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  • Joel J. Digris, MSPT, Owner, Achieva Rehab

Dizziness - Get me off of this ride!!!

Dizzines ranks second only to pain in patient complaints at physician visits. Here's a little secret about me....I LOVE patients that are dizzy!!! Well, most patients that are dizzy.

There are different types of dizziness and many ways that the symptom is described. Lightheadedness, haziness, foggy, cloudy, blurry, vertigo, spining and on and on. I once had a patient who described it as "squirrelly." When I say I LOVE patients that are dizzy, it is because physical therapy can have a profound impact on this debilitating feeling that can really be a scare and limit the activity level of those suffering. We will discuss one particular type of dizziness below, but, most types of dizziness respond VERY WELL to PT.

The best kind of dizziness for me is the worst kind of dizziness for the least in terms of the severity of the sensation. True vertigo is caused by nystagmus, which is essentially repeated contraction of eye muscles that shouldn't be working together at the same time. My dizziness is caused by my eye muscles? In the type of dizziness that I will speak about here, Benign Paroxysmal Positional Vertigo or BPPV, the eye muscles are heavily involved. See below...this is nystagmus.

There are eye muscles that move the eye side to side and eye muscles that move the eye up and down and eye muscles that have a rotary effect...they turn the eye clockwise or counter-clockwise. These eye muscles are connected to the inner ear. WHY?? One of the jobs of the inner ear is to make sure your eyes can stay focused while your head moves. Try this..stare at your TV, or a book, or computer, and move your head side to side and up and down. You are still able to maintain your gaze fixed while your head is moving...that's because the inner ear is telling your eye muscles how to react to the movement of your head so that the eye essentially can stay in place relative to the head.

Picture a hula-hoop filled with fluid AND rocks. If you turn the hula hoop, the fluid inside naturally moves. The rocks move as well...BUT!!...not at the same speed or direction necessarily because they are heavier than the water. The inner ear is similar. When not stricken with BPPV, when you move your head, fluid moves in the Semicircular Canals and sensory nerves are stimulated inside the canal...this nerve stimulation is what manages the contraction or relaxation of the eye muscles. In another section of the inner ear, there are "rocks" or otoconia, which serve a physiological purpose. For one reason or another, illness, bump on head, some of those "rocks" get dislodged and move into the Semicircular Canal (Hula Hoop). Now, when you move your head a certain way, the eye muscles get the stimulation that they should be getting from the fluid movement, but, they ALSO get a different stimulation from the "rocks" or "crystals" and pairs of eye muscles work together to move the eye in a way it wasn't designed to move. The result is NYSTAGMUS.

That eye movement, as seen above, is what causes the nauseating feeling that the world is spinning around you. BPPV lasts less than a minute and is usually felt while getting up and down from bed, rolling in bed, bending over, or looking up to the ceiling. Lightheadedness and nausea may remain a bit longer than the vertigo. How scary is that feeling? How often is someone going to want to replicate the movement that brought it on? It's a terrible feeling, especially if the reason is unknown. I'm not saying that all vertigo is BPPV..certainly not, but, certain physical therapists have been fortunate enough to learn how to determine that.

Here is the part I LOVE! BPPV can be cured in a high majority of cases in just about TEN MINUTES!!!! A therapist will take a complete history, perform a few tests to confirm the diagnosis, and implement a treatment...the results are pretty amazing! That is why I LOVE patients who are's very exciting to ease someones worries in such a short span of time. Let's get you off of that ride so you can get back to life!!!

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