner ear balance organ can be unsteady and they need to learn how to rely more on their vision and feet for balance.

Our balance system is like a three legged table holding us up (eyes, ears, legs). If one system is weak , the others need to work harder to keep us steady. If two sensors are weak (for example: poor vision and numb feet) it becomes much harder.

Our vestibular therapists are skilled at evaluating balance problems and devising exercise programs to address the weak areas.  Mainly we educate patients on the importance of moving their head, as this is the job of the inner ear, to sense where our head is in space. If we don’t move our head enough, the inner ear can get lazy. We must walk every day. We encourage 20 min /day, or 10,000 steps a day. Walking is one of the best ways to stimulate our balance system. Keep your legs strong through heel and toe raises, mini squats, etc. 

We become very visually dependent as we age, so we assess a patient’s ability to balance with their eyes closed, and we will challenge them during therapy to do exercises with eyes closed to make their other sensors ( legs/ ears)work harder.

It is not enough to just put someone on a cane or walker after a fall.  If this happens, the patients balance system will only weaken as they are using their hands for balance. They need to have an evaluation to determine cause of the fall and be given exercises to address their deficits. Our goal is for people to use their eyes, ears and legs for balance and only use a cane or walker only when  absolutely necessary. No two patients are alike as to why they fell. A customized evaluation and treatment plan is necessary to restore normal balance.

There is no drug that can improve balance.  It takes hard work and the help of a skilled therapist.

The second condition that is severely mismanaged is dizziness. While dizziness can come from many different sources: the inner ear, the brain, the heart. Each of these conditions present very differently and again a skilled vestibular therapist can usually identify the source pretty easily.

The most common cause of dizziness is Benign Paroxysmal Positional Vertigo ( BPPV). Benign means it won’t kill you. Paroxysmal means it comes and goes. Positional : dizziness with change in position. Vertigo: spinning.  There have been significant advances in the treatment of BPPV which is caused by particles/ crystals being dislodged from the utricle in the inner ear into a place where they don’t belong (semi- circular canal). This can cause mild to severe room spinning when someone moves their head against gravity such as bending over, looking up or getting in or out of bed). It is usually brief in duration, less than a minute.

 We have treated thousands of patients over the years with this condition. In the past the only treatment for this was medication, usually Meclizene or Antivert.  Since, 1980 a more effective method was discovered by Dr John Epley. Unfortunately, all these years later many patients are still being prescribed medication when current clinical practice guidelines advise against the use of it. Meclizene or Antivert are sedatives and can cause more harm than good when it comes to BPPV.  These medications can increase a patient’s fall risk and do not fix the problem of dislodged crystals from the inner ear. The only benefit of these drugs is to decrease nausea/vomiting that may be a side effect of the vertigo.

The best treatment for BPPV is canalith repositioning maneuvers. The therapists at our office are skilled at evaluation BPPV to determine if the particles are displaced in the right or left ear, and in which of the 3 canals in the inner ear. Based on this evaluation we perform the proper canalith repositioning maneuver to move the crystals back to where they belong.  There is a 95% success rate with these maneuvers. Simply stated the patient rolls from the side that causes them to be dizzy over to the opposite side ending with their nose facing downward in most cases. It is a simple maneuver when done by a skilled therapist.

So, the bottom line is again, JUST SAY NO TO DRUGS when it comes to vertigo.  Say yes to vestibular therapy, to remedy this problem and to learn how to identify which ear/canal is causing the problem so you can treat yourself in the event it should reoccur, as re- occurrence is common in BPPV.

Dr. Margaret Fitzpatrick PT, OCS

Owner Willow Grove & Hatboro Physical Therapy