Balance allows you to maintain a stable and upright position when sitting, standing, reaching, walking and leaning. If you have a balance problem, you may experience tripping, swaying, stumbling, dizziness, vertigo or even falling.
Your balance may seem fine when standing still or performing a single task, but balance problems may become apparent when you move about or try to do more than one thing at a time, such as walking while turning your head to talk to another person.
In this segment, Laura Corbridge, Bryan physical therapist, discusses vertigo and how based on evaluation and testing, a specific treatment plan will be developed to improve and develop your balance system.
Selected Podcast
Vertigo: Causes, Prevention and Treatment
Featured Speaker:
Laura Corbridge, Bryan physical therapist
Laura Corbridge is a physical therapist at Bryan Health. Transcription:
Vertigo: Causes, Prevention and Treatment
Melanie Cole (Host): Have you ever had the feeling that you’re spinning or that everything around you is spinning? You may have benign positional vertigo, and that can affect many aspects of your quality of your life. My guest today is Laura Corbridge. She’s a Bryan physical therapist. Welcome to the show, Laura. Please talk about the difference between vertigo or benign positional vertigo and simple dizziness that some people get sometimes.
Laura Corbridge (Guest): Right, the word dizziness is really an umbrella form, so a lot of people refer to dizziness as many different things. Dizziness can be true vertigo, which is a spinning sensation which often feels like you’re spinning or the environment is spinning. Or you may have somebody say they feel dizzy when they actually are having some blood pressure issues, and it’s more of a lightheaded sensation. Other common causes of dizziness is when people feel more of an imbalance. That has to do with more of their balance systems not giving them the right information. Our job is to really figure out when someone says dizzy, what kind of dizziness they’re talking about and that will help us lead them to be able to have the appropriate treatment.
Melanie: People get this – they start getting it more often, what are some of the triggers – what are some things that you can identify, or help people to identify that might set off this type of situation?
Laura: BPPV or benign paroxysmal positional vertigo is that feeling of that sensation of spinning. It’s primarily when you change positions so when people get up and down from bed, or if they roll over to their side, or they’re bending forward to tie their shoes, or if they have to tip their head back, those are really common positions for people to have that spinning sensation. That’s different than the other dizziness sensations like I talked about earlier. There’s really no rhyme or reason why some people have this. It’s estimated there’s 107 new cases per one million people each year and it’s more common for people over the age of 50 and if you’re female. Some of the causes behind this is – really some people just wake up, and they’ll say, “But I woke up, I sat up, and I felt this intense spinning sensation,” and they have no real reason why that happened. Sometimes it’s more common if you’ve had a fall. Sometimes if someone’s had a fall, you can have that spinning sensation because of that mechanical problem in that inner ear, which is where this stems from. If somebody has a history of an inner infection or other vestibular-based disorders, you are more likely to get this BPPV, and it’s also been associated with people who’ve had a history of migraines, or motion sensitivity, or even osteoporosis or diabetes.
Melanie: Does it run in families sometimes?
Laura: I have heard a very strong genetic disposition, so if some people say – after I get done talking to them they’ll say, “You know, my aunt had this,” or, “My mom or grandma always had this problem,” so there is a genetic composition to it, as well.
Melanie: If somebody complains about this, you are a vestibular physical therapist, yes?
Laura: Yes, I’ve had advanced training to be able to perform vestibular based tests and to be able to do treatment for these vestibular disorders. The first thing is to find out what kind of dizziness they’re having and after my assessment, it seems like it’s more of this benign positional vertigo, then we’ll look at some treatment techniques.
Melanie: Let’s speak about some of the treatment techniques, Laura, because people don’t know if there’s something that can be done. They’ve heard about medications for this, but first speak from the physical therapist’s point of view, what you would do with somebody?
Laura: Right, well the first thing is to find out where exactly that little crystal is – it’s a little piece of otoconia that gets dislodged – and it’s in a space that it should not be in. We have three canals in our inner ear that help sense movement. These canals have fluid in them, and they tell the nerve cells where your head is in space. They are not gravity dependent, so what happens when this little crystal piece becomes loose from a structure within the ear that it’s supposed to be – and every once in awhile that will break off, and like I said, there’s really no rhyme or reason at times this happens – it gets dislodged in one of those canals. What happens is, that free floating crystal stimulates those hair cells and that fluid movement, which then tells your brain that you’re moving when you’re not really moving.
The biggest thing is to find out where that crystal is at because then all it is is a mechanical problem that we have to move that crystal from that area to another area that doesn’t cause problems. The biggest thing is finding out which canal is involved, so a lot of times we’ll do a further assessment with positional testing – having people do positions to stimulate those canals and then what’s really neat is that we can actually look at how their eyes move, and we can tell by the position they're in and how the eyes move, what canal is involved and this will help guide our treatment.
Melanie: Are there some things that people can do at home to work on this, as well?
Laura: There’s a lot of information out there, and there are a lot of treatment techniques. There is one canal that’s the most common, and that’s called the posterior canal, and that’s the most common where people get this little crystal stuck. There are a lot of treatment techniques out there. There’s something called the Modified Epley. There’s something called the Half-Somersault. There’s a lot of things out there. The problem is that sometimes you don’t know what canal is involved and if you don’t do those right, or know the canal that’s involved, it’s not going to make a difference, and you’re not going to be able to clear that crystal out completely. A lot of times when this is a new sensation, it’s a very scary sensation – people feel like they’re falling. People feel like they’re really out of control – you might need an actual professional to help guide you on what treatment technique is going to work best for you. My biggest goal is to teach somebody to be able to manage this because unfortunately if you have BPPV once, you’re more likely to have an increased incidence of having it in the future. The biggest thing is to be able to teach someone how to control this, so if that happens again, they wake up with that spinning, they have the knowledge base to know exactly how to treat this, so they don’t have to keep coming back to a physical therapist, or to the ENTs or audiologists to perform these techniques.
Melanie: Tell us a little bit about the balance and fall evaluations that you do at Bryan Health.
Laura: There’s a lot of things that we can look at somebody for balance. Vestibular physical therapy is one big part of that, so screening people about a history of BPPV, other vestibular-type disorders because some of these disorders have been undiagnosed or untreated, and that can lead to people having those balance and fall deficits. There are actually people who have BPPV that are not diagnosed for many, many years, and they’ve learned to change or avoid those positions that tend to exacerbate the problem, but they might have falls related to that problem. Really being able to look at somebody’s whole entire system – their vestibular system as well as looking at their strength and flexibility and other balance testing to figure out exactly where they’re having those deficits at. We have specialized treatment techniques as well as evaluative techniques. We have video lenses that we can put on people’s eyes so we can see exactly how their eyes move when we put them in positions when we’re testing for that BPPV. We also have a NeuroCom Balance Master, which is very unique and it tells us exactly what systems they’re using for their balance, whether they’re using their vision or they’re using their vestibular system, or they’re using their joints -- their somatosensory system effectively. That helps guide our treatment plan. After we’re able to do that, we’re able to really individualize the program for somebody because balance has a lot of different meanings for different people.
Melanie: Well it certainly does, and that proprioceptive learning curve that people go through when they’re working with you is really something that can help them with all of the different aspects of their life, Laura, not just if they suffer from vertigo. Are there some prevention techniques that you would like to tell us about -- anything they can do to prevent actual vertigo from occurring if they know that they have it, or to work on balance and falls?
Laura: If somebody has a history of vertigo – that BPPV – if they know one side is typically affected, we talk to them about not laying on that side for prolonged periods of time, avoiding positions where they have to have those pillows where their head is tipped back more, that can predispose them to having a recurrence. And basically, having that conversation about what they’re doing in their normal life that may be triggering those recurrences. As well as for other balance things, keeping active, keeping in good exercise programs, keeping your flexibility, and looking at other community-based programs, such as Yoga, and Tai Chi, and all of those programs, and if you’re still having issues, to really contact a physical therapist to really do that individualized plan of care.
Melanie: Thank you, so much, Laura, for being with us today. That’s really great information. If you’d like to learn more about balance and fall evaluations at Bryan, you can go to bryanhealth.org/balance, that’s bryanhealth.org/balance. Or, you can call 402-481-9445. This is Melanie Cole. You’re listening to Bryan Health Radio. Thanks, so much, for listening.
Vertigo: Causes, Prevention and Treatment
Melanie Cole (Host): Have you ever had the feeling that you’re spinning or that everything around you is spinning? You may have benign positional vertigo, and that can affect many aspects of your quality of your life. My guest today is Laura Corbridge. She’s a Bryan physical therapist. Welcome to the show, Laura. Please talk about the difference between vertigo or benign positional vertigo and simple dizziness that some people get sometimes.
Laura Corbridge (Guest): Right, the word dizziness is really an umbrella form, so a lot of people refer to dizziness as many different things. Dizziness can be true vertigo, which is a spinning sensation which often feels like you’re spinning or the environment is spinning. Or you may have somebody say they feel dizzy when they actually are having some blood pressure issues, and it’s more of a lightheaded sensation. Other common causes of dizziness is when people feel more of an imbalance. That has to do with more of their balance systems not giving them the right information. Our job is to really figure out when someone says dizzy, what kind of dizziness they’re talking about and that will help us lead them to be able to have the appropriate treatment.
Melanie: People get this – they start getting it more often, what are some of the triggers – what are some things that you can identify, or help people to identify that might set off this type of situation?
Laura: BPPV or benign paroxysmal positional vertigo is that feeling of that sensation of spinning. It’s primarily when you change positions so when people get up and down from bed, or if they roll over to their side, or they’re bending forward to tie their shoes, or if they have to tip their head back, those are really common positions for people to have that spinning sensation. That’s different than the other dizziness sensations like I talked about earlier. There’s really no rhyme or reason why some people have this. It’s estimated there’s 107 new cases per one million people each year and it’s more common for people over the age of 50 and if you’re female. Some of the causes behind this is – really some people just wake up, and they’ll say, “But I woke up, I sat up, and I felt this intense spinning sensation,” and they have no real reason why that happened. Sometimes it’s more common if you’ve had a fall. Sometimes if someone’s had a fall, you can have that spinning sensation because of that mechanical problem in that inner ear, which is where this stems from. If somebody has a history of an inner infection or other vestibular-based disorders, you are more likely to get this BPPV, and it’s also been associated with people who’ve had a history of migraines, or motion sensitivity, or even osteoporosis or diabetes.
Melanie: Does it run in families sometimes?
Laura: I have heard a very strong genetic disposition, so if some people say – after I get done talking to them they’ll say, “You know, my aunt had this,” or, “My mom or grandma always had this problem,” so there is a genetic composition to it, as well.
Melanie: If somebody complains about this, you are a vestibular physical therapist, yes?
Laura: Yes, I’ve had advanced training to be able to perform vestibular based tests and to be able to do treatment for these vestibular disorders. The first thing is to find out what kind of dizziness they’re having and after my assessment, it seems like it’s more of this benign positional vertigo, then we’ll look at some treatment techniques.
Melanie: Let’s speak about some of the treatment techniques, Laura, because people don’t know if there’s something that can be done. They’ve heard about medications for this, but first speak from the physical therapist’s point of view, what you would do with somebody?
Laura: Right, well the first thing is to find out where exactly that little crystal is – it’s a little piece of otoconia that gets dislodged – and it’s in a space that it should not be in. We have three canals in our inner ear that help sense movement. These canals have fluid in them, and they tell the nerve cells where your head is in space. They are not gravity dependent, so what happens when this little crystal piece becomes loose from a structure within the ear that it’s supposed to be – and every once in awhile that will break off, and like I said, there’s really no rhyme or reason at times this happens – it gets dislodged in one of those canals. What happens is, that free floating crystal stimulates those hair cells and that fluid movement, which then tells your brain that you’re moving when you’re not really moving.
The biggest thing is to find out where that crystal is at because then all it is is a mechanical problem that we have to move that crystal from that area to another area that doesn’t cause problems. The biggest thing is finding out which canal is involved, so a lot of times we’ll do a further assessment with positional testing – having people do positions to stimulate those canals and then what’s really neat is that we can actually look at how their eyes move, and we can tell by the position they're in and how the eyes move, what canal is involved and this will help guide our treatment.
Melanie: Are there some things that people can do at home to work on this, as well?
Laura: There’s a lot of information out there, and there are a lot of treatment techniques. There is one canal that’s the most common, and that’s called the posterior canal, and that’s the most common where people get this little crystal stuck. There are a lot of treatment techniques out there. There’s something called the Modified Epley. There’s something called the Half-Somersault. There’s a lot of things out there. The problem is that sometimes you don’t know what canal is involved and if you don’t do those right, or know the canal that’s involved, it’s not going to make a difference, and you’re not going to be able to clear that crystal out completely. A lot of times when this is a new sensation, it’s a very scary sensation – people feel like they’re falling. People feel like they’re really out of control – you might need an actual professional to help guide you on what treatment technique is going to work best for you. My biggest goal is to teach somebody to be able to manage this because unfortunately if you have BPPV once, you’re more likely to have an increased incidence of having it in the future. The biggest thing is to be able to teach someone how to control this, so if that happens again, they wake up with that spinning, they have the knowledge base to know exactly how to treat this, so they don’t have to keep coming back to a physical therapist, or to the ENTs or audiologists to perform these techniques.
Melanie: Tell us a little bit about the balance and fall evaluations that you do at Bryan Health.
Laura: There’s a lot of things that we can look at somebody for balance. Vestibular physical therapy is one big part of that, so screening people about a history of BPPV, other vestibular-type disorders because some of these disorders have been undiagnosed or untreated, and that can lead to people having those balance and fall deficits. There are actually people who have BPPV that are not diagnosed for many, many years, and they’ve learned to change or avoid those positions that tend to exacerbate the problem, but they might have falls related to that problem. Really being able to look at somebody’s whole entire system – their vestibular system as well as looking at their strength and flexibility and other balance testing to figure out exactly where they’re having those deficits at. We have specialized treatment techniques as well as evaluative techniques. We have video lenses that we can put on people’s eyes so we can see exactly how their eyes move when we put them in positions when we’re testing for that BPPV. We also have a NeuroCom Balance Master, which is very unique and it tells us exactly what systems they’re using for their balance, whether they’re using their vision or they’re using their vestibular system, or they’re using their joints -- their somatosensory system effectively. That helps guide our treatment plan. After we’re able to do that, we’re able to really individualize the program for somebody because balance has a lot of different meanings for different people.
Melanie: Well it certainly does, and that proprioceptive learning curve that people go through when they’re working with you is really something that can help them with all of the different aspects of their life, Laura, not just if they suffer from vertigo. Are there some prevention techniques that you would like to tell us about -- anything they can do to prevent actual vertigo from occurring if they know that they have it, or to work on balance and falls?
Laura: If somebody has a history of vertigo – that BPPV – if they know one side is typically affected, we talk to them about not laying on that side for prolonged periods of time, avoiding positions where they have to have those pillows where their head is tipped back more, that can predispose them to having a recurrence. And basically, having that conversation about what they’re doing in their normal life that may be triggering those recurrences. As well as for other balance things, keeping active, keeping in good exercise programs, keeping your flexibility, and looking at other community-based programs, such as Yoga, and Tai Chi, and all of those programs, and if you’re still having issues, to really contact a physical therapist to really do that individualized plan of care.
Melanie: Thank you, so much, Laura, for being with us today. That’s really great information. If you’d like to learn more about balance and fall evaluations at Bryan, you can go to bryanhealth.org/balance, that’s bryanhealth.org/balance. Or, you can call 402-481-9445. This is Melanie Cole. You’re listening to Bryan Health Radio. Thanks, so much, for listening.