Disclaimer: During our Dizziness Can Be Stubborn webinar, many inquirers asked for specific treatment recommendations for their particular scenario. Please be advised that as per our College regulations, I am not permitted to provide treatment advice for an individual’s symptoms without performing an assessment. Hopefully my more general responses will help answer your questions, but the best approach is to discuss your particular symptoms with your Doctor and Vestibular Therapist.
Q: I have a question about vestibular exercises that my GP suggested for me to try to help with vertigo symptoms I have been suffering from for years now. Can you explain what kind of exercises are given?
A: As discussed in the webinar, vestibular rehabilitation should be individualized to be the most effective. Most GP’s have often been trained in the Epley maneuver, which is designed for the most common form of BPPV, but not the other variants nor treatments for non-BPPV vestibular conditions.
In addition to education, typically, the exercises would come from one or more of the following categories depending on what is found during assessment:
- Canalith repositioning maneuver(s) if the problem is BPPV
- Gaze stabilization: improving the eyes’ ability to focus during head movement
- Habituation: graded repeated exposure to movements that reproduce symptoms
- Static balance: exercises to improve balance often with eyes closed +/- a footing challenge
- Dynamic balance: exercises to improve balance while in motion and while the head is moving
- Manual therapy +/- neck proprioception exercises: hands-on treatment and home exercises for the neck that may include using a laser head-lamp to work on awareness and control of head position, if there appears to be some contribution from the neck.
- General conditioning
Q: I've had vestibular neuritis for about 6 months (only discovered recently that was what it was). I'm doing habituation exercises (approx. 11 days). I felt like my symptoms got worse for the first week, now they have receded to about what they were before I started the exercises. Is that normal? (I do know that it usually takes at least 2 weeks to see results---but I was surprised when things seemed to be getting worse).
A: Firstly, I feel compelled to clarify that a vestibular neuritis (infection of the nerve coming from the inner ear toward the brain) is not something you would have for 6 months. It would run its course within a couple of weeks but then typically leaves behind reduced vestibular input (unilateral vestibular hypofunction).
In the webinar, I mentioned that the rehabilitation can make symptoms ramp up a little because you go from avoiding symptom-provocation to actually doing things that work into the symptoms. The trick is to work with your therapist to tweak the exercises such that any increase in symptoms is mild and brief.
Q: You said: Things that make me dizzy can make me well? So can I jump into my yoga and stretches which include a lot of head movement again? I had been avoiding or doing very little.
A: The research is quite clear that symptom avoidance delays recovery. So yes, you should be being active, doing the movements that cause your symptoms but maybe not quite “jumping into” things! I know this sounds counterintuitive and it doesn’t apply to every situation, but as a general rule ths can work, if done in a certain way.
Let’s use an example such as you having a vestibular mismatch that makes you dizzy every time you turn quickly to the left. If you do those left turns repeatedly (several times a day for several days), just quickly enough to gently reproduce your symptoms, with a nice recovery between each one, the brain should start to 'habituate.'
Habitation results in reduction of symptoms and increased tolerance to previously troublesome movements. You can then increase your speed of movement and/or combine with other activities in the same manner – doing symptom provoking activities in a graded way – with gentle reproduction of symptoms and recovery afterward until you are back to as near normal as possible.
To learn more about vestibular rehabilitation, check out our services page. If you’re interested in booking an assessment with a vestibular therapist, you can do so online or find a clinic near you.
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