What is it?
Vertigo is a false sensation of movement, often spinning. This can be perceived as a movement of self or movement of the environment. Commonly, the term vertigo is used interchangeably with dizziness. However, dizziness is a sensation of lightheadedness, faintness, or unsteadiness. Although dizziness, vertigo, and falls may be more common as we age, these are not “Just part of getting older.”
Our bodies use 3 systems to control our balance: vision, proprioception (sensation), and the vestibular system (inner ear). The brain processes information from these 3 systems in order to instruct the body to make timely and necessary adjustments to the environment. Vision provides the brain with information about where your head and body are in relation to the world around you. Proprioception from our joints gives the brain information on where our feet and legs are positioned and how your head and neck are oriented. The balance organ of the inner ear makes up the vestibular system, which provides information about movements and position of your head, including speed and direction. This system allows your head to move while your eyes stay focused on a target. The brain processes all this information then sends signals to your muscles to move in a manner that will keep your balance and/or focus your eyes to see clearly while you are in motion. Misinformation from either of these 3 systems will result in the perception of vertigo or dizziness, which can lead to imbalance and/or falls.
The vestibular system includes the brain and the inner ear. The labyrinth is the primary organ of the inner ear, which includes the cochlea (hearing), and the vestibular apparatus. The vestibular apparatus is made up of the semicircular canals, responsible for maintaining balance and one’s orientation to their environment. These canals function as a “Fluid-filled compass” providing info to the brain on position, direction, and speed depending on the way the fluid is displaced within the canals.
The cause of vertigo depends on the origin of the problem. Because the vestibular system is made up of the brain and the inner ear, injury or altered information from either can result in the sensation of vertigo. Infections of the inner ear or disorders such as Meniere’s disease or benign paroxysmal positional vertigo can cause the spinning sensation. Trauma resulting in concussion can affect the vestibular system as well. Migraines, tumors, and stroke may cause vertiginous symptoms. There can be psychological causes of vertigo such as anxiety, also as these pathways in the brain interconnect. Roughly 50% of all dizziness is of inner ear origin, 5% due to medical or neurological problems, and about 15% caused by psychological disturbances.
Increased age (50 and older)
Sex (women > men)
Trauma (i.e. head injury)
The previous episode of vertigo
Signs & Symptoms
Depending on the cause of vertigo, various assessment methods may be necessary to determine the origin of the problem. A Clinician may use Frenzel goggles to evaluate eye movements, or nystagmus, which can indicate whether vertigo is caused by a problem with the brain or if coming from the inner ear. Clinicians may also use positional testing, which changes the orientation of the head and body. If the inner ear is suspected, this testing may indicate which ear is involved.
A Clinician will gain much information from detailed information from the patient, including the initial onset of symptoms, what activities/positions provoke dizziness, duration of symptoms, any history of similar complaint, any associated hearing loss, ringing or fullness in the ears, changes in HR or breathing and whether symptoms are accompanied by nausea/vomiting.
How Can Therapy Help?
Physical therapists are able to treat patients with balance and vestibular problems. Some PTs have specialized training in vestibular rehabilitation. A vestibular physical therapist has specialized training to assess and treat conditions affecting the inner ear. Examination by a vestibular PT will include testing to determine how the inner ear and brain are processing eye movement, body position, and motion in order to identify the cause of dizziness and/or unsteadiness. An individualized treatment plan will be developed based on symptoms and findings during the exam to correct balance, resolve dizziness/vertigo, and meet the patient’s goals.
It is important to recognize that fear of falling and decreased movement/activity increase the risk of a fall. However, many dizziness and balance disorders can be successfully treated by physical therapy. Working with a PT can help a patient overcome dizziness, resolve weakness, improve balance, and increase confidence in order to return to safe and normal mobility in their environment.
For More Info
What is Vertigo?
Understanding the Causes of Vertigo
Treating Vertigo with Physical Therapy