Frequently Asked Questions
What are some common words used to describe dizziness?
- Spinning (vertigo)
- Head pressure
Does the word “vertigo” mean something special?
Vertigo has a very specific meaning to a health care practitioner, and should only be used to describe the sensation that you are spinning or that the world is spinning.
What is the difference in prognosis among patients who have an inner ear problem, a brain problem, or a problem of both the inner ear and the brain?
Usually, when a person has a problem limited to the inner ear, they are considered to have a very good prognosis. Unfortunately not all people fully recover from an inner ear problem, because there has been damage to the ear structures. Dizziness caused by a brain problem usually requires more physical therapy visits and is more difficult to recover from. People who have both inner ear and brain damage can improve, but the recovery is often less than those who have problems in just one system.
How can physical therapy help to correct a balance problem?
There is evidence that physical therapy intervention can help people who are dizzy and/or who have balance problems. Through eye/head exercises, balance exercises, and walking exercises, balance and dizziness problems can improve.
Are all physical therapists able to help with balance and dizziness problems?
Just like doctors, physical therapists often have specialized training. Finding a physical therapist with specialized training in balance and dizziness problems is important. The most convenient therapist may not be the best for you. Try to find a physical therapist who has experience treating balance and dizziness problems.
How long should I expect to spend with a physical therapist on my first visit?
Generally, you should expect to spend one hour with the physical therapist for your first visit.
What happens the first time that you visit a physical therapist who specializes in balance and dizziness problems?
The physical therapist usually will send you some forms to complete prior to your first visit. These forms help shorten the questions the therapist will ask you and also will serve as a systematic way to make sure they do not forget to ask you important questions. From the forms, the physical therapist will ask you additional questions so they can better appreciate and understand your problems.
The physical therapist will ask you questions about how your problem interferes with your life (work, jobs at home, leisure, and social activities). In addition, they will attempt to determine what makes you worse or better. You will be asked about what other things you have done prior to seeing a physical therapist to help your problem and whether any of those things made you any better.
If you have brought or had balance tests previously, the physical therapist will be very interested in reviewing the findings. The physical therapist can explain to you what the results mean again, as sometimes it is difficult to remember all of the things that your doctor told you in your visit with her/him. Those balance test results can help the therapist determine how well you might recover from your balance disorder.
The physical therapist also will ask you the following:
- Have you fallen? If so, did you get hurt or have to see a doctor?
- Do you have weak bones?
- Do you have dizziness when you are not moving?
- Do you hear noises in your ear(s)?
- Do you ever experience any fullness in your ears?
- What is the best and worst your dizziness has been within the last 24 hours?
- Do you “spin” or feel “lightheaded” or “dizzy”?
After learning about your problem, the physical therapist will perform some painless testing that includes:
- Testing how well you can feel things with your feet
- Testing your coordination
- Testing your strength and motion
- Testing your eye muscles to see if they move normally
- Performing several walking tests
- Performing the Dix-Hallpike maneuver, a test to determine if you have any loose calcium carbonate crystals in your ear
- Several standing balance tasks
After all of the testing by the physical therapist, what comes next?
The physical therapist will determine what type of exercises to provide you and will also determine how frequently to see you. Most of the exercising is done at home, because it can be inconvenient and costly to visit the physical therapist frequently. You will usually receive pictures of the exercises that you are asked to perform, as it is hard to remember everything that you are told during your visit. Subsequent visits generally last approximately 45 minutes to one hour.
How often will I be scheduled to see the physical therapist?
The number of visits can range from once every week or two, up to two times a week. The duration of your care could range from one or two visits up to several months, depending on your problem. Generally, people with BPPV need fewer visits than do people with inner ear problems in both ears, or dizziness caused by a brain disorder. Your therapist should discuss the frequency of your planned visits with you during your initial visit.
Why don’t some people improve with physical therapy?
There are some conditions that make getting better more difficult for people living with balance and dizziness problems such as:
- A problem with the brain
- Migraine headaches
- Eye problems as a child, such as crossed eyes
- Obsessive-compulsive disorder or a perfectionistic personality
- An anxiety problem
- Being afraid of falling
- Poor vision or a recent cataract operation
We don’t yet know why, but some people who do everything that they are supposed to do still may not improve. Overall we know that about 80 percent of people have some degree of improvement with physical therapy.
Benign Paroxysmal Positional Vertigo (BPPV)
What is BPPV? Do I have loose ear crystals?
The Dix-Hallpike test can confirm the diagnosis of benign paroxysmal positional vertigo, commonly called BPPV. BPPV is the most common cause of dizziness (spinning) that occurs with a change of head position. BPPV may affect anyone, but is more common in older people. The average age of people with BPPV is about 60 years old. The symptoms of BPPV usually come on quickly and do not usually last longer than 60 seconds (although it seems like it lasts forever), and it is usually experienced when people get out of bed or roll over in bed. BPPV can be corrected with the Epley maneuver or particle repositioning maneuver, but it comes back in about 15 percent of people each year, and the likelihood of getting it back increases over time. BPPV runs in families and can cause people to fall. If your BPPV was caused by head trauma, you are more likely to get BPPV again.
I think that I have BPPV. Who do I need to see to have this problem fixed?
There are several types of health care professionals who can help with moving the crystals that produce BPPV. The professionals at the Center for Balance Disorders can advise you regarding whom to see.
Does my age or my gender make a difference in how I recover from a balance or dizziness problem?
There is no evidence that age or gender makes any difference in your recovery. Your recovery is based on hard work under the guidance of a health care provider. Some people improve more than others, but age and gender don’t seem to matter.
Is there any hope for me getting better in the future, if I have not fully recovered after a trial of physical therapy?
There is hope in the future for you if you have not fully recovered from your dizziness and balance problem. There are researchers sponsored by the National Institutes of Health who are studying the balance system. We are learning more about balance and dizziness problems every day, so do not lose hope.