Feeling dizzy, lightheaded or otherwise unsteady is as common as it is dangerous. About 69 million Americans have balance problems including vertigo—the sensation of spinning or moving even though your body remains still. Balance difficulties contribute to many of the falls reported by a quarter of the over-65 population every year—and falls can break bones, cause head trauma or result in injuries that often lead to other health issues.
Vertigo and other out-of-balance feelings can arise from a variety of causes, including low blood pressure, medication side effects, ear infections, headaches or other disturbances of the vestibular, or balance, system. So it’s important to understand what keeps us steady and what can go wrong. But much about balance may come as a surprise due to common misconceptions like these.
Myth 1: Dizziness is mostly a vision problem.
The Balanced Facts: What experts sometimes call the balance organ is actually located in the inner ears. “It consists of a bony structure containing three fluid-filled canals that help assess where we are in space,” says Sue Ellen Boyer, AuD, an audiologist at Monmouth Medical Center Southern Campus (MMCSC). Cranial nerves connect this essential component of the vestibular system to the brain, which sends information from the ears through the central nervous system to the rest of the body. “The ear, brain and eyes all work together to keep us upright and balanced,” Dr. Boyer says.
Myth 2: Primary care doctors are the main providers.
The Balanced Facts: Treatment depends on what’s making you feel off kilter, but primary care physicians often refer patients with balance problems to an audiologist who has expertise in assessing vestibular disorders. In many cases, treatment is then handled by physical therapists. “Physical therapy and audiology work as a team,” Dr. Boyer says.
“People with vestibular and balance problems often don’t think of physical therapy as a treatment option,” says Anthony Baldachino, PT, DPT, a doctor of physical therapy at MMCSC’s Balance and Vestibular Program. “But we are specially trained in vestibular therapy.” Vestibular deficits can make everyday activities like walking, climbing stairs, showering and brushing teeth difficult. “Dizziness can be debilitating,” Dr. Baldachino says. “Vestibular therapy can help rehabilitate people so they regain control over their movements, activities and lives.”
Myth 3: Balance problems are tough to diagnose.
The Balanced Facts: A variety of tests can quickly help audiologists and physical therapists understand what’s causing balance issues. In one noninvasive approach, a variety of methods are used to observe eye movements as the head tilts in assorted positions or patients view an object from different directions. How eyes move can reveal which ear is having a vestibular problem, and even what part of the vestibular organ is involved.
Equipment for diagnosing vestibular problems at MMCSC’s program includes state-of-the-art infrared goggles for testing and a standing platform that moves while patients view a scene on a wraparound screen. “We can typically get to the bottom of what is causing dizziness and make an appropriate referral for treatment, whether through physical therapy or another specialty such as neurology or otolaryngology,” Dr. Boyer says.
Myth 4: Vertigo is difficult to treat.
The Balanced Facts: Many cases of dizziness are caused by a condition called benign paroxysmal positional vertigo (BPPV), in which tiny crystals that help maintain orientation in the inner ear become displaced. “It’s a very common condition that’s easily treated with simple, noninvasive maneuvers,” Dr. Boyer says.
“We put a person in different positions that help dislodged crystals get back to home base and alleviate dizziness, often in a single session,” says physical therapist Laurie Ferraro, PT. People with severe symptoms or difficulties with both ears may require multiple sessions or additional forms of rehabilitation therapy.
Myth 5: Flat surfaces are best for therapy.
The Balanced Facts: If you have a weak vestibular system, controlled exercises done with the help of a trained vestibular therapist may actually place you on uneven or unstable surfaces. “The goal is to challenge people and retrain the brain to achieve better balance,” Ferraro says. “We might start a patient on a firm surface but progress to standing on a foam pad or a board that wobbles.” Once you feel safer and steadier on unstable surfaces, staying balanced on level ground will seem less difficult.
Therapists may also work on posture, head position and gaze to help people deal with problems such as staying balanced while walking. “Each person is different, so patients need individualized programs,” Ferraro says.
While vertigo sometimes resolves on its own, you should seek help if dizziness recurs, you feel nauseated or you have a fall. If dizziness is accompanied by symptoms such as double vision, limb weakness or difficulty speaking, get an immediate evaluation at the Emergency Department.
“If you need vestibular therapy, we usually are able to fully resolve issues,” Baldachino says. “Most patients make a full recovery.”
A patient tests balance using equipment called Computerized Dynamic Posturography with (from left) Anthony Baldachino, PT, DPT; Laurie Ferraro, PT; and Sue Ellen Boyer, AuD.
Simple Steps to Foil Falls
- Check vision and hearing annually.
- Ask for a fall risk assessment from your doctor or a balance professional.
- Review your medications with your doctor to identify any that might increase the risk of falls.
- At home, improve lighting, remove tripping hazards and install sturdy handrails.
- Exercise regularly to work on balance, strength and flexibility.
Learn more about balance and vestibular rehabilitation at Monmouth Medical Center Southern Campus.