Vertigo is complex condition caused by miscommunication between the vestibular, visual and somatosensory systems. It is characterized by a spinning sensation where an individual can perceive themselves or their environment rotating. Studies estimate that vertigo affects over 90 million people worldwide. There are several known causes of vertigo, which range from viral infections to more chronic conditions such as Ménière’s Disease.
Depending upon symptom severity, vertigo has historically been treated by both invasive and conservative interventions. Invasive interventions typically include surgical procedures or prescription of vestibular suppressant drugs. However, due to the significant side effects associated with these invasive procedures, many patients seek a more conservative approach in managing their symptoms.
Vestibular rehabilitation therapy (VRT) is a type of physical therapy designed to promote habituation and compensation for deficits associated with vestibular pathologies. VRT programs are tailored to individual patients, and often include a combination of vestibular ocular reflex (VOR), balance, and gait exercises. Numerous studies indicate that VRT can be effective for individuals in the treatment of vestibular and balance disorders.
One type of vertigo that is particularly treatable in the outpatient physical therapy setting is benign paroxysmal positional vertigo (BPPV). BPPV is characterized by repeated episodes of positional vertigo that are caused by changes in head position. It is the most common disorder of the vestibular system affecting up to 21% of all patients with vertigo. BPPV is caused by the displacement of calcium crystals (otoconia) in the inner ear from the utricle into one of three semi-circular canals. This results in abnormal displacement of the fluid within the inner ear resulting in short duration episodes of vertigo associated with changes in head position.
The Epley maneuver is a canalith repositioning technique used to treat BPPV by moving the displaced otoconia from the semi-circular canals back into the utricle. Research indicates that when performed correctly this treatment can be 90-97% effective in resolving the symptoms associated with BPPV. Unlike many treatment modalities in physical therapy the Epley maneuver oftentimes yields instant gratification for most patients resulting in immediate relief of their symptoms. However, some patients experience some residual symptoms secondary to overcompensation of the vestibular system. These individuals are instructed in habituation and visual tracking exercises in order to recalibrate the vestibular system. Additionally, patients are educated in how to take themselves through the Epley maneuver independently to address any future episodes of vertigo.
If you experience dizziness or vertigo with change in position or have experienced falls you may benefit from vestibular rehabilitation therapy.