Feeling Wobbly? Physical Therapy Can Help You Regain Balance

Balance disorders can have a significant impact on your life. Balance problems can occur due to vestibular system disorders.  They can make you lightheaded, dizzy and unsteady on your feet, challenging your ability to safely take part in regular daily activities.

Balance disorders are caused by a range of factors, some more serious than others. But to better understand how your sense of equilibrium can be thrown off kilter, consider how your body uses three different systems that work together to help you maintain balance in various situations.

• Vestibular system in your inner ear: This complex set of sensory organs helps with spatial orientation and coordination.
• Vision: Your eyes send messages to your brain to help it understand your place in relation to the world around you.
• Joints and muscles: Receptors in joints and muscles are constantly communicating with your brain to help it interact with your environment. For example, your brain knows how to keep you upright, whether you are walking, running or just leaning in a certain direction.

Problems with any of these systems can create balance issues, with some easier to treat than others.

Balance Disorder Causes

The most common  vestibular disorder that may cause balance issues is benign paroxysmal positional vertigo (BPPV). The condition is related to tiny crystals found in your inner ear. The crystals play a role in monitoring your head’s movements and position, relative to gravity.

Sometimes those crystals can be knocked out of place, winding up in the wrong spot in your vestibular system, and may cause your balance to go awry. This condition (BPPV) can result in  dizziness, the feeling that the room is spinning, loss of balance, nausea and vomiting. The symptoms usually last for less than a minute, and are usually associated with position changes. On its own, BPPV isn’t dangerous, though it can make you vulnerable to sustaining a fall.

Often there is no obvious cause for the condition, but it can be related to a blow to the head or, rarely, disorders that cause damage to your inner ear. The condition is also more common in women, and those with osteoporosis, diabetes or high blood pressure. It is treatable with physical therapy.

Among other causes of balance disorders:

• Neuropathy is a nerve condition, often related to diabetes, that causes numbness and pain in the arms and legs that can throw off your balance
• Vision problems, including double vision or vision loss
• Concussions and other head traumas
• Inner-ear infections that affect the vestibular nerve
• Stroke
• Medications
• Meniere’s disease
• Surgical complications

Vestibular Rehabilitation

Not every cause of balance disorders can be treated by a physical therapist through vestibular rehabilitation. That’s why your initial evaluation for balance and dizziness will include screening tests designed to get to the root causes of your condition.

Your therapist will examine your eyes to see how they’re moving and how well you’re able to focus and see clearly while moving  your head . The tests will examine the communication between your eyes, inner ear, and brain. You may also be asked to move through a variety of body positions to see if your dizziness worsens, and to assess your gait and balance. Some of the balance assessments include looking at how you navigate obstacles, walk on unstable surfaces and walk or stand while moving your head.

If you have BPPV, vestibular rehabilitation should be able to alleviate symptoms and improve your quality of life. Therapy includes:

• Repositioning maneuvers to relocate the dislodged inner ear crystals to their proper place
• Specific eye and head exercises designed to improve your brain’s ability to use vestibular information effectively
• Balance training to increase your body’s ability to react to movement and use all three balance systems appropriately

How well you respond to treatment will dictate the duration of your therapy. For some people, a couple sessions will be enough. But others may need several months of treatments, including at-home exercises.

How Effective Is Therapy?

Vestibular rehabilitation  has proven to be very effective against BPPV. The key is getting those stray crystals back where they belong. Once there, they should remain in place, however there is a chance it could reoccur in the future.

After the crystal issue is resolved, attention will turn to exercises designed to help you with any residual dizziness or balance issues and to compensate for the changes to your vestibular system. Therapy can help with compensation strategies to increase your safety in the home and community.