A Physical Therapy Guide to Dizziness
Feeling dizzy has the potential to ruin your day. Does this happen to you? Your alarm goes off, and as you roll over and sit up, you experience the room spinning out of control, almost like you are on a ship in rough water. You may have an immediate headache, feel sick to your stomach, and have a sensation of fear. So you lie back down, and the spinning is still there. Scared and frustrated, you lie still and slowly feel a little relief.
Dizziness is what it feels like when someone experiences vertigo. It affects 30% of individuals 18 to 79 years old1 and accounts for 5% of primary care clinic visits.2 It's so common that doctors sometimes dismiss dizziness as nothing to worry about since it can have so many possible causes, or none at all.
Although dizziness can be debilitating, the good news is that some physical therapists have specialized training to discover and treat the root cause. In this guide we will cover the symptoms, causes, and possible treatments for dizziness.
- What's the Difference Between Dizziness and Vertigo?
- What Does Dizziness Feel Like?
- Causes Associated with Dizziness
- How to Diagnose Dizziness
- What If Conservative Treatment Doesn't Work?
- How Do I Prevent Dizziness?
- Is it Time to Seek Treatment?
Dizziness is defined as having a whirling sensation in the head which can result in a fall.3 People often have questions about dizziness versus vertigo. Vertigo is the actual spinning sensation whereas dizziness can encompass lightheadedness. This distinction can make dizziness challenging to diagnose and can be scary to experience. Causes can be narrowed down to benign (treatable by a skilled physical therapist) or severe (requiring emergency medical care). This guide will help you better interpret vertigo versus dizziness, and determine if seeking physical therapy or additional medical care is right for you.
Experiencing dizziness is slightly different for everyone. For some it feels like they are spinning and are unable to stay upright. For others, it feels like the world is spinning, such as being on a rocky boat or an airplane with extreme turbulence. It can be helpful to classify an occurrence of dizziness into one of the following categories: vertigo, lightheadedness, or disequilibrium.1
What Are the Symptoms of Vertigo?
- Dizziness that increases with head movement
- A continual feeling of spinning when waking or rolling over in bed
- Loss of balance, or inability to gain balance
- Headache and nausea
- Sudden onset, which may or may not have a direct cause
- Rapid and uncontrolled side-to-side eye movements (nystagmus)
What Are the Symptoms of Lightheadedness?
- Feeling faint
- Fuzzy or blurry vision
- Dizzy-like sensations upon standing up
What Are the Symptoms of Disequilibrium?
- Sensation of unsteadiness not in your head
- Feeling the need to hold onto something to prevent falling
Some forms of dizziness have "no know etiology" meaning there is not always a distinct identifiable cause to the dizziness. Some causes associated with dizziness include:
- Alcohol use
- Pressure changes associated with air travel
- Steady motion for several days such as being on a cruise
- Inner ear issues
- Medication-related side-effects
- Health conditions of the heart, lungs and/or brain
- Viral infections
What Are the Benign Conditions of Dizziness?
These are the conditions that respond well to physical therapy interventions. They can occur independently or at the same time. When infections are present, additional medical care is needed to address the infection in conjunction with PT to restore function.1
- Jet lag
- Benign paroxysmal positional vertigo (BPPV)
- Vestibulo-ocular dysfunction
- Mal debarquement syndrome
- Meniere disease
- Vestibular neuritis (usually caused by herpes virus)
- Excessive alcohol use (acute symptoms)
When Should I Go To the ER For Dizziness?
There can be some potentially serious causes of dizziness, which require a trip to the emergency department, or even hospitalization.4 Such causes include:
- Vertebral-basilar insufficiency
- High blood pressure
- Heart conditions
- Chronic alcohol use causing cerebellar deficits and viscosity of inner ear
Diagnosing your type of dizziness is often a matter of ruling out the severe causes of dizziness and ruling in the benign causes, to determine if physical therapy is your best option for care. A CityPT will discuss your medical history, how the dizziness started, what provokes it, and other recent events in your life. They will then discuss how it is impacting your lifestyle and develop a treatment program to return you to function.
During the initial exam, you can expect:
- An in-depth review of medical history, symptoms, and activity levels
- An assessment of risk factors for severe causes of dizziness
- A physical examination of neck structures and range of motion
- Eye tracking tests
- Head movement analysis specific to the vestibular system
- Posture and gait analysis
If you are diagnosed with a benign cause of dizziness, your physical therapist will work with you to develop a treatment plan.
The first step to treat benign paroxysmal positional vertigo (BPPV) is to complete position specific maneuvers for the vestibular system and resolve your symptoms.
The next step for treating BPPV is to address other benign causes of dizziness5 and practice adaptation exercises with a vestibular rehabilitation (VR) focus. These exercise are meant to improve your symptoms but not to push you far enough that you are too dizzy to complete your day. You can think of this as recalibrating your nervous system.
As your CityPT observes goal progress on your Dashboard, they will then progress you into more advanced VR programs appropriate for your prior activity levels. This will likely include a gradual increase in the frequency, duration, and intensity of your activities.
As you return to your normal activities you can expect guidance on:
- Calming your dizziness
- Adjusting your activity levels and visual inputs to decrease the neural stimulation throughout your day
- Using assistive devices, if appropriate, to prevent falls
If conservative care for dizziness does not work:
- Consult with an optometrist to further assess your vision
- Consult with a physician to rule out possible infections or other medical causes
- Modify your environment to decrease the aggravating stimuli
Since there is no definitive cause for BPPV or vestibulo-ocular dysregulation, it is hard to prevent. To prevent the serious causes of dizziness try these strategies:
- Stay hydrated
- Develop and maintain an active lifestyle for enhanced cardiovascular health
- Eat a balanced diet
There are many videos available on the internet for treatment of vertigo, but if you perform them incorrectly they can actually make your condition worse and increase the length and severity of your symptoms. Paradoxically, your risk of falls may also increase as you inadvertently limit the activities that provoke symptoms.
Our CityPT physical therapists thoroughly assess and treat dizziness. At the end of your evaluation you will know why you are dizzy, what to do about it, and if you need to seek additional health care providers.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Dizzy Definition & Meaning - Merriam-Webster. https://www.merriam-webster.com/dictionary/dizzy#medicalDictionary. Accessed July 24, 2022. ↩
Herr RD, Zun L, Mathews JJ. A directed approach to the dizzy patient. Ann Emerg Med. 1989;18(6):664-672. doi:10.1016/s0196-0644(89)80524-4 ↩
Simocel, Lucinda & Bittar, Roseli & Sznifer, Juliana. (2008). Adaptation Exercises of Vestibulo-ocular Reflex on Balance in the Elderly. Intl. Arch. Otorhinolaryngol.. 12. 183-188. ↩