Pang Physical Therapy

Vestibular Rehabilitation

Helping you Navigate and Recover from Dizziness

What is Vestibular Rehabilitation and how does it Help with Dizziness?

Dizziness is one of the most common problems that people go to the doctor for, although that doesn’t make it any less distressing. Every day tasks such as reading, grocery shopping, or driving all become much more daunting when feeling dizzy. People who are dizzy often describe a wide range of sensations such as feeling faint, woozy, or unsteady. Vertigo refers to dizziness that creates a false sense of you or your surroundings spinning or moving when they in reality are not. Physical therapy for dizziness is known as vestibular rehabilitation. 

A person’s balance is largely influenced by their vestibular system. That is, in simple terms, the system compromising of your inner ear and brain that create your sense of balance. Therefore, dizziness can be caused by either inner ear issues or neurological disorders. There are many disorders that can impact your vestibular system and it is crucial to determine the root cause for an effective treatment plan. The good news is that vestibular rehabilitation has been shown to be particularly effective for addressing and resolving dizziness.  

Common Symptoms of Vestibular Disorders

  • Dizziness
  • Vertigo 
  • Motion intolerance 
  • Motion sensitivity
  • Nausea/vomiting
  • Fatigue
  • Imbalance
  • Brain Fog 
  • Tinnitus or ear ringing 
  • Trouble focusing
  • Irritability 
  • Anxiety/Depression
  • Vision issues
Therapist assessing cervicogenic dizziness

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Physical Therapist performing BPPV maneuver to assess dizziness

Common Dizziness Diagnoses

Dizziness can be caused by a wide variety of disorders. It is crucial to determine the right type in order to direct treatment. The conditions below are by no means an exhaustive list of vestibular disorders but represent some of the most common diagnoses.  

BPPV is a disorder of the inner ear that causes vertigo. Symptoms can be intense and highly distressing but the good news is that it is easily treated for the vast majority of people. BPPV is caused by displaced calcium carbonate crystals in the inner ear.

Treatment involves something called canalith repositioning maneuvers in which the patient’s head is moved into a series of positions. The aim of the maneuver is to return the aforementioned displaced calcium carbonate crystals into the right place. Symptoms are resolved once the crystals are returned to the right place in the inner ear.  

Vestibular migraine refers to a sub type of migraine headache that is associated with dizziness. It is considered a central disorder in that it the dizziness is caused by the brain versus an issue in the ear.

Treatment includes vestibular rehabilitation, addressing of any neck issues, and discussion on appropriate lifestyle modifications. Click here to learn more about how physical therapy can help with migraine

Cervicogenic means originating from the neck. Many people do not realize that neck dysfunction is also one of the leading causes of dizziness. 

There is ample evidence that physical therapy is highly effective for resolving cervicogenic dizziness. 

Treatment will include addressing of musculature imbalances, normalizing of neck motion, manual therapy/massage, and other modalities. 

Concussion is a mild traumatic brain injury that results from an impact injury to the head. The field of concussion rehabilitation is rapidly developing and it is well accepted that physical therapy is the gold standard intervention.

Concussion can also often be accompanied by something called labyrinthian concussion, in which damage is done to the soft tissue of the inner ear.

Treatment includes neck exercises, vestibular rehabilitation, and vision therapy. Click here to learn more about how physical therapy can help with concussion.  

Meniere’s disease is a disorder in which symptoms are caused by abnormal fluid pressure in the inner ear. It is a chronic condition that causes episodes of vertigo, ear ringing, and hearing loss. It is difficult to diagnose and can often be mistaken for BPPV.

Treatment includes vestibular rehabilitation to reduce symptoms between attacks and dietary/lifestyle changes. 

Vestibular neuritis refers to sudden inflammation of the nerves in the inner ear, thereby causing symptoms of dizziness and imbalance. It presents with a wide range of severity with some experiencing only mild symptoms and others more extreme. 

Vestibular rehabilitation is widely considered the standard for treating vestibular neuritis. Exercises involve challenging balance, eye movements, and more. 

Reviews

I would highly recommend Jimmy Pang as a physical therapist. His professionalism, knowledge and flexibility made my knee replacement surgery a safe, effective and positive experience. He made the best use of our time together and created an exercise plan that allowed me to recover fully in my home environment, making adjustments as I improved, and successfully helped me regain my flexibility, mobility and strength. Jimmy is also a great listener and just a pleasure to be around! I look forward to seeing him again after my next knee replacement surgery.

I worked with Jimmy over the course of several months. I was lucky enough to find someone knowledgeable in treating sciatic nerve pain. Several months into my pregnancy, I started to experience severe sciatic nerve pain rendering me unable to walk at times, and unable to find relief on my own. When I started working with Jimmy, he took the time to get to know me and my situation. I could tell the care plan was tailored to my needs. During our sessions, he focused on identifying activities that showed the best results. He also took the time to show me exercises to do on my own. As my belly continued to get larger, I expected my back to get worse. However, the table stretches, and exercises Jimmy put together for me improved my back. I was more ambulatory and comfortable further into my pregnancy thanks to his knowledge and personalized care. If I had not received the level of care he provided I would have been unable to continue working. I highly recommend him if you’re looking for a knowledgeable physical therapist who genuinely cares about the outcomes of his patients.

Jimmy took my pain seriously, both physical and emotional, and utilized a variety of strategies to address it. He is a gem when it comes to sharing new resources and has introduced me to so many new treatment approaches, particularly at the forefront of pain management research. From his own experiences with chronic pain, he delivers insightful comments of empathy and support that really stuck with me, validated my experience, and served as a mantra helping make the hard times easier to get through. I've gone to Jimmy with instances of both acute and chronic pain. Jimmy has helped me through the acute instances, and reframed my relationship with lifelong pain as a journey with trial and error, peaks and valleys, mindfulness, and acceptance.

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