FYZICAL

For more information on the author Fyzical Therapy & Balance Center Fort Myers, CLICK HERE.Waking up feeling dizzy can be a disorienting and scary experience, but if it happens infrequently, there is probably no cause for concern. Occasional dizziness is very common, and there are several reasons why you may feel dizzy, woozy, or off balance in the morning. However, if you frequently wake up with dizziness, it may be time to make an appointment with a doctor to rule out serious health concerns.There are several forms of dizziness, including imbalance, lightheadedness or wooziness, vertigo, and dizziness related to anxiety or fear. Vertigo is a unique type of dizziness in that it includes a spinning or rotating component. You may experience any of these forms of dizziness when you wake up.Physical therapy is an effective way to manage dizziness symptoms, regardless of the cause. The providers at FYZICAL are highly trained and have experience in helping people overcome dizziness and get their mornings back on track. Using evidence-based methods, our holistic therapies provide an effective strategy to minimize dizziness without the need for medications or surgical approaches.What is the cause of dizziness?Dizziness is not a disorder, but rather a symptom that can be caused by many things. For people who are experiencing dizziness when they wake up, dysfunction in the circulatory system or peripheral vestibular system may be the cause. Some medications can also cause morning dizziness, as can alcohol and recreational drugs. Even dehydration or low blood sugar can make you feel dizzy.To understand dizziness that occurs when you wake up, it may be helpful to understand how our bodies keep us balanced under normal circumstances and where things can go wrong.The circulatory systemWithout adequate blood flow, brain cells dont receive the fuel they need, and you will feel dizzy or lightheaded. The circulatory system plays a crucial role in maintaining normal brain function. The brain is an energy-intensive organ, using about 25% of the oxygen you breathe and about 60% of the glucose (sugar) that you eat. In some cases, there may be adequate blood flow but there is not enough oxygen or glucose to sustain brain function. Disorders like sleep apnea can prevent your brain from getting enough oxygen while you sleep, and going to bed on an empty stomach can cause low blood sugar-induced dizziness when you wake up. People with diabetes are at particular risk for low blood sugar that can lead to dizziness and pre-syncope (feeling like youre going to faint) or syncope (fainting).The vestibular systemMost of us rarely think about the ear as anything other than our hearing organ, but the ear contains one of our most important balance organs, the peripheral vestibular system. There are three section of the ear: the outer ear, which is made up of the ear lobe and the canal; the middle ear, which includes the bones of hearing and Eustachian tube, which regulates pressure; and the inner ear, which is composed of the cochlea and the peripheral vestibular system.The peripheral vestibular system also plays a role in maintaining proper blood flow. Because it senses your spatial orientation, it influences blood flow. When the brain receives signals that you have gone from lying down to standing up, for example, the cardiovascular system changes how it directs blood flow in order to accommodate your change in position.The peripheral vestibular system plays a major role in helping us maintain consistent balance. The peripheral vestibular system is housed in the inner ear, and has two important components:Otolithic organsThe otolithic organs, or otoliths, are tiny inner ear structures that sense linear motion (up/down, left/right, forward/backward) and transmit information about our spatial orientation to the brain. The otoliths are found under a sticky gelatinous membrane that contains embedded calcium carbonate crystals. Every time you move, the membrane also moves, and the embedded crystals activate inner ear hair cells that go on to send information about the speed and direction of your motion to the brain. If these hair cells are activated erroneously, the brain receives incorrect information regarding whether and how you are moving, which leads to a feeling of imbalance or dizziness.Semicircular canalsThe inner ear has three semicircular canals that are filled with fluid. When you turn your head to the left or right, tilt your head toward your shoulder, or nod up and down, the fluid moves through the canals, sending information about your rotational movements to the brain. When inner ear fluid is displaced inappropriately, you will experience the characteristic spinning sensation known as vertigo.The peripheral vestibular system of the inner ear sends information to the central vestibular system, which is located in the brain. Under normal circumstances, the brain integrates information from your peripheral vestibular system with information from other systems (visual, motor, sensory) about your movement, and you maintain balance and equilibrium. If the peripheral vestibular system is active when you arent moving, the brain receives mismatched information from the different systems, causing you to lose equilibrium.Although dizziness can be caused by central vestibular system dysfunction, the majority of cases of dizziness are caused by abnormalities in the peripheral vestibular system. Physical therapy is an evidence-based treatment strategy that can treat inner ear disorders and provide long-term improvements to balance and equilibrium.Waking up dizzy in the morningWaking up to a spinning room or without normal equilibrium is never a good way to start your day. There are a number of potential causes for waking up feeling dizzy, and many of them can be prevented with some simple lifestyle changes.DehydrationDehydration is one of the most common reasons why people are dizzy when they wake up. When you're dehydrated, you actually lose blood volume. This makes your blood pressure drop, resulting in insufficient delivery of oxygenated blood to the brain. This can make you feel dizzy when you are lying down, and the dizziness will worsen when you go from lying down to standing up.A common factor in dehydration-related dizziness in the morning is alcohol. If you woke up dizzy and nauseous or in a room that was spinning after a night of imbibing, alcohol is a likely culprit.Low blood sugarIn order to maintain normal function, the brain depends on a sugar called glucose for energy. When you eat, glucose is transported from your digestive system to your blood stream and delivered to the brain. If you skip dinner, you may experience dizziness the next morning because your blood doesnt have sufficient amounts of glucose to keep your brain working properly. Low blood glucose is also called low blood sugar or hypoglycemia.DiabetesDiabetes is a condition that affects blood glucose (sugar) levels. People with diabetes are missing an enzyme that allows glucose to get into the bloodstream, so diabetics have an increased risk for low blood sugar in the morning, which can lead to dizziness and fainting. Sleep apnea and other obstructive breathing conditionsAnything that interferes with your breathing will reduce the amount of oxygen that gets to your brain, leaving you feeling dizzy or woozy. A common complaint among people with obstructive breathing conditions is, I woke up in the middle of the night feeling dizzy. While sleep apnea is the most common type of obstructive breathing condition, others include chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma. Even having a common cold could interfere with normal breathing while you sleep.Orthostatic hypotensionIf your morning dizziness sets in when you first sit up or get out of bed, you may be experiencing orthostatic (or postural) hypotension. This is a condition that is caused by inadequate blood flow to the brain and occurs when people get up too quickly after they have been sitting or lying down. Dizziness or lightheadedness related to orthostatic hypotension lasts for just a second or two, so if your dizziness is persistent, there is probably something else contributing to it.MedicationsSome medications are known to cause dizziness, and you may wake up in the middle of the night or in the morning feeling lightheaded or faint. Blood pressure medications like ACE inhibitors, beta-blockers, and calcium-channel blockers can all cause dizziness. In addition, drug interactions may leave you feeling dizzy.Benign paroxysmal positional vertigo (BPPV)Benign paroxysmal positional vertigo, or BPPV, is a disorder of the inner ears peripheral vestibular system. When we move, crystals in the inner ear activate tiny hair cells that send information about our movements to the brain. These are normally attached to a membrane so they cant accidentally activate hair cells. Age-related degeneration or head trauma can cause these crystals to become detached, and they activate hair cells at inappropriate times. This signals to the brain that we are moving even when were not.If you regularly experience vertigo when waking up, you may have BPPV. People with BPPV often get vertigo when they roll over in bed or turn their head. BPPV can also affect just one ear, which would cause dizziness only when you turn or roll to one side. BPPV-related vertigo lasts for 15-20 seconds, and BPPV can also cause lightheadedness, nausea and vomiting, nystagmus (rapid, involuntary eye movements), and fainting.Other causes of dizziness in the morningLabyrinthitis: This is inflammation in the inner ear that affects nerve signaling between the peripheral vestibular system and the brain. It may be caused by an ear infection or head trauma, and usually resolves within 3-6 weeks. Some people with labyrinthitis may be especially prone to dizziness after a period of lying down, especially if they sleep in a position that allows fluid to accumulate in the affected inner ear.Mnire's disease: Mnire's disease is a rare disease that is still poorly understood. It is associated with severe vertigo that can last for several hours. Other symptoms of Mnire's disease include tinnitus (ringing in one or both ears), intermittent hearing loss in one or both ears, and a sensation of fullness in the ear.Anxiety: If your dizziness always occurs on the morning of a big day, anxiety could be the cause. There are several helpful exercises that can help you control anxiety and minimize dizziness without resorting to anti-anxiety medications.When to see a doctorIn most cases, occasionally waking up feeling dizzy is not a serious cause for concern. However, if you are regularly experiencing dizziness or vertigo when you wake up, it is recommended that you make an appointment with your doctor.If your dizziness is accompanied by any of the following, seek immediate medical treatment:Chest painTrouble breathingRapid heart rateConfusionSlurred speechSevere headacheNumbness in the face, arms, or legsDouble visionOngoing vomitingHow to stop feeling dizzyFor many people, drinking plenty of water, eating a healthy diet, and making sure to get some exercise to promote blood flow are sufficient to prevent dizziness. If you are taking prescription medications, ask your doctor whether they could be causing your dizziness.One of the most effective ways to manage dizziness is physical therapy. Nearly all of the root causes of dizziness respond well to physical therapy, and providers who are experienced in treating dizziness can tailor an exercise plan to meet your needs.The experts at FYZICAL are highly trained and skilled in treating different forms of dizziness. Our holistic, whole-body approach doesn't depend on medications or surgery, and many people find that the benefits of physical therapy go beyond helping them overcome dizziness.FYZICAL offers free assessments that can help you understand your dizziness and anxiety and create a tailored exercise program that will help you manage your symptoms.

For more information  on the author, Fyzical , CLICK HERE!Balance Therapy - The Mission of Changing LivesBrian Werner built a $2 million balance and physical therapy practice in less than 10 years thanks to his detailed evaluation tests, elaborate therapy systems, and revolutionary equipment. Now he's rebranded his business in hopes of helping millions more who suffer from dizziness.An 82-year old man sits in a black, oversized chair. We'll call him John Smith (HIPAA laws don't allow us to reveal his true name). He looks like he could be your father or maybe grandfather, a favorite uncle or kindly neighbor. Large black straps come over each shoulder locking into another strap stretched across his midsection. The space-like goggles placed neatly over his eyes give the appearance that he's ready to be launched into orbit. The chair is affixed to a gyroscope-like structure that appears as if it was built on a sci-fi movie set.A press of a button and John's seat turns him sideways then upside down. He will be spun and contorted for only a few minutes and he's cured. It's easy to envision a crowd of children with snow cone stained lips at a state fair lining up to take a turn on this apparatus. But this is no carnival ride. It's an Epley Omniax Chair. It's John's chance to stop feeling like he's riding a merry-go-round when he sleeps at night. The Epley Omniax Chair is one of many devices and procedures that Brian Werner, PT, MPT, uses at his recently rebranded Fyzical Therapy and Balance Centers in Henderson and Las Vegas, Nevada. The chair helps patients suffering from the effects of Benign Paroxysmal Positional Vertigo (BPPV) and other vestibular disorders return to normalcy. His clinics specialize in diagnosing and treating patients with all types of peripheral and central nervous system disorders of the balance system.Biggest Problem Among the Elderly in AmericaWerner has a passion for helping those who struggle with dizziness. After earning his Masters in Physical Therapy from Northern Arizona and working as a PT for several years, he helped open and operate several balance centers starting in Las Vegas in 2001. "By 2005 I got the entrepreneurial seizure," Werner laughed. "Once you've worked 80 hours a week for someone else, you want to try and do your own thing." Balance disorders are the third most common complaints to primary care physicians and in emergency rooms. They're the number one complaint in the elderly population. Thirty percent of the elderly in this country will suffer from vertigo; that's 12.5 million Americans. And as many as 475,000 hip fractures annually are the result, a devastating accident that 25 percent of seniors die from within a year of it happening. The stats are only going to grow larger. "Baby boomers are growing older. The stats aren't going to change. That means more people will be going to doctors with balance or dizziness problems. I knew there was going to be an increased need for this type of specialized care," Werner said. "I'm one of the first to drive a business model towards it in the nation."90% + of Problems IdentifiedPatients undergo a series of evaluations upon arriving at Fyzical. Doctors of audiology conduct comprehensive hearing and inner ear testing. Next, a Computerized Dynamic Posturography (CDP) test is administered. It identifies with objective evidence where patients' balance problems are stemming from: Is it in their eyes, their proprioceptors in their lower extremities, or is it coming from the inner ears? Last are the Video nystagmography Test (VNG) and Vestibular Autorotation Test (VAT). These examinations look for postural instabilities in the eyes or nystagmus of the eyes. "As your postural stability in standing and walking is controlled by your balance system, your eyes are also controlled by the same systems," Werner explained."In the past, we treated based upon subjective information supplied by the patient, as we didn't have the technology or really know how to measure the balance system well. Now, we practice evidence-based medicine," he added. "We can identify what's causing the balance problem in 90%+ of the patients just by a battery of three or four tests."The Latest in Balance TechnologyMany of Werner's patients suffer from loose crystals brought upon by BPPV. The Epley Omniax Chair aligns the ear's semicircular canal to be parallel with the gravitational pull of the earth allowing maximum force to reposition the crystals quickly and efficiently, thereby reducing the nausea that comes with the standard maneuver. The chair is ideal for patients like John Smith, who are elderly and have certain physical limitations. "I met with Dr. Epley and we became friends. I believe we were one of the first in the world to get the final versions of his chairs," Werner shared. "The guy who invented the Epley maneuver invented the chair why wouldn't you want it? What he's using with his patients is what we're using with ours on a daily basis." Not everyone needs the Epley Omniax Chair. Other forms of treatment at Fyzical include vestibular rehabilitation, which is repositioning maneuvers, adaption training, and habituation exercises.Balance retraining physical therapy is also offered, a combination of vestibular rehabilitation with orthopedic management or standardized physical therapy. "That's the beauty of the model we've developed. There's the balance program and there's pain management. We want it to be a seamless program between the two," Werner urged. "That's perfect because most of our patients are older. They don't walk in with one problem. They have multiple problems. We can take care of them all."First to Use a Safety Gate SystemFear can neutralize and make ineffective even the most dynamic therapy treatments. If a patient is afraid of falling while training, he or she may never fully recover. Werner identified this issue and developed a way for his patients to maximize their treatment sessions while providing reassurance that they're completely safe. "I was a gymnast through high school and college. When gymnasts practice, they're at times in harnesses and attached to ropes in case someone falls. That way they can minimize injuries," Werner said. "I came up with the same principle as it pertains to therapy." Werner employs a safety gate system at Fyzical. Patients wear a full-body harness attached by dynamic ropes to a ceiling-mounted trolley system that slides along a track. Patients can perform a full array of exercises while sliding along the 100 to 120-feet of track. And they're easily switched from one track to another as they progress from one phase of therapy to the next."The patient needs to experience the very edge of their ability and at the same time know they're not going to get hurt. Our safety gate system is there as a precaution. They'll still fall, but they fall in their harness and not to the ground," Werner clarified. "Patients get so much more out of their therapy by being able to push themselves without being afraid. We're one of the first in the U.S. to use this approach."

For more information on the author Fyzical Therapy & Balance Center Sarasota, CLICK HERE.Chronic DizzinessChronic dizziness is a frustrating, persistent disorder that can significantly interfere with normal daily activities and prevent people from being able to do the things they want to do. Chronic dizziness can take a few different forms, depending on what the precipitating event was, the physical and psychological contributions to the disorder, and the symptoms that are experienced.Chronic dizziness is often initiated by a precipitating medical event. For example, an inner ear infection called labyrinthitis can cause dizziness/vertigo that lasts for several weeks, but typically resolves fully. However, some people continue to experience persistent, fluctuating labyrinthitis symptoms, including dizziness (but not vertigo) and increased sensitivity to complex visual stimuli (e.g. driving in the rain, complicated patterns), that are made worse by passive and active movements (e.g. riding in a car and walking, respectively).To meet criteria for chronic dizziness, symptoms must be present more days than not for at least 3 months. Most people have symptoms for several hours every day. In addition, the disorder must cause significant functional impairment or distress. Triggers usually include an upright posture (standing or walking) and moving visual stimuli.Chronic dizziness is frequently associated with an anxiety disorder that worsens symptom severity. Common symptoms of an anxiety disorder include excessive worrying about life events, loss of ability to carry out routine tasks, and anticipatory anxiety in advance of a situation that may cause dizziness. People who are anxious about becoming dizzy actually increase their risk for a dizzy spell.DizzinessBefore we get into a discussion on chronic dizziness, lets briefly review dizziness types and mechanisms.Dizziness is an umbrella term that includes the following subtypes:Vertigo:A spinning or tilting sensation; a sense of motion when youre not movingPresyncope:Feeling like you are going to faint (fainting is called syncope); also called lightheadedness or giddinessDisequilibrium:A sense of imbalance or instability, often experienced when you are walkingThe vestibular system is an important balance organ, and when it isnt working properly, you will feel dizzy. Consequently, dizziness is sometimes called a vestibular symptom, and disorders that cause dizziness are known as vestibular disorders.Vestibular disorders can be caused by structural (anatomical), functional (physiological), or psychiatric (particularly anxiety) abnormalities.Structural and functional vestibular disorders are initially acute or episodic, but they can both transition to a chronic state. Psychiatric vestibular disorders are not considered to be acute or episodic, rather, they are chronic, progressive conditions.Chronic dizziness treatmentThe most effective treatment approaches to chronic dizziness emphasize a holistic approach that addresses both physical and psychological aspects of the disorder. In many cases, people with chronic dizziness have seen several doctors in a variety of specialties without ever being accurately diagnosed, and the standard dizziness treatments they are given are often ineffective. Many people who have unsuccessfully tried medications find that physical therapy is a more effective treatment strategy.When treating chronic dizziness, it is important to understand what caused it and what contributes to it. For example, one person may have had an acute case of vestibular neuritis that transitioned into chronic dizziness without anxiety, while someone else may have a psychiatric vestibular disorder with high anxiety and panic attacks. Treatment plans for these people may look very different. Treatments should be tailored to suit the specific needs of each patient.Vestibular rehabilitation therapyVestibular rehabilitation therapy (VRT) is the gold standard in treating structural dizziness. VRT is an exercise-based physical therapy program that can alleviate symptoms associated with many forms of chronic dizziness.VRT leads to significant improvements in vertigo symptoms, fall risk, posture and balance, and overall emotional status in people who have vestibular forms of dizziness (i.e. inner ear dysfunction). One recent study found that 79% of VRT patients reported subjective improvements in their chronic dizziness symptoms.VRT is has also successfully helped people with mild forms of psychiatric vestibular disorders, although more serious cases may be better treated by combining VRT with behavioral therapy and, if necessary, medications.Importantly, maximum efficacy requires a commitment from the person being treated. People who are less than 75% compliant with their physical therapy regimen have poorer outcomes than people who are fully compliant.Cognitive behavioral therapyCognitive behavioral therapy (CBT) is one of the most successful behavioral therapies for helping people manage chronic dizziness that has a significant psychological component. CBT identifies negative thought patterns and replaces them with positive ones. Over time, this can significantly reduce chronic dizziness symptoms and improve mood and outlook.Chronic dizziness that has a structural origin (e.g. peripheral vestibular system disorder) or a functional origin (e.g. vestibular neuritis) may respond well to CBT, but physical therapy should also be used to address the physical aspects of the disorder.MedicationsDepending on the cause of your chronic dizziness, some medications may help you manage the symptoms:Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that can be very helpful for people who have psychiatric vestibular disorders or anxiety with dizziness.Benzodiazepines are prescription anti-anxiety drugs that can reduce dizziness and anxiety, but they are for short term, intermittent use only, as they are associated with a high risk for developing physical and psychological dependence/addiction.If your chronic dizziness is related to vestibular migraine, anti-migraine drugs may reduce symptom severity and duration.Nausea and vomiting can be treated with prescription antihistamines or anticholinergics.Although medications have their place in treating anxiety and dizziness disorders, in many cases physical therapy and behavioral therapy are as (or more) effective than pharmacological treatment options.Central nervous system therapiesUntil recently, it was thought that chronic dizziness was the result of impaired compensation after an injury. Compensation is the process of recovering normal function through central and peripheral nervous system reorganization; in other words, your nervous system adapts to overcome damages associated with the injury. Recent evidence suggests that the recovery process is even more complex and includes changes in the way the brain integrates and processes spatial information. If this is proven to be true, it suggests that a peripheral nervous system disorder can have long-term functional consequences in the central nervous system.Treatment options that target the central nervous system are currently being tested, with some promising preliminary results. Transcranial cerebellar direct current stimulation (tcDCS) was shown to enhance the benefits that physical therapy provides, and repetitive transcranial magnetic stimulation (rTMS) treatment was shown to reduce the frequency and severity of dizziness spells.Chronic dizziness and lightheadednessLightheadedness, also known as presyncope, is the feeling that you are about to pass out. Chronic dizziness and lightheadedness may be experienced together, especially if a dysautonomia (a disorder of the autonomic nervous system) or a dysrhythmia (abnormal heartbeat) is also present. Lightheadedness can also be caused by orthostatic hypotension (low blood pressure) that occurs when you stand up too quickly.Chronic dizziness and headachesVestibular migraine is a chronic headache disorder that often includes dizziness or vertigo. Vestibular migraine is characterized by light sensitivity, imbalance, nausea/vomiting, ringing in one or both ears, spatial disorientation, and intolerance to moving visual stimuli.Chronic subjective dizzinessChronic subjective dizziness (CSD) is a unique type of chronic dizziness. It is a progressive disorder that is characterized by disequilibrium and hypersensitivity to complex visual stimuli. CSD is not caused by vestibular dysfunction, and dizziness is linear, rather than vertiginous. Unlike some types of dizziness that are obvious to observers, the dizziness associated with CSD is called subjective imbalance because even though the person with CSD feels imbalanced, they would not appear dizzy or off-balance to an observer.Why some people develop CSD is not yet clear. Evidence suggests that both physical and psychological factors contribute to CSD, and many CSD symptoms are emotional or behavioral. CSD was originally thought to be a psychogenic disorder; that is, a disorder of the mind, without any physical contribution. We now know that there are psychological and physical components to CSD, but the majority of people ('60%) with CSD also have an anxiety disorder.There are three types of CSD:Otogenic CSD:Dizziness developed as a result of a temporary medical condition (e.g. vestibular neuritis) and there was no history of anxiety before the inciting eventPsychogenic CSD:Dizziness develops in the absence of an apparent physical cause and coincides with the course of an anxiety disorderInteractive CSD:Dizziness developed after a transient medical condition in someone with a predisposition to, or a history of, anxiety disordersIn order to be diagnosed with CSD, the following diagnostic criteria must be met:Persistent dizziness without vertigoHypersensitivity to ones own movement and the movement of objects in the environmentSymptoms of CSD are exacerbated by complex visual stimuli (e.g. driving in the rain, moving through a crowd)Symptoms must be present for at least 3 monthsNo evidence of a vestibular disorder or another physical cause (e.g. brain lesion)Balance function test results do not identify the patient as having impaired balanceTreatment options for CSD are similar to those for other types of chronic dizziness, including VRT and physical therapy, cognitive behavioral therapy, and medications.Chronic dizziness and fatigueFatigue is a key trigger of dizziness. Usually, fatigue and dizziness are transient symptoms that resolve with rest, but there are some chronic conditions that include fatigue and dizziness.Chronic fatigue syndromeChronic fatigue syndrome (CFS) is a condition that is characterized by overwhelming fatigue, even after a good nights sleep. In addition to dizziness, CFS symptoms include muscle pain, headaches, difficulty thinking or focusing, insomnia, rapid heart rate, and flu-like symptoms. The cause of CFS is unknown, but stress and anxiety may have a significant role in the development and persistence of CFS symptoms.Postconcussional syndromeFatigue and chronic dizziness are common symptoms after head trauma or whiplash. Other common symptoms include irritability, mood swings, dysphoria, insomnia, weakness, headache, short term memory loss, and inability to focus. Postconcussional symptoms often resolve within a week or so, but they may persist for several weeks, depending on the severity of the trauma and the care received after the accident.Other causes of dizziness and fatigueLow blood pressure and low blood sugar are two common causes of dizziness and fatigue, but they are usually temporary conditions. However, unmanaged diabetes, malnutrition, anemia, and obstructive breathing disorders (e.g. sleep apnea, emphysema) can cause persistent dizziness and fatigue.Vestibular migraine may also cause episodic fatigue and dizziness. Migraine frequency can vary from several attacks per year to near-daily attacks, and dizziness and fatigue may coincide with the migraine or may occur before or after the migraine.Somatic symptom disorder (SSD) is a poorly understood condition that is characterized by persistent physical symptoms (including dizziness and/or fatigue) that do not have an obvious medical explanation. People with SSD are preoccupied with their symptoms and find them to be very disruptive or distressing.Dizziness and nauseaDizziness and nausea are non-specific symptoms, meaning that there are multiple potential causes. Chronic dizziness is often associated with increased sensitivity to complex or moving visual stimuli, which can cause nausea and motion sickness, even if youre not moving. If you regularly suffer from dizziness and nausea, you may want to make an appointment with your doctor to learn about your options. There are several medications that may reduce the severity of your symptoms.Importantly, dizziness or vertigo that is accompanied by ongoing vomiting could indicate a serious, even life-threatening medical issue, and you should seek medical treatment immediately.FYZICAL is a dedicated group of physical therapy providers who are highly trained and skilled in helping people manage symptoms related to chronic dizziness. Using a holistic, whole-body approach, we will work with you to develop an exercise program that can help you get your balance, and your life, back.FYZICAL offers free assessments that can help you understand why youre feeling dizzy and help you explore ways to resolve these symptoms and regain your life.

For more information on Fyzical, Click Here.Having the motivation to exercise can sometimes be a challenge. Building the motivation to exercise when it is freezing outside... of course that can be a challenge. If you are a workout warrior who loves running outside, hiking, biking, and burning those calories off under the warm sun each day, the winter months can be devastating to your waistline.Here are some tips to keeping an eye on the prize for the next time beach season rolls around!Warm yourself up !If you are an individual that prefers to workout outside, make sure to increase your body temperature and heart rate before stepping outside. Warm up with a light cardio for 5-10 minutes inside your home. This way when you step outside, you are warm both physically and mentally.Select your clothes the night before: If you like to work out in the morning, select the clothes you will be wearing the night before. This will prepare your brain to get ready in the morning and will be much easier to crawl out of your warm bed and go outside for that quick jog!Pack your clothes: Do you work out after work? Instead of stopping at home to change, pack your clothes and head straight to the gym after work. Stopping at home and grabbing a quick snack, sitting on the couch and flipping on the TV sounds much easier than getting back in the car and heading to the gym.Mix it up! Perhaps your go to workout is playing soccer with your friends, rock climbing, or something that just isn't possible during the winter months. This doesn't have to be a bad thing! Think of this as an opportunity! Try your hand at some new sports. Mixing up the muscles you work can be very good for your body. If you have never tried to ski or snowboard, give it a shot and see how your legs feel the next day. Your gym probably offers a handful of classes each day. You may be pleasantly surprised at the workout you get from a Yoga or spinning class. Play like a kid again: Activities like running in the snow, snowball fights, sledding, and making snow angels are not reserved for children. Remember how fun these days were as a kid! You'll be surprised how challenging playing around in the snow can be for a few hours.FYZICAL Fitness: Having a medically-based fitness professional lead your workouts is a great way to stay in shape, in addition to building your motivation. Our friendly and knowledgeable FYZICAL therapists can customize a total health and wellness plan that bridges physiology, exercise and nutrition to meet your fitness goals .Find a FYZICAL near you to see what type of fitness memberships are available.Watch what you eat: In addition to the cold weather, the cooler months bring plenty of opportunities to fall off the healthy eating train! Eating your children's leftover Halloween candy, Thanksgiving, Christmas... there always seems to be something unhealthy to snack on around the house. Ditch them after the holiday. If they are in your house, you will eat them!Remember, the winter months offer plenty of excuses for you to not get up and move. Remember to love your life!

For more information on the author, FYZICAL, CLICK HERE!At FYZICAL Therapy and Balance Centers, fall prevention is the cornerstone of our mission; Balance is part of our name after all! The week of September 21st is the start of the fall season, but it also kicks off Fall Prevention Awareness Week. Each year we bring focus to this very important topic though our Fight the Fall! campaign.We are offering FREE Fall Risk Assessments to identify individuals of all ages and conditions at risk of falling. In fact, as a national organization, FYZICAL is looking to set a record for the most Fall Risk Assessments conducted during Fall Prevention Awareness Week: September 21st-25th!To set up your free screening, call your nearest FYZICAL Therapy and Balance Center to request an appointment today!Falls are preventable. If you or someone you know suffers from imbalance, keep in mind that early intervention is key. Falling is not an inevitable result of aging, and there are steps you can take to improve your balance and decrease the chances of falling. By identifying risk, future injuries can be prevented. Our skilled physical therapists will create a program specifically tailored to your needs, so you can begin your quest to regain your footing, your confidence, and your freedom. Together we can Fight the Fall!What You Should Know About Fall Risk & PreventionJust about everyone has experienced a fall at some point after losing their balance or tripping over an object. Although common, falls can be dangerous and lead to many types of injuries, some of them long-term or even fatal. Fortunately, the most common causes of falling are also preventable.What happens in the body when we fall?Falling occurs because the bodys balance has been disrupted. A persons body can maintain balance because the brain receives and interprets information from several different types of sources:1Vision (from the eyes)Proprioception (from the joints and muscles, which provide sense of touch)Vestibular system (from the inner ear, which senses motion, equilibrium, and where we are in a physical space)Based on this input, the brain sends information to different parts of the body to help maintain balance. Sometimes the different sources may send conflicting information. For example, have you ever gotten off of a treadmill, boat, or out of a moving car only to feel like you are still moving?Most of the time, the brain can correct conflicting information to keep a person steady on their feet. Occasionally, however, a person may become off-balance and fall.Falling is both common and dangerous.The U.S. Centers for Disease Control and Prevention (CDC) reports that more than one out of four older people (those aged 65 and up) falls each year.2 Twenty percent of falls lead to serious injuries, such as broken bones or a head injury.The CDC also has found:More than 3 million older people are injured in falls and receive treatment in emergency departments each year.At least 300,000 older people are hospitalized for hip fractures each year. Of these hip fractures, 95 percent are caused by falling.Falls are the most common cause of traumatic brain injuries.Medical costs for falls in 2015 were more than $50 billion, with Medicare and Medicaid taking on 75 percent of these costs.A person who falls once becomes more likely to fall again, especially at an older age.People who have fallen in the past tend to become fearful of another fall, which can make them socially withdrawn or lessphysically active, which actually increases the risk of falls.What are the risks of falling?The risk of falling increases with age, but falls can happen to anyone, at any time, for many different reasons. Most cases of falling involve several different causes or risk factors.3,4 Some of the more common types include:Muscle weakness, especially in the legsLack of vitamin DTrouble with walking or balanceSide effects of medications like sedatives, antidepressants, or cold medicine that can cause drowsiness or dizzinessPoor visionLoss of hearingFoot pain or improper footwearUneven flooring or stairsClutter in the homeConsumption of alcoholMemory loss, difficulty concentrating, or confusionFainting or loss of consciousnessPoor balanceIncontinence that causes frequent or urgent trips to the bathroomDrop-in blood pressureWalking on ice or wet floorsIf you find that you are dizzy or otherwise losing your balance, dont ignore it. Its important to seek help as soon as balanceissues begin. A lot of people wait too long. But the longer you wait, the worse it can get.How can physical therapy help prevent falls?Improving your walking skills technically known as your gait and your balance are interrelated challenges. At FYZICAL Therapy & Balance Centers, we help you master these skills to decrease your risk of injury, while also increasing your confidence and independence.Balance and gait are inextricably linked because they tend to impact one another. Therapy that improves gait and balance works to help keep the bodys different balance and movement systems functioning in harmony.Gait and balance training has a range of benefits:Avoiding injuries associated with falls or dizzinessIncreased confidence with your footing and movementReduced pain from poor posture or gaitWhat happens in balance and gait training?First, well evaluate your gait to determine potential problems with strength and posture. Simple movements to test balance are also part of the assessment. Together, these basic evaluations help us know what to focus on in terms of therapy.Hip and ankle weakness often leads to balance problems, as does poor posture. Strength and flexibility movements can help counteract these problems. These are often as simple as leg lifts while seated in a chair, or knee marching. We may also practice standing on one leg, walking heel-to-toe, or tracking the movement of your thumb with your eyes as you move it in various positions.The team at FYZICAL Therapy & Balance Centers knows how important balance and walking are for independent living, as well as for work activities, exercise, sports, and enjoying life in general.We offer the following programs and therapies to help reduce the risk of falls:Assessment and Evaluation ProgramsDifficulty WalkingGait Training and Balance ProgramsFall Prevention and Balance RetrainingManual TherapyFitness and Wellness ProgramsVestibular RehabFunctional Training

The term dizziness can describe various sensations, including lightheadedness, faintness, a room-spinning sensation (vertigo), or unsteadiness. Due to the additional stress on the body while exercising, feeling dizzy after running is common and has various potential causes. This article will review the most common causes of dizziness after running and strategies for preventing and addressing dizziness to promote safer and more enjoyable running experiences.DehydrationAmong the most common causes of dizziness while running is dehydration. Dehydration occurs when the amount of fluid taken in is less than the fluid lost. Since the body is about 70% water, remaining adequately hydrated is necessary for all essential body functions. When the body exercises, energy needs increase, which in turn increases body temperature. To cope with this temperature increase, the body sweats and loses water in the process. This phenomenon is especially common on a hot day.When the body is in a state of water loss, the risk of dehydration and subsequent dizziness increases. Dizziness from dehydration results from inadequate blood supply to the brain due to low blood volume. Additional signs that the body is dehydrated include:Dry mouthDry coughHeadacheWeaknessTiredness or fatigueConfusion or deliriumFast heart rate but low blood pressureLow appetite or sugar cravingFlushed skinChillsHeat intoleranceConstipationDark-colored urineSwollen feetMuscle crampsAs running, and exercise in general, pose a significant dehydration risk, experts have created guidelines to prevent and treat dehydration experienced by runners. This advice is particularly relevant for long-distance runners.In particular, about two hours before a run, it is recommended that runners pre-hydrate by drinking between 17 and 20 oz of water. During exercise, runners should drink between 5 and 10 oz of water every 15 to 20 minutes. For post-exercise hydration, experts recommend drinking 16 to 24 oz of water for every pound lost during a run. This advice emphasizes the importance of weighing yourself (ideally with an empty bladder) before and after a run to monitor your hydration status. Generally, if someone loses several pounds after a run, they must drink more water. Staying hydrated when not exercising is also important for preventing dehydration and dizziness while running.Once dehydration symptoms develop, hydration becomes even more essential to make up for water loss. Drinking small sips of water instead of chugging is generally recommended for someone who is exercising. In addition to drinking water, runners with signs of dehydration should stop exercising at least until symptoms improve and consider drinking a sports drink for added carbohydrates and electrolytes. Symptoms that do not improve after drinking water can be a sign that more aggressive hydration, such as intravenous (IV) hydration, is needed. In this situation, people should seek immediate medical care.Low Blood SugarAnother common cause of dizziness while running is hypoglycemia or low blood sugar. When exercising, the body needs an increased amount of water and energy in the form of carbohydrates. During the initial phase of exercise (first 15 minutes), the body uses glucose from the muscles and the blood to power physical activity. Once this supply runs out, the body gets glucose from other sources, such as the liver. Similar to the brains response to dehydration, the brain cannot handle persistently low blood sugar, and this deprivation can lead to dizziness. Other signs of low blood sugar include:Trembling or shakingSweatingChillsWeaknessFast heart rateConfusionDifficulty concentratingExtreme hungerAnxietyTiredness or fatigueIrritabilityLip, tongue, and/or cheek tingling or numbnessPale skinRecognizing the signs of low blood sugar is the first step of effective management, followed by consuming carbohydrates. Drinking a healthy sugary beverage, such as a sports drink, is the fastest way to raise blood sugar, followed by snacks such as raisins and applesauce. Depending on the severity of the symptoms, it may also be necessary to stop exercising after an episode of low blood sugar to allow adequate rest and recovery. General strategies for the prevention of exercise-induced hypoglycemia (EIH) include:Eating a nutrient-dense, balanced meal or snack before exercising to ensure the blood contains enough glucose (sugar) to power physical activity.Noticing how you feel during exercise and taking care to modify the exercise if symptoms of low blood sugar occur.Importantly, people with diabetes are at increased risk of developing EIH. Special prevention considerations for those living with diabetes include:Monitoring your blood sugar before, during, and after exercise to identify patterns and make necessary treatment plan decisions.Adjusting your insulin dose prior to exercising with the help of a medical professional, as needed.Orthostatic HypotensionOrthostatic, or postural, hypotension a drop in blood pressure when a person transitions from lying down or sitting to standing is another potential trigger for dizziness after running. Usually, when a person stands up, the body adapts and preserves circulation to the organs by increasing blood pressure. If this adaptation does not occur, blood pools in the feet, leading to orthostatic hypotension. The diagnostic criteria for orthostatic hypotension include:A drop in systolic (top number) blood pressure by at least 20 mmHg within two to five minutes of transitioning from sitting to standing.A drop in diastolic (bottom number) blood pressure by at least 10 mmHg within two to five minutes of transitioning from sitting to standing.Orthostatic hypotension can occur in otherwise healthy people but more commonly occurs when people have chronic medical conditions or take certain medications. Common causes related to running, which may also be signs of other underlying conditions, include dehydration, low blood sugar, overexertion, and heat exhaustion. Managing orthostatic hypotension requires addressing the underlying cause and, in the case of runners, resting until symptoms improve. In addition to dizziness, symptoms to monitor include:Blurry visionWeaknessFaintingConfusionOverexertion and HyperventilationOverexertion can also cause dizziness after running. The more individuals exert themselves during exercise, the more energy the body requires. As a result, overexertion increases the risk of dehydration, low blood pressure, and dizziness. If someone is dizzy during or after a challenging workout, they should rest, breathe deeply, and hydrate to improve blood pressure. Overexertion can be avoided by developing and following a set exercise plan that prioritizes gradual intensity build-up.In regards to overexertion, hyperventilation or rapid breathing can also lead to dizziness while running. When someone hyperventilates, they exhale excess carbon dioxide, which leads to low blood levels of carbon dioxide and dizziness. Breath-holding may also cause dizziness during exercise. Learning and practicing effective breathing practices is highly recommended for runners who notice that they are holding their breath or hyperventilating during their exercise.Heat ExhaustionDizziness after running can also develop due to heat exhaustion. Heat exhaustion occurs when the body overheats and may occur with overexertion, particularly on a hot day. Heat exhaustion is one of three heat-related illnesses. The most severe of these is heatstroke, followed by heat exhaustion and heat cramps, which is the most mild of these conditions. Dizziness from heat exhaustion typically results from dehydration, which causes a drop in blood pressure. Along with dizziness, symptoms of heat exhaustion include:Cool, moist skin with goosebumps during heat exposureFaintnessFatigueWeak, fast pulseHeavy sweatingOrthostatic hypotensionMuscle crampsNauseaHeadache Any of these symptoms can start suddenly or progress slowly over time. Prolonged periods of exercise increase the risk of heat exhaustion. Runners with signs of heat exhaustion should stop activity and rest in a cool place. Drinking cool water and a sports drink for added electrolytes is also important. If these modifications do not improve symptoms within an hour or they worsen, a doctor should be notified. Signs that require immediate medical attention include confusion, loss of consciousness, the inability to drink water or a core body temperature that is greater than or equal to 104 F.Chronic Medical ConditionsPeople living with certain medical conditions are more likely to experience dizziness after running. One such condition is postural orthostatic tachycardia syndrome (POTS). POTS causes orthostatic intolerance (OI), which occurs due to a severe reduction in blood flow to the heart when a person transitions from lying down to standing. As a result, dizziness during exercise is particularly common for people who are living with POTS. Despite the risks, safe exercise is still recommended for people with POTS.The best exercise practices for people living with POTS include adhering to their medication regimen, prioritizing increased fluid intake, wearing compression stockings, and gradually increasing physical activity over time. Individuals performing this type of activity should also focus on working toward performing fully upright exercises without experiencing dizziness or syncope (loss of consciousness).These recommendations can also be helpful for people living with other chronic conditions associated with increased risk of dizziness after exercise, such as Parkinsons disease, Addisons disease, diabetes, benign paroxysmal positional vertigo (BPPV), and thyroid conditions. Importantly, persistent dizziness after running without an underlying cause can be a sign of cardiovascular (heart) disease and warrants prompt medical attention.Symptoms that accompany dizziness and typically require a medical evaluation include:HeadacheVision changesNauseaVomitingConfusionArrhythmias or racing heart rateDifficulty breathingChest painPhysical Therapy Can HelpIn addition to incorporating prevention and treatment strategies into the daily routine, physical therapy can also help people who are dizzy after running. This form of therapy is particularly useful for those who live with chronic medical conditions or experience recurring dizziness. Physical therapists can help create safe exercise plans and will work with you to ensure you are practicing effective strategies to prevent dizziness. These strategies include pre- and post-workout stretching, gradual intensity increases, hydration, and nutrition.For people with pre-existing conditions that cause dizziness while running, physical therapists will tailor recommendations to their condition. At FYZICAL, expert physical therapists are available to evaluate balance and dizziness disorders that affect exercise. They offer programs such as gait and balance training, functional training, and fall prevention retraining, among others.FYZICAL also offers vestibular rehab for people who experience dizziness after running due to inner ear problems, such as BPPV. Vestibular rehabilitation aims at improving a persons ability to compensate for issues with their vestibular or balance system. Regular vestibular exercises can train the brain to tolerate vestibular stimulation, which improves symptoms and exercise tolerance.Generally, vestibular exercises start with very slow movements that gradually increase in speed over time. Experts recommend continuing the exercise if dizziness develops but pausing if more severe symptoms occur, such as nausea and vomiting. People should work towards doing each movement about 20 times. At FYZICAL, physical therapists will help people incorporate these vestibular exercises safely to improve symptoms.Exercise avoidance can also affect people with chronic dizziness that is associated with exercise. FYZICAL uses special equipment, such as the Safety Overhead Support (SOS) system, to help with this problem. The SOS system allows people to perform exercises while attached to a harness, allowing them to exercise without fear of falling. Using this type of equipment in conjunction with support from a physical therapist can help people build up to safe, independent exercise.SummaryVarious conditions can cause dizziness after running, most of which can be prevented and treated with simple interventions. Hydration, adequate nutrition, and well-timed rest are crucial to prevent dizziness during exercise. People with pre-existing conditions must be incredibly attentive to their bodys needs before, during, and after running. Along with a proper medical evaluation for underlying causes, physical therapy can be beneficial for developing safe exercise practices that reduce dizziness. If you are interested in learning more about physical therapy for dizziness and balance issues, call FYZICAL to discuss details and how to get started.Locate a FYZICAL near you to learn more about our services.FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life!

Dizziness and vertigo affect about 15% to 20% of adults per year. Although often used interchangeably, dizziness and vertigo are considered distinct sensations. Dizziness is a general term that may have different meanings depending on the person. The term could mean that a person feels light-headed, unsteady, or faint. People experiencing vertigo may also describe the sensation as dizziness, but vertigo is more specific.The exact definition of vertigo is a false sense of movement, described by some as a sensation that they are spinning or that the world around them is spinning. Although vertigo fits under the umbrella of dizziness, it is the only cause of dizziness that causes this spinning sensation. Dizziness with eye movements can manifest as lightheadedness, unsteadiness, or vertigo. People with these symptoms should discuss them with a health professional because they may indicate an underlying disease. This article will review how eye movements are related to dizziness, conditions that commonly cause this symptom and possible treatment strategies.How Eye Movements Cause DizzinessKnowing how the eyes usually move is necessary to understand why people may experience dizziness during eye movement. The eyes move in four basic ways: saccades, smooth pursuit, vestibulo-ocular movements, and vergence movements.SaccadesRapid eye movements that abruptly alter the point of eye fixation are called saccades. Saccades are often described as ballistic movements because the eyes are unable to adjust to a new target once the movement starts. Saccades can be voluntary but also occur reflexively whenever the eyes are open. These eye movements can be small (reading a book) or large (looking around a room).Smooth PursuitSmooth pursuit movements are smaller than saccades, and they are executed to focus a moving stimulus centered on the fovea the center of the eyes macula where eyesight is sharpest. The macula is a small area in the retina (back of the eye) that helps people see detailed objects, such as faces and written words. Since people can choose whether or not to track a moving stimulus, smooth pursuits are voluntary. However, most people end up performing a saccade when they attempt to make smooth pursuit movements without a moving target to follow.VestibuloOcular MovementsVestibuloocular eye movements compensate for head movements by stabilizing the eyes relative to their surroundings. These movements are reflexive, meaning they are performed subconsciously. The inner ears vestibular system, which is responsible for keeping the body balanced, detects subtle, quick changes in head position, leading to rapid corrective eye movements. The semicircular canals bony tubes that are a part of the vestibular system and sense head position tell the eyes to move in the opposite direction of the head to remain fixated on a stationary object while the head is moving.Vergence MovementsVergence movements keep targets that are located at different distances from the observer aligned with each eyes fovea. Unlike the first three movement types, vergence movements are disconjugate moves the eyes in different directions. In particular, they cause the eyes to rotate toward or away from each other to focus on a closer or farther object. Vergence movements are one of three visual responses that are triggered by interest in a nearby object. The other two are the accommodation of the lens (object focus) and pupil constriction.Eye Movements and DizzinessBy using these specific movements, the eyes work together with the vestibular system and proprioceptors (nerve sensors) in the legs and feet to maintain balance. Dizziness or vertigo may develop if any of these three components stops working properly or does not communicate with the others. When someone experiences dizziness, unsteadiness, and disorientation due to visual triggers, including eye movement, it is called visual vertigo.The remainder of this article will review the most common medical conditions that are associated with dizziness and visual vertigo, along with steps to manage them.Ocular DysfunctionThe most common conditions that cause dizziness with eye movement can be divided into two groups those that occur due to ocular dysfunction and those that develop as a result of vestibular dysfunction. Ocular dysfunction refers to conditions that directly affect eye function.Binocular Visual DysfunctionBinocular visual dysfunction (BVD) is a common cause of dizziness with eye movements due to ocular dysfunction. BVD affects about 20% of people in the United States (US). People with BVD are often misdiagnosed at first with vestibular migraines, which is a rare condition. A common subtype of binocular dysfunction is convergence insufficiency a condition in which the eyes cannot work together to focus on objects at close distances.BVD develops due to eye misalignment, where the eyes send two images to the brain that are positioned differently. When this happens, the brain cannot correctly process the situation and signals the eye muscles to compensate for misalignment with realignment. This forced realignment only works temporarily and leads to further misalignment.The cycle that results from misalignment and realignment leads to eye muscle fatigue and the sensation that objects are moving. The symptoms include:DizzinessVisual VertigoEye strainHeadachesNauseaAnxietyLight sensitivityBalance issuesFrequent head tiltingMotion sicknessNeck painDifficulty reading and learningBVD can be linked to certain conditions, such as traumatic brain injury (TBI) and stroke. Additionally, some people are born with facial asymmetry (one eye is higher than the other), eye muscle issues, or nerve problems that lead to BVD. Treating BVD requires correcting the eye misalignment with micro-prism lenses. These lenses work by bending light to realign the images produced by both eyes.Traumatic Brain InjuryAbout half of people with TBI experience dizziness and balance problems during their recovery period. Symptom severity depends on TBI severity, referring to which part of the brain was injured, additional injuries, and possible interaction with medications. There are several causes for balance problems after TBI, including vision problems, but BVD and inner ear problems are the most prominent causes of post-TBI dizziness.StrokeAfter a stroke, people may experience dizziness related to eye movement due to nerve damage. If the blood clot that caused the stroke affects the eye nerves, eye movement will be affected. This damage can manifest as BVD or other conditions, including nystagmus involuntary and rapid eye movements.NystagmusNystagmus is a condition that is characterized by rapid, repetitive, and uncontrolled eye movements that can be congenital or acquired. Congenital nystagmus usually affects both eyes and most commonly causes blurry vision. Symptoms of congenital nystagmus typically start between six weeks and three months of age. Acquired nystagmus develops later in life, is generally caused by an underlying medication condition or medication, and can affect one or both eyes. People with acquired nystagmus often describe shaky vision as the main symptom.The rapid eye movements caused by nystagmus commonly lead to vertigo and dizziness. People may also experience light sensitivity, nighttime vision problems, and difficulty with balance. Although nystagmus itself is not dangerous, the condition can be a sign of a serious underlying brain condition, such as a stroke, a brain tumor, head trauma, or certain inflammatory diseases. A medical professional should evaluate people with new onset nystagmus to rule out these potentially life-threatening conditions.Vestibular DysfunctionVestibular dysfunction refers to balance difficulties that result from peripheral injury to the inner ear, central injury to the central nervous system (CNS), or both. Both central and peripheral vestibular dysfunction can lead to nystagmus and dizziness when moving the eyes.Benign Paroxysmal Positional VertigoBenign paroxysmal positional vertigo (BPPV) accounts for 20% of individuals who experience severe dizziness/vertigo, making it the most common cause of peripheral vestibular dysfunction. BPPV causes short episodes of dizziness or vertigo that are usually one-sided and develop due to abnormal inner ear crystal movement. Normally, inner ear crystals are anchored to the inner ear. When they become dislodged, they tend to move to the most dependent position within the semicircular canals. This movement is registered by the inner ear machinery as movement, causing vertigo.Typically, symptoms of BPPV are most noticeable with changes in position and upon waking up in the morning. BPPV is usually diagnosed through a comprehensive exam by a medical professional. Certain physical exam maneuvers can elicit symptoms of BPPV that help confirm the diagnosis. One maneuver used during the exam, the Epley maneuver, can also be used to treat symptoms of BPPV at home or during physical therapy.Meniere DiseaseMeniere disease is another common condition that causes peripheral vestibular dysfunction. Usually, this disease is characterized by vertigo, hearing loss, and tinnitus (ringing in the ears). Vertigo typically occurs in episodes that last minutes to hours. The exact cause is unknown but is thought to be related to volume disturbances within the endolymphatic sac an inner ear organ filled with fluid called endolymph. Meniere disease usually affects one side. However, in about 17% of individuals diagnosed with this condition, bilateral (affecting both sides) symptoms develop.Importantly, Meniere disease can manifest as a vestibular variant that does not cause hearing loss or tinnitus. This variant can be difficult to differentiate from a vestibular migraine a migraine that is characterized by balance and dizziness symptoms with or without headache.Vestibular NeuronitisAnother cause of vertigo is vestibular neuronitis inflammation of the vestibular nerve. Experts believe acute viral or post-viral inflammation causes vestibular neuronitis. However, if the inflammation also affects the cochlea the part of the inner ear containing the organ of Corti that responds to sound vibrations the condition is called labyrinthitis. In addition to vertigo, people with labyrinthitis experience hearing loss.Transient Ischemic Attack and StrokeIn contrast to peripheral vestibular dysfunction, the most common causes of central vestibular dysfunction are transient ischemic attack (TIA) and ischemic stroke involving the vestibular nerve tracts, cerebellum, or brainstem. The cerebellum is the part of the brain that is primarily responsible for maintaining balance. TIAs and ischemic strokes are caused by blood clot formation in the brains blood vessels, which hinders adequate blood flow to the affected part of the brain.TIAs, as the name suggests, are transient, meaning that the blood vessel blockage is temporary and the symptoms resolve. Ischemic strokes are permanent blockages that cause irreparable damage and prolonged symptoms. Central vestibular dysfunction causes similar symptoms as peripheral vestibular dysfunction, including vertigo, nausea, vomiting, gait difficulties, and nystagmus. It is important to recognize these symptoms as possible signs of a stroke to promote immediate medical care.Treating Symptoms with Physical TherapyThe first step in treating dizziness with eye movement is identifying and addressing its underlying cause. Although many of the conditions described here cause persistent symptoms despite appropriate medical management, treatment with physical therapy can provide additional relief. For both ocular and vestibular dysfunction, vestibular rehabilitation can be beneficial.Vestibular rehabilitation involves exercises that are designed to relieve dizziness and imbalance. In order to increase exercise tolerance, these exercises focus on building up speed and intensity slowly over time. As a result, vestibular rehabilitation programs require a significant investment of time. Vestibular rehabilitation aims to repeatedly stimulate the vestibular system and increase the brains ability to compensate for head and eye movements without causing dizziness.At FYZICAL Therapy & Balance Centers, expert physical therapists are available to determine eligibility for vestibular rehab and guide people through the program. When done correctly, vestibular rehabilitation can markedly improve the quality of life for people who are living with dizziness. Exercises to expect when receiving vestibular rehabilitation at FYZICAL include eye movement control, balance retraining, strengthening, and stretching.SummaryFeeling dizzy with eye movement can be disorienting and distressing, and identifying the underlying cause is essential for appropriate management and symptom relief. Physical therapy offers effective symptom management for people with chronic dizziness related to ocular or vestibular dysfunction. By increasing a persons tolerance to head and body movement, vestibular rehabilitation and other balance-oriented physical therapy programs can improve a persons ability to move the eyes without becoming dizzy.  If you want to learn more about physical therapy options to improve balance and dizziness, call FYZICAL today.Locate a FYZICAL near you to learn more about our services.FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life!

Dementia refers to a group of conditions that cause cognitive impairment (difficulty thinking and reasoning) and affect a persons ability to socialize and perform necessary daily functions. Physical symptoms such as trouble balancing, dizziness, vertigo, and urinary or bowel incontinence may develop. Psychological symptoms, such as personality changes, agitation, hallucinations, and anxiety, may also occur, depending on the type of dementia that develops and its progression.Symptoms are largely based on which part of the brain is most affected by dementia. For example, damage to the cerebellum the main part of the brain that is responsible for balance may be the contributing factor when people with dementia experience dizziness.Dementia is subdivided into stages. In the early stages, symptoms are mild and may cause minor functioning problems. As the disease progresses to later stages, symptoms become more severe and prevent people from performing basic life activities, such as bathing or eating.The most common type of dementia among older adults is Alzheimers disease. Other types of dementia include vascular dementia, frontotemporal dementia, Lewy body dementia, and mixed dementia. There is a potential for people with any form of dementia to experience dizziness, but the likelihood of this symptom occurring and its timing may differ based on the type of dementia.Alzheimers DiseaseAlzheimers disease is a progressive condition characterized by the accumulation of abnormal proteins in the brain that leads to the loss of neurons and decreased brain function. The exact cause of Alzheimers disease is unknown but is likely multifactorial, meaning it is caused by a combination of age-related changes, as well as genetic, environmental, and lifestyle factors.Alzheimers is less likely than other degenerative brain diseases to cause balance issues, dizziness, or vertigo because it most commonly affects the brains cortex the part of the brain that is responsible for higher-level functions, including decision-making, impulse control, memory, and personality. Furthermore, evidence suggests that the cortex plays a greater role in maintaining balance than previously believed due to its involvement in processing visual information. This connection could explain the potential for developing dizziness and other balance-related symptoms during Alzheimers disease and other cortex-based forms of dementia, such as frontotemporal dementia (FTD).Research has also demonstrated a potential connection between frequently losing balance and the risk of developing Alzheimers later on in life, suggesting that the loss of balance could be one of the earliest signs of the disease for some people. However, in most cases, balance issues and dizziness develop in the later stages of Alzheimers. As more brain cells become damaged, basic functions such as walking, seeing clearly, and processing the environment become more difficult, making people feel dizzy and off balance.A notable exception to this pattern is posterior cortical atrophy, a specific type of Alzheimers dementia. Balance difficulties are common for people with posterior cortical atrophy because this condition causes damage to the cerebellum. In Alzheimers and other types of dementia, these symptoms can also manifest as a change in gait or how a person walks. Typically, people who feel off balance will avoid lifting their feet while walking, resulting in a shuffling gait.Gait changes can first indicate that someone is suffering from balance problems. Other signs of balance issues include walking unsteadily, bumping into objects, walking in shorter steps, sitting or walking in a stooped position, and turning in small steps. Loved ones should be diligent in watching for these signs, as people with Alzheimers and other forms of dementia can have trouble communicating what is bothering them.Vascular DementiaVascular dementia is the second most common dementia type after Alzheimers, and it is caused by an accumulation of blood clots in the brain that reduce blood flow, causing brain damage and subsequent symptoms. As vascular dementia can affect the entire brain or parts of it, this form of dementia is more likely to cause dizziness and balance issues than other dementia (e.g., Alzheimers). As a result, when people with Alzheimers develop dizziness and balance problems, it is important to evaluate them for vascular dementia.Blood clots can form in any part of the brain, and the symptoms differ based on which part of the brain is affected. Dizziness due to vascular dementia is most often noted when blood clots form in the cerebellum and can occur at any stage of illness, depending on the size and number of blood clots. Bleeding due to a ruptured blood vessel, such as from a stroke, may also cause vascular dementia.Mixed DementiaMixed dementia is diagnosed when a person has symptoms of at least two types of dementia, and it is usually a combination of the most common types Alzheimers disease and vascular dementia. Most people are diagnosed with one form of dementia, usually Alzheimers, and are not diagnosed with mixed dementia until an autopsy is performed.More studies are needed to fully understand the symptoms most often present in mixed dementia. However, similar to vascular dementia and Alzheimers, the symptoms that develop are based on the location and severity of brain damage. Dizziness can potentially develop at any stage, depending on these factors. Mixed dementia highlights the importance of thorough evaluation for other forms of dementia when someone is diagnosed with Alzheimers disease.Frontotemporal DementiaFrontotemporal dementia (FTD) refers to a group of conditions called frontotemporal disorders that primarily affect the frontal and temporal lobes of the brains cortex. The most common form, behavioral variant FTD (bvFTD), causes changes in thought processing. Although bvFTD can run in families, the cause of bvFTD is unknown in most cases. The most common symptoms are personality, judgment, and behavioral changes. People may become disinterested in family or activities that used to bring joy, have increased impulsivity, repeat themselves often, and have difficulty problem-solving. As with Alzheimers, people can also develop balance problems and dizziness as their disease progresses.Additionally, bvFTD can occur together with movement disorders, such as amyotrophic lateral sclerosis (ALS) and Parkinsons disease. Although rare in combination, bvFTD-ALS and bvFTD with parkinsonism are characterized by balance issues from muscle weakness and stiffness, respectively.Lewy Body DementiaLewy body dementia (LBD) is the third most common type of dementia. Although scientists understand that abnormal protein deposition is involved, the exact cause of LBD is unknown. LBD most commonly causes visual hallucinations (seeing things that are not actually there) and changes in concentration, attention, and wakefulness. These symptoms often change throughout the day, and this fluctuation helps differentiate LBD from Alzheimers. LBD also causes movement difficulties, including balance problems and dizziness, more often than Alzheimers. Movement-related symptoms can develop early on in the disease or as it progresses, but symptom development varies on an individual basis.TreatmentAs most types of dementia cannot be cured, treatment focuses on symptom management and preserving a persons quality of life. Whenever someone with dementia has dizziness, they should be evaluated by a health professional. A thorough can help identify possible causes for dizziness other than dementia, including medication side effects and treatable medical problems, such as heart disease. Commonly used medications that can cause dizziness include certain antidepressants, anti-seizure medications, blood pressure-lowering medications, and sedatives. Immediate medical attention is recommended if a person experiences sudden, severe headaches, one-sided weakness, difficulty speaking, or chest pain in addition to dizziness.Occupational and Physical TherapyOccupational and physical therapists (OTs and PTs) can also be helpful with regard to managing dizziness and balance problems caused by dementia. Safety is a primary concern when people with dementia become dizzy, given that older people are most commonly affected and at an increased risk of falling. OTs and PTs can provide helpful recommendations for keeping the home as safe and useable as possible. They can also work with people to reduce muscle weakness and stiffness through safe exercise. Improved muscle strength and flexibility can help prevent falls when someone with dementia is dizzy.There are also exercises that can be done at home with the help of a loved one to improve balance. The exercises described below are low-impact, meaning they slowly raise the heart rate and exert less pressure on the joints, and focus on leg muscle strengthening, as well as preserving bone density. Importantly, all at-home exercises should be discussed with a physical therapist before starting to ensure safety and proper form.Single Leg StandStand next to a chair, only touching the chair if neededLift a leg to stand on one foot and hold for 10 secondsReturn the foot to the floor and repeat 10 times, if possible, on each sideCalf RaisesStand holding the back of the chair, with assistance if neededLift the heels as high as possible, onto tiptoesPlace the heels back on the floor and repeat 10 times, if possibleStraight Leg RaisesLie down on your back, making sure that the lower back is in contact with the floorBend one knee to 90 degrees with the foot on the floor, keeping the other leg straightLift the straight leg to the same level as the bent knee and lower back downRepeat 10 times, if possible, on each side1-Leg StandStand near a chair or countertop for balance assistance, if neededStand on one leg as long as possible, up to 30 secondsSwitch legs and try to repeat 3 to 5 times on each sideWhen this exercise gets easier, try doing additional activities while standing on one leg, such as brushing your teeth or while washing dishesSit to Stand and Stand to SitStand up from a chair without using the arms for assistanceIf difficult at first, sit on a firm pad that lifts you and makes standing easierAs you return to a seated position, slowly lower your body into the chair without dropping suddenly to a seated positionRepeat as many times as possible (doing this exercise while watching TV is recommended)Mobility aids are also typically recommended for people with dementia who experience dizziness and balance problems. These include canes, walkers, and rollators (walkers with wheels). Importantly, these may not be advisable for everyone with dementia, as operating a mobility aid requires a certain level of brain function that may not be possible for all individuals. The option of using a cane or walker should be discussed with a health professional beforehand. Important considerations for cane use include:Usually, a better option if a person favors one sideHolding a cane in the hand opposite the problematic sideHeight should be at about the hip level without causing shoulder raiseFoam handles help with a weak gripRubber tips improve cane tractionAn extra attachment is often needed on the cane end when traveling over icy areasA cane should be hung on a hanging hook, to prevent trippingConsiderations for walker and rollator use include:Having added support for half of the body provided by both armsThe possibility of having a seat if a person needs restRollators are easier to turn, but also require the ability to apply brakesTwo other useful options for people with dementia and dizziness are personal alarms and fall sensors. Personal alarms are an option for people who can operate them. They are worn and activated by the person if a fall occurs. Fall sensors are an alternative option that does not require operation by the person wearing them. These sensors will automatically alert a persons loved one when they experience a sudden motion that is consistent with a fall.SummaryDepending on the type of dementia and the part of the brain affected, dizziness may occur in the early or later stages of dementia. Whenever someone is diagnosed with a form of dementia, the individual, along with loved ones, should be prepared for potential balance problems and dizziness.Managing these and other symptoms of dementia requires a team of caretakers that includes loved ones, physicians, and therapists, among others. Physical therapists can be especially beneficial in helping patients enhance physical strength and improve balance. At FYZICAL, expert physical therapists are available to assess balance and identify people at risk of falling. They will create an individualized treatment program specific to a persons needs, taking into account other symptoms of dementia that affect mobility.Especially useful for people with dementia, FYZICAL has equipment such as the Safety Overhead Support (SOS) system, which uses a harness and ceiling-mounted rails to allow people to exercise without fear of falling. If you or a loved one has dementia and balance difficulties, call FYZICAL to learn more about safe physiotherapy options to improve symptoms and promote a better quality of life.

For more information on the author Fyzical Therapy & Balance Center Fort Myers, CLICK HERE.Chronic DizzinessChronic dizziness is a frustrating, persistent disorder that can significantly interfere with normal daily activities and prevent people from being able to do the things they want to do. Chronic dizziness can take a few different forms, depending on what the precipitating event was, the physical and psychological contributions to the disorder, and the symptoms that are experienced.Chronic dizziness is often initiated by a precipitating medical event. For example, an inner ear infection called labyrinthitis can cause dizziness/vertigo that lasts for several weeks, but typically resolves fully. However, some people continue to experience persistent, fluctuating labyrinthitis symptoms, including dizziness (but not vertigo) and increased sensitivity to complex visual stimuli (e.g. driving in the rain, complicated patterns), that are made worse by passive and active movements (e.g. riding in a car and walking, respectively).To meet criteria for chronic dizziness, symptoms must be present more days than not for at least 3 months. Most people have symptoms for several hours every day. In addition, the disorder must cause significant functional impairment or distress. Triggers usually include an upright posture (standing or walking) and moving visual stimuli.Chronic dizziness is frequently associated with an anxiety disorder that worsens symptom severity. Common symptoms of an anxiety disorder include excessive worrying about life events, loss of ability to carry out routine tasks, and anticipatory anxiety in advance of a situation that may cause dizziness. People who are anxious about becoming dizzy actually increase their risk for a dizzy spell.DizzinessBefore we get into a discussion on chronic dizziness, lets briefly review dizziness types and mechanisms.Dizziness is an umbrella term that includes the following subtypes:Vertigo:A spinning or tilting sensation; a sense of motion when youre not movingPresyncope:Feeling like you are going to faint (fainting is called syncope); also called lightheadedness or giddinessDisequilibrium:A sense of imbalance or instability, often experienced when you are walkingThe vestibular system is an important balance organ, and when it isnt working properly, you will feel dizzy. Consequently, dizziness is sometimes called a vestibular symptom, and disorders that cause dizziness are known as vestibular disorders.Vestibular disorders can be caused by structural (anatomical), functional (physiological), or psychiatric (particularly anxiety) abnormalities.Structural and functional vestibular disorders are initially acute or episodic, but they can both transition to a chronic state. Psychiatric vestibular disorders are not considered to be acute or episodic, rather, they are chronic, progressive conditions.Chronic dizziness treatmentThe most effective treatment approaches to chronic dizziness emphasize a holistic approach that addresses both physical and psychological aspects of the disorder. In many cases, people with chronic dizziness have seen several doctors in a variety of specialties without ever being accurately diagnosed, and the standard dizziness treatments they are given are often ineffective. Many people who have unsuccessfully tried medications find that physical therapy is a more effective treatment strategy.When treating chronic dizziness, it is important to understand what caused it and what contributes to it. For example, one person may have had an acute case of vestibular neuritis that transitioned into chronic dizziness without anxiety, while someone else may have a psychiatric vestibular disorder with high anxiety and panic attacks. Treatment plans for these people may look very different. Treatments should be tailored to suit the specific needs of each patient.Vestibular rehabilitation therapyVestibular rehabilitation therapy (VRT) is the gold standard in treating structural dizziness. VRT is an exercise-based physical therapy program that can alleviate symptoms associated with many forms of chronic dizziness.VRT leads to significant improvements in vertigo symptoms, fall risk, posture and balance, and overall emotional status in people who have vestibular forms of dizziness (i.e. inner ear dysfunction). One recent study found that 79% of VRT patients reported subjective improvements in their chronic dizziness symptoms.VRT is has also successfully helped people with mild forms of psychiatric vestibular disorders, although more serious cases may be better treated by combining VRT with behavioral therapy and, if necessary, medications.Importantly, maximum efficacy requires a commitment from the person being treated. People who are less than 75% compliant with their physical therapy regimen have poorer outcomes than people who are fully compliant.Cognitive behavioral therapyCognitive behavioral therapy (CBT) is one of the most successful behavioral therapies for helping people manage chronic dizziness that has a significant psychological component. CBT identifies negative thought patterns and replaces them with positive ones. Over time, this can significantly reduce chronic dizziness symptoms and improve mood and outlook.Chronic dizziness that has a structural origin (e.g. peripheral vestibular system disorder) or a functional origin (e.g. vestibular neuritis) may respond well to CBT, but physical therapy should also be used to address the physical aspects of the disorder.MedicationsDepending on the cause of your chronic dizziness, some medications may help you manage the symptoms:Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that can be very helpful for people who have psychiatric vestibular disorders or anxiety with dizziness.Benzodiazepines are prescription anti-anxiety drugs that can reduce dizziness and anxiety, but they are for short term, intermittent use only, as they are associated with a high risk for developing physical and psychological dependence/addiction.If your chronic dizziness is related to vestibular migraine, anti-migraine drugs may reduce symptom severity and duration.Nausea and vomiting can be treated with prescription antihistamines or anticholinergics.Although medications have their place in treating anxiety and dizziness disorders, in many cases physical therapy and behavioral therapy are as (or more) effective than pharmacological treatment options.Central nervous system therapiesUntil recently, it was thought that chronic dizziness was the result of impaired compensation after an injury. Compensation is the process of recovering normal function through central and peripheral nervous system reorganization; in other words, your nervous system adapts to overcome damages associated with the injury. Recent evidence suggests that the recovery process is even more complex and includes changes in the way the brain integrates and processes spatial information. If this is proven to be true, it suggests that a peripheral nervous system disorder can have long-term functional consequences in the central nervous system.Treatment options that target the central nervous system are currently being tested, with some promising preliminary results. Transcranial cerebellar direct current stimulation (tcDCS) was shown to enhance the benefits that physical therapy provides, and repetitive transcranial magnetic stimulation (rTMS) treatment was shown to reduce the frequency and severity of dizziness spells.Chronic dizziness and lightheadednessLightheadedness, also known as presyncope, is the feeling that you are about to pass out. Chronic dizziness and lightheadedness may be experienced together, especially if a dysautonomia (a disorder of the autonomic nervous system) or a dysrhythmia (abnormal heartbeat) is also present. Lightheadedness can also be caused by orthostatic hypotension (low blood pressure) that occurs when you stand up too quickly.Chronic dizziness and headachesVestibular migraine is a chronic headache disorder that often includes dizziness or vertigo. Vestibular migraine is characterized by light sensitivity, imbalance, nausea/vomiting, ringing in one or both ears, spatial disorientation, and intolerance to moving visual stimuli.Chronic subjective dizzinessChronic subjective dizziness (CSD) is a unique type of chronic dizziness. It is a progressive disorder that is characterized by disequilibrium and hypersensitivity to complex visual stimuli. CSD is not caused by vestibular dysfunction, and dizziness is linear, rather than vertiginous. Unlike some types of dizziness that are obvious to observers, the dizziness associated with CSD is called subjective imbalance because even though the person with CSD feels imbalanced, they would not appear dizzy or off-balance to an observer.Why some people develop CSD is not yet clear. Evidence suggests that both physical and psychological factors contribute to CSD, and many CSD symptoms are emotional or behavioral. CSD was originally thought to be a psychogenic disorder; that is, a disorder of the mind, without any physical contribution. We now know that there are psychological and physical components to CSD, but the majority of people ('60%) with CSD also have an anxiety disorder.There are three types of CSD:Otogenic CSD: Dizziness developed as a result of a temporary medical condition (e.g. vestibular neuritis) and there was no history of anxiety before the inciting eventPsychogenic CSD: Dizziness develops in the absence of an apparent physical cause and coincides with the course of an anxiety disorderInteractive CSD :Dizziness developed after a transient medical condition in someone with a predisposition to, or a history of, anxiety disordersIn order to be diagnosed with CSD, the following diagnostic criteria must be met:Persistent dizziness without vertigoHypersensitivity to ones own movement and the movement of objects in the environmentSymptoms of CSD are exacerbated by complex visual stimuli (e.g. driving in the rain, moving through a crowd)Symptoms must be present for at least 3 monthsNo evidence of a vestibular disorder or another physical cause (e.g. brain lesion)Balance function test results do not identify the patient as having impaired balanceTreatment options for CSD are similar to those for other types of chronic dizziness, including VRT and physical therapy, cognitive behavioral therapy, and medications.Chronic dizziness and fatigueFatigue is a key trigger of dizziness. Usually, fatigue and dizziness are transient symptoms that resolve with rest, but there are some chronic conditions that include fatigue and dizziness.Chronic fatigue syndromeChronic fatigue syndrome (CFS) is a condition that is characterized by overwhelming fatigue, even after a good nights sleep. In addition to dizziness, CFS symptoms include muscle pain, headaches, difficulty thinking or focusing, insomnia, rapid heart rate, and flu-like symptoms. The cause of CFS is unknown, but stress and anxiety may have a significant role in the development and persistence of CFS symptoms.Postconcussional syndromeFatigue and chronic dizziness are common symptoms after head trauma or whiplash. Other common symptoms include irritability, mood swings, dysphoria, insomnia, weakness, headache, short term memory loss, and inability to focus. Postconcussional symptoms often resolve within a week or so, but they may persist for several weeks, depending on the severity of the trauma and the care received after the accident.Other causes of dizziness and fatigueLow blood pressure and low blood sugar are two common causes of dizziness and fatigue, but they are usually temporary conditions. However, unmanaged diabetes, malnutrition, anemia, and obstructive breathing disorders (e.g. sleep apnea, emphysema) can cause persistent dizziness and fatigue.Vestibular migraine may also cause episodic fatigue and dizziness. Migraine frequency can vary from several attacks per year to near-daily attacks, and dizziness and fatigue may coincide with the migraine or may occur before or after the migraine.Somatic symptom disorder (SSD) is a poorly understood condition that is characterized by persistent physical symptoms (including dizziness and/or fatigue) that do not have an obvious medical explanation. People with SSD are preoccupied with their symptoms and find them to be very disruptive or distressing.Dizziness and nauseaDizziness and nausea are non-specific symptoms, meaning that there are multiple potential causes. Chronic dizziness is often associated with increased sensitivity to complex or moving visual stimuli, which can cause nausea and motion sickness, even if youre not moving. If you regularly suffer from dizziness and nausea, you may want to make an appointment with your doctor to learn about your options. There are several medications that may reduce the severity of your symptoms.Importantly, dizziness or vertigo that is accompanied by ongoing vomiting could indicate a serious, even life-threatening medical issue, and you should seek medical treatment immediately.FYZICAL is a dedicated group of physical therapy providers who are highly trained and skilled in helping people manage symptoms related to chronic dizziness. Using a holistic, whole-body approach, we will work with you to develop an exercise program that can help you get your balance, and your life, back.FYZICAL offers free assessments that can help you understand why you're feeling dizzy and help you explore ways to resolve these symptoms and regain your life.

What Makes People Feel Dizzy?When people report feeling dizzy, it may mean several different things. Dizziness is a term that describes several broad types of symptoms:- Vertigo - a false sensation of movement, especially of whirling, spinning, or being off-balance,- Lightheadedness - sometimes referred to as presyncope (syncope means fainting), this is a feeling of being about to faint,- Disequilibrium - this is a sensation of being unsteady or off-balance that is brought on by visual illusions or other dysfunctions in the visual system of the eyes and brain, and- Psychological - dizziness a variety of symptoms brought on by anxiety or other psychological disorders, often described as a feeling of floating, rocking back and forth, or being removed from ones body.All types of dizziness are a serious concern, as they can cause falls and other accidents. People who suddenly become dizzy while driving may lose control of their vehicle and cause a motor vehicle accident.Besides the significant safety risk, dizziness has been associated with depressive symptoms, worsened self-reported health, and reduced overall well-being.Does COVID-19 Cause People to Feel Dizzy?The first two types of dizziness vertigo and lightheadedness have been associated with COVID-19 infection. The virus that causes COVID-19 (the severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 virus) can bring on dizziness in a variety of ways, some of which are not yet fully understood. COVID-19 has hit humankind hard and fast, and still presents many unanswered questions to medical science.People who are already prone to falls such as the elderly may be especially susceptible to suffer injury from dizziness. Unfortunately, this is the same population that is most susceptible to experience moderate to severe symptoms when infected with COVID-19.Lets look at each of these two types of dizziness and how they are related to COVID-19.Vertigo and COVID-19Vertigo has recently been identified as a symptom of COVID-19. In fact, about 2% of people who become infected with SARS-CoV-2 will experience vertigo as their first symptom.Vertigo is a disturbing and even dangerous symptom. Although vertigo itself is a sensation of spinning, swaying, and being off-balance, its usually also accompanied by nausea and vomiting, visual disturbances, and sweating. These accompanying symptoms may be severe. The dizziness, nausea, vomiting, and sweating usually appear suddenly as if out of nowhere and can cause people to fall from their feet, or lose the ability to control their vehicle if they're driving.Bouts of vertigo can come and go, lasting anywhere from seconds to hours, or they can be constant, lasting days or weeks. Vertigo can be debilitating. People are often so off-balance that they cannot even stand or walk. Even laying in bed with vertigo is uncomfortable, as the world seems to be spinning around. They are often unable to read or even watch TV in many cases because of the whirling sensation and visual disturbances. As well, the nausea and vomiting can be severe, worsening the experience.Vertigo can be caused by anything that affects the body's mechanisms for maintaining our sense of balance. COVID-19 can cause vertigo by disrupting the balance circuits in the brain and the inner ear.Vertigo that is caused by disruption of the brains balance circuits is known as central vertigo, because it involves the brain, which is part of the central nervous system. The brain circuits involved in our sense of balance are primarily in the brainstem and cerebellum.COVID-19, like many other viruses, is known to be neuro-invasive, which means that it is able to get into the brain and cause disease. The research literature has documented that about 36% of people with COVID-19 develop neurological symptoms from the effects of the SARS-CoV-2 virus on the brain.The SARS-CoV-2 virus which causes COVID-19 has been found to cause brain swelling, partial brain cell degeneration, and brain inflammation (encephalitis). It seems to primarily do so through its activation of the immune system, which produces chemicals (cytokines) that can be toxic to the brain.In addition to these mechanisms of injuring the brain, the virus can also cause a stroke. This can occur due to inadequate oxygen supply to the brain due to impaired lung function. As well, COVID-19 is known to cause an increase in blood clotting, which can result in blood clots travelling in the bloodstream and blocking the brains circulation. In these ways, COVID-19 makes infected patients susceptible to stroke, even if the virus doesn't make it to the brain.If any of these mechanisms of injuring the brain occur in the areas responsible for the sense of balance, vertigo may occur. As well, when COVID-19 affects the brain, other symptoms may be present, such as headache, confusion, visual disturbances, and impaired sense of smell.In addition to central vertigo caused by brain dysfunction vertigo can also be caused by inner ear problems; in which case it is known as peripheral vertigo. The inner ear contains the vestibular apparatus, which is an anatomical structure that senses whether or not we are moving or tilted. Anything that disturbs the vestibular apparatus can cause vertigo by fooling the brain into thinking that we are off-balance or moving.COVID-19 can induce peripheral vertigo by causing inflammation of the vestibular nerve (vestibular neuritis), inflammation of the vestibular apparatus itself (labyrinthitis), or by causing inflammation of the nearby middle ear (otitis media).The specific nature of the vertigo symptoms such as how long the bouts of vertigo last, whether or not the vertigo is continuous, and the severity of the vertigo depend upon which part of the balance system is affected. For example, central vertigo may produce different symptoms than will labyrinthitis or vestibular neuritis. This helps doctors and physical therapists assess where the cause of the dizziness is and how best to treat it.Lightheadedness and COVID-19As with vertigo, people who experience lightheadedness the feeling of being about to faint often describe the symptom as dizziness or being dizzy.Lightheadedness is caused by an inadequate oxygen supply to the brain. It usually resolves rapidly as soon as the brain gets enough oxygen again, but fainting, coma, and even death may occur if adequate oxygen supply is not promptly restored.Inadequate oxygen intake and circulation is a common manifestation of severe COVID-19. People with severe cases of COVID-19 may require a breathing life support system (intubation and ventilation) in an ICU until they recover from the infection.COVID-19 can cause lightheadedness in several ways:- Inadequate lung function - COVID-19 causes pneumonia (inflammation of the lungs), which can cause serious impairment of lung function. As well, COVID-19 can cause the part of the brain that controls breathing to malfunction, so that the body stops trying to breathe,- Heart Problems-  even if the lungs and breathing are working properly, inadequate circulation due to heart problems can result in inadequate oxygenated blood getting to the brain. COVID-19 has been associated with several heart problems that can significantly affect circulation:- Heart attack or angina (myocardial ischemia),- Inflammation of the heart (myocarditis), and- Irregular heartbeat (arrhythmia),- Blood clots - COVID-19 is known to cause excessive clotting of the blood (hypercoagulability). This can result in blood clots that travel in the bloodstream (thromboembolism) and cause injury to the lungs, heart, or brain, and- Low blood pressure (hypotension) - COVID-19 has been associated with sudden, extreme drops in blood pressure that can cause impaired circulation and oxygenation of vital body tissues, including the brain.Lightheadedness (presyncope) and/or fainting (syncope) have been reported to occur in about 3% of COVID-19 cases. Most cases are older people (the average age in one study was 69), and those with other health problems, especially heart disease, diabetes, and high blood pressure.COVID-19 Dizziness and VertigoOf the two types of dizziness symptoms associated with COVID-19 vertigo and lightheadedness vertigo is generally the most problematic and severe. Lightheadedness is usually transient and resolves as soon as oxygen supply is restored; often even lying down and elevating the feet (the Trendelenburg position) is all that's required.Vertigo, however, tends to be much longer lasting, and difficult to treat. Unlike lightheadedness, the cause of vertigo dizziness is often difficult to discover, and difficult to treat. At this point, its unclear how long dizziness symptoms will continue in people who develop COID-19-associated vertigo, simply because we don't have enough long-term data available. Some causes of vertigo are associated with chronic dizziness, but we do not yet know if this occurs with COVID-19.Treating Vertigo DizzinessUnfortunately, dizziness from vertigo is difficult to treat, and there are no medications that very effective at relieving the horrible dizziness. Medications are used to try to reduce swelling in the inner ear or brain (such as steroids, diuretics, and antihistamines), and to treat nausea. Unfortunately, many of these medications are very sedating, and do not provide much relief from the dizziness.Hopefully, treating the COVID-19 and allowing the body to heal from the effects of the virus will likely result in the resolution of the vertigo, but we don't yet know for sure what to expect.A type of physical therapy known as vestibular rehabilitation offers a non-medication approach to relieving dizziness from vertigo. Some cases of dizziness from vertigo may not get better unless the individual is treated with specific exercises and physical therapy for their dizziness and balance.Physical therapists are trained to assess each patients dizzy symptoms in order to customize the optimal treatment approach for that individuals specific type of vertigo. This is important because different types of vertigo respond to different types of treatment. This is why expertise in treating vertigo is important when selecting a physical therapist.Vestibular rehabilitation exercises may include walking exercises, head and eye exercises, and balance exercises. As well, physical therapists can provide education about the specifics of the dizziness, and important safety information.With vestibular rehabilitation, physical therapists are able to achieve several specific goals for improving vertigo dizziness and stabilizing balance and gait. This involves using several therapeutic principles that are well known to improve postural control and balance:- Adaptation - this involves training individuals with the symptoms of dizziness to overcome the false perception of movement due to errant signals from the inner ears to the eyes to the brain, spine, and feet.- Habituation - this is where physical therapists introduce repetitive movements that are designed to get the brain used to moving properly despite the vertigo. With repetition, the brain gets used to (habituates to) the vertigo and begins ignoring the false signals from the balance system, and- Sensory substitution - this involves strengthening other senses, specifically vision and sense of touch (proprioception), in order to compensate for the impaired sense of balance.A recently published systematic review of the research literature has shown that exercise-based vestibular rehabilitation provides significant improvements in vertigo symptoms, balance, and the emotional effects of dealing with dizziness, as well as reducing the risk of falls from dizziness.Dizziness Treatment at FYZICALFYZICAL Therapy & Balance Centers provide specialized physical therapy for a wide variety of musculoskeletal, neurological, and inner ear conditions that cause dizziness and poor balance, including vertigo.The dizziness treatment program at FYZICAL uses established proprietary treatment and recovery protocols that include specialized cutting-edge equipment that is not available at other physical therapy centers. This makes the specialized physical therapists at FYZICAL an excellent choice for those seeking relief from dizziness of any kind.The FYZCAL physical therapy team concentrates on strengthening the impaired vestibular system and engaging neuroplasticity the ability of the brain to learn new movements and behaviors to optimize other senses (such as vision and touch) to compensate for the brains or inner ears inability to maintain a proper sense of balance. This optimizes adaptation, habituation, and sensory substitution for helping get dizzy patients back on their feet and functioning again.FYZICAL offers low-cost assessments to diagnose dizziness and to determine each individuals falling risk. The physical therapists at FYZICAL will then create a recovery program tailored to each patients specific condition and needs.FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you ,visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life!To learn more about how FYZICAL Therapy & Balance Centers can help you, click here.During the COVID-19 pandemic, FYZICAL remains dedicated to the health and safety of our employees and patients. The situation is rapidly evolving, but we continue to monitor and follow the latest health and safety guidelines from the CDC (Centers for Disease Control and Prevention) and local public health organizations. For more information about your safety at FYZICAL Therapy and Balance Centers.Article Written & Submitted By: FYZICAL (click here for more information)

For more information on the author Fyzical Therapy & Balance Center Sarasota, CLICK HERE.Waking up feeling dizzy can be a disorienting and scary experience, but if it happens infrequently, there is probably no cause for concern. Occasional dizziness is very common, and there are several reasons why you may feel dizzy, woozy, or off balance in the morning. However, if you frequently wake up with dizziness, it may be time to make an appointment with a doctor to rule out serious health concerns.There are several forms of dizziness, including imbalance, lightheadedness or wooziness, vertigo, and dizziness related to anxiety or fear. Vertigo is a unique type of dizziness in that it includes a spinning or rotating component. You may experience any of these forms of dizziness when you wake up.Physical therapy is an effective way to manage dizziness symptoms, regardless of the cause. The providers at FYZICAL are highly trained and have experience in helping people overcome dizziness and get their mornings back on track. Using evidence-based methods, our holistic therapies provide an effective strategy to minimize dizziness without the need for medications or surgical approaches.What is the cause of dizziness?Dizziness is not a disorder, but rather a symptom that can be caused by many things. For people who are experiencing dizziness when they wake up, dysfunction in the circulatory system or peripheral vestibular system may be the cause. Some medications can also cause morning dizziness, as can alcohol and recreational drugs. Even dehydration or low blood sugar can make you feel dizzy.To understand dizziness that occurs when you wake up, it may be helpful to understand how our bodies keep us balanced under normal circumstances and where things can go wrong.The circulatory systemWithout adequate blood flow, brain cells don't receive the fuel they need, and you will feel dizzy or lightheaded. The circulatory system plays a crucial role in maintaining normal brain function. The brain is an energy-intensive organ, using about 25% of the oxygen you breathe and about 60% of the glucose (sugar) that you eat. In some cases, there may be adequate blood flow but there is not enough oxygen or glucose to sustain brain function. Disorders like sleep apnea can prevent your brain from getting enough oxygen while you sleep, and going to bed on an empty stomach can cause low blood sugar-induced dizziness when you wake up. People with diabetes are at particular risk for low blood sugar that can lead to dizziness and pre-syncope (feeling like you're going to faint) or syncope (fainting).The vestibular systemMost of us rarely think about the ear as anything other than our hearing organ, but the ear contains one of our most important balance organs, the peripheral vestibular system. There are three section of the ear: the outer ear, which is made up of the ear lobe and the canal; the middle ear, which includes the bones of hearing and Eustachian tube, which regulates pressure; and the inner ear, which is composed of the cochlea and the peripheral vestibular system.The peripheral vestibular system also plays a role in maintaining proper blood flow. Because it senses your spatial orientation, it influences blood flow. When the brain receives signals that you have gone from lying down to standing up, for example, the cardiovascular system changes how it directs blood flow in order to accommodate your change in position.The peripheral vestibular system plays a major role in helping us maintain consistent balance. The peripheral vestibular system is housed in the inner ear, and has two important components:Otolithic organsThe otolithic organs, or otoliths, are tiny inner ear structures that sense linear motion (up/down, left/right, forward/backward) and transmit information about our spatial orientation to the brain. The otoliths are found under a sticky gelatinous membrane that contains embedded calcium carbonate crystals. Every time you move, the membrane also moves, and the embedded crystals activate inner ear hair cells that go on to send information about the speed and direction of your motion to the brain. If these hair cells are activated erroneously, the brain receives incorrect information regarding whether and how you are moving, which leads to a feeling of imbalance or dizziness.Semicircular canalsThe inner ear has three semicircular canals that are filled with fluid. When you turn your head to the left or right, tilt your head toward your shoulder, or nod up and down, the fluid moves through the canals, sending information about your rotational movements to the brain. When inner ear fluid is displaced inappropriately, you will experience the characteristic spinning sensation known as vertigo.The peripheral vestibular system of the inner ear sends information to the central vestibular system, which is located in the brain. Under normal circumstances, the brain integrates information from your peripheral vestibular system with information from other systems (visual, motor, sensory) about your movement, and you maintain balance and equilibrium. If the peripheral vestibular system is active when you arent moving, the brain receives mismatched information from the different systems, causing you to lose equilibrium.Although dizziness can be caused by central vestibular system dysfunction, the majority of cases of dizziness are caused by abnormalities in the peripheral vestibular system. Physical therapy is an evidence-based treatment strategy that can treat inner ear disorders and provide long-term improvements to balance and equilibrium.Waking up dizzy in the morningWaking up to a spinning room or without normal equilibrium is never a good way to start your day. There are a number of potential causes for waking up feeling dizzy, and many of them can be prevented with some simple lifestyle changes.DehydrationDehydration is one of the most common reasons why people are dizzy when they wake up. When you're dehydrated, you actually lose blood volume. This makes your blood pressure drop, resulting in insufficient delivery of oxygenated blood to the brain. This can make you feel dizzy when you are lying down, and the dizziness will worsen when you go from lying down to standing up.A common factor in dehydration-related dizziness in the morning is alcohol. If you woke up dizzy and nauseous or in a room that was spinning after a night of imbibing, alcohol is a likely culprit.Low blood sugarIn order to maintain normal function, the brain depends on a sugar called glucose for energy. When you eat, glucose is transported from your digestive system to your blood stream and delivered to the brain. If you skip dinner, you may experience dizziness the next morning because your blood doesn't have sufficient amounts of glucose to keep your brain working properly. Low blood glucose is also called low blood sugar or hypoglycemia.DiabetesDiabetes is a condition that affects blood glucose (sugar) levels. People with diabetes are missing an enzyme that allows glucose to get into the bloodstream, so diabetics have an increased risk for low blood sugar in the morning, which can lead to dizziness and fainting. Sleep apnea and other obstructive breathing conditionsAnything that interferes with your breathing will reduce the amount of oxygen that gets to your brain, leaving you feeling dizzy or woozy. A common complaint among people with obstructive breathing conditions is, I woke up in the middle of the night feeling dizzy. While sleep apnea is the most common type of obstructive breathing condition, others include chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma. Even having a common cold could interfere with normal breathing while you sleep.Orthostatic hypotensionIf your morning dizziness sets in when you first sit up or get out of bed, you may be experiencing orthostatic (or postural) hypotension. This is a condition that is caused by inadequate blood flow to the brain and occurs when people get up too quickly after they have been sitting or lying down. Dizziness or lightheadedness related to orthostatic hypotension lasts for just a second or two, so if your dizziness is persistent, there is probably something else contributing to it.MedicationsSome medications are known to cause dizziness, and you may wake up in the middle of the night or in the morning feeling lightheaded or faint. Blood pressure medications like ACE inhibitors, beta-blockers, and calcium-channel blockers can all cause dizziness. In addition, drug interactions may leave you feeling dizzy.Benign paroxysmal positional vertigo (BPPV)Benign paroxysmal positional vertigo, or BPPV, is a disorder of the inner ears peripheral vestibular system. When we move, crystals in the inner ear activate tiny hair cells that send information about our movements to the brain. These are normally attached to a membrane so they cant accidentally activate hair cells. Age-related degeneration or head trauma can cause these crystals to become detached, and they activate hair cells at inappropriate times. This signals to the brain that we are moving even when were not.If you regularly experience vertigo when waking up, you may have BPPV. People with BPPV often get vertigo when they roll over in bed or turn their head. BPPV can also affect just one ear, which would cause dizziness only when you turn or roll to one side. BPPV-related vertigo lasts for 15-20 seconds, and BPPV can also cause lightheadedness, nausea and vomiting, nystagmus (rapid, involuntary eye movements), and fainting.Other causes of dizziness in the morningLabyrinthitis: This is inflammation in the inner ear that affects nerve signaling between the peripheral vestibular system and the brain. It may be caused by an ear infection or head trauma, and usually resolves within 3-6 weeks. Some people with labyrinthitis may be especially prone to dizziness after a period of lying down, especially if they sleep in a position that allows fluid to accumulate in the affected inner ear.Mnire's disease: Mnire's disease is a rare disease that is still poorly understood. It is associated with severe vertigo that can last for several hours. Other symptoms of Mnire's disease include tinnitus (ringing in one or both ears), intermittent hearing loss in one or both ears, and a sensation of fullness in the ear.Anxiety: If your dizziness always occurs on the morning of a big day, anxiety could be the cause. There are several helpful exercises that can help you control anxiety and minimize dizziness without resorting to anti-anxiety medications.When to see a doctorIn most cases, occasionally waking up feeling dizzy is not a serious cause for concern. However, if you are regularly experiencing dizziness or vertigo when you wake up, it is recommended that you make an appointment with your doctor.If your dizziness is accompanied by any of the following, seek immediate medical treatment:Chest painTrouble breathingRapid heart rateConfusionSlurred speechSevere headacheNumbness in the face, arms, or legsDouble visionOngoing vomitingHow to stop feeling dizzyFor many people, drinking plenty of water, eating a healthy diet, and making sure to get some exercise to promote blood flow are sufficient to prevent dizziness. If you are taking prescription medications, ask your doctor whether they could be causing your dizziness.One of the most effective ways to manage dizziness is physical therapy. Nearly all of the root causes of dizziness respond well to physical therapy, and providers who are experienced in treating dizziness can tailor an exercise plan to meet your needs.The experts at FYZICAL are highly trained and skilled in treating different forms of dizziness. Our holistic, whole-body approach doesn't depend on medications or surgery, and many people find that the benefits of physical therapy go beyond helping them overcome dizziness.FYZICAL offers free assessments that can help you understand your dizziness and anxiety and create a tailored exercise program that will help you manage your symptoms.

Having good balance is a critical component of healthy aging. Everyday activities like reaching for your coffee cup, bending down to pick up the paper, putting on your shoes, and getting up from a chair require subtle shifts in your body's weight distribution. A healthy sense of balance allows you to hold your position or move at will during these weight fluctuations without falling.Gravity is constantly pulling you downward, giving you the tendency to fall, but your ability to balance prevents this from happening. Balance control is a complex physiological process and, just as with muscles, if you don't use it, you lose it. As the body ages, muscle strength, joint range of motion, and reaction time all decrease. These factors can have a negative effect on an older persons balance control and may lead to balance dysfunction a factor linked to falls among the elderly.Falls from poor balance can cause serious, and even life-threatening, injuries. In fact, according to the CDC, accidental falls are the leading cause of death among older adults. Each year, one in three adults over the age of 65 falls, and the risk of falling increases proportionately with age at80 years, over half of seniors fall annually1. Recovery from a fall can sometimes take at least a year in a long-term facility, with some patients never returning to their homes. Among this age group, falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths. Most of the fractures caused by falling are in the arm, hand, ankle, spine, pelvis, and hip, with hip fractures being one of the most serious types of fall injury, often resulting in long-term functional impairment, nursing home admission, and increased mortality One out of five hip fracture patients dies within a year of their injury.In fact, falls account for 25% of all hospital admissions, and 40% of all nursing home admissions 40% of those admitted to nursing homes do not return to independent living; 25% die within a year.These statistics are pretty grim but don' t for a minute think that there's nothing you can do about it or that it wont happen to you. Perhaps you believe that if you limit your activities and become even more sedentary that your chances of falling will decrease (not true!). If you think you can avoid falling as long as you stay at home, know this: The majority of all falls take place inside the home5. Those who do fall are two-to-three-times more likely to fall again, and many people who fall, even if they are not seriously injured, develop a fear of falling.Injuries from falls, reduced mobility and activity, and the fear of falling can significantly reduce your quality of life, making you dependent on others and taking away your freedom to move and live independently.But here's the good news: Falls are preventable. Falling is not an inevitable result of aging, and there are steps you can take to improve your balance and decrease your chances of falling.Muscle strength and flexibility, which are an imperative part of maintaining good balance, decrease with age, especially for sedentary adults, but these can be partially restored with the right physical therapy program.Studies have shown that attention to certain risk factors, such as impaired balance, can significantly reduce rates of falling. Considerable evidence indicates that the most effective fall reduction programs involve systematic fall risk assessment and targeted interventions6.Additional research reveals that a physical therapist-prescribed exercise program targeting balance and strength can be effective in improving a number of balance and related outcomes in older people with mild balance impairment.At FYZICAL, we have a comprehensive Balance Program that includes assessment and evaluation programs, balance retraining, and vestibular rehabilitation. With balance retraining and vestibular rehabilitation, our goal is to improve balance function and visual-motor control, increase general activity levels, and help your body compensate for inner ear disorders. We utilize a state-of-the-art balance machine and our balance therapy programs have a 99% balance improvement success rate.As balance dysfunction can sometimes cause problems with walking, we also have a Gait Training program. Gait training consists of making sure that your manner of walking is as effective, sure-footed, and safe as it possibly can be. A balanced, steady gait helps in the prevention of falls and injuries. Strength, endurance, motion, balance, and coordination are all components of an effective gait and our certified physical therapists work with patients to help them reach their goal of safe mobility.Improving your balance can reduce your risk of falling, so make it a priority to get a balance assessment test from your doctor or a certified Physical Therapist. Then, find a physical therapy facility that employs aqua therapy. Once that's complete, a program of physical therapy specifically tailored to your balance needs will be created so you can begin your quest to regain your footing, your confidence, and your freedom.1 Falls Among Older Adults: An Overview, Centers for Disease Control and Prevention,http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html2 Ibid.3 Hip Fractures Among Older Adults, Centers for Disease Control and Prevention,http://www.cdc.gov/HomeandRecreaionalSafety/Falls/adulthipfx.html4 How Often Falls Occur, Learn Not to Fall, http://www.learnnottofall.com/content/fall-facts/how-often.jsp5 Where Seniors Fall, Learn Not to Fall,http://www.learnnottofall.com/content/fall-facts/where-seniors-fall.jsp6 Judy A. Stevens, A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults,2nd Edition (Atlanta: CDC, 2010),1.7 Xiao Jing Yang, et al., Effectiveness of a Targeted Exercise Intervention in Reversing Older Peoples Mild Balance Dysfunction: A Randomized Controlled Trial, Physical Therapy, 92 (2012).8 Noh DK, et al., The Effect of Aquatic Therapy on Postural Balance and Muscle Strength in Stroke Survivors A Randomized Controlled Pilot Trial, PubMed: ClinRehabil, 2088 (10-11),http://www.ncbi.nlm.nih.gov/pubmed/189554289 MelissaGaskil, Finding the Way,TodayinPT.com

Dizziness is one of the most common problems that prompt a visit to the doctors office, affecting about 15% to 35% of adults in the general population. Although doctors typically define dizziness as having disturbed or impaired spatial orientation, symptoms can be experienced in a variety of ways. When someone mentions feeling dizzy, this could mean that the person feels lightheaded, confused, nauseous, unbalanced or unsteady, disoriented, or as if the room is spinning.Feeling dizzy can be alarming, but it is rarely a sign of a life-threatening illness. In most cases, dizziness occurs in healthy people and is not a sign of any underlying medical condition. However, people who struggle with chronic dizziness are more likely to experience symptoms of depression, social impairments, and negative perceptions of their health. This article will review some of the most common causes of dizziness in healthy people along with ways to manage them.DehydrationAbout 70% of the human body is composed of water, so adequate hydration is key. Although the exact amount of water each adult needs per day varies, the risk of dehydration increases when people consistently drink inadequate amounts of water. Dehydration results from an imbalance of fluid intake and excretion, where the body uses or loses more fluid than it takes in.Symptoms of dehydration in adults include dizziness, decreased urination, dark-colored urine, muscle aches, dry mouth, headache, fatigue, confusion, and severe thirst. Although people with chronic illnesses are more likely to experience dehydration, healthy people can also become dehydrated and dizzy. Strenuous exercise without adequate hydration or simply sweating a lot on a hot day can also make a healthy person become dehydrated. In addition, alcohol consumption can lead to dehydration in otherwise healthy people.Preventing and treating dehydration starts with recognizing the signs and symptoms and drinking more water. Prevention is always best, so healthy people who are exercising or notice themselves sweating on a hot day should remember to hydrate during their daily activities. Once the symptoms of dehydration begin, hydrating becomes even more important to make up for water loss. If drinking water does not improve dizziness or the symptoms worsen, medical care is recommended. Symptoms such as severe headaches and confusion often warrant immediate medical evaluation.StressAnother common cause of dizziness in healthy people is stress, which refers to a real or perceived threat to a persons sense of equilibrium (emotional and physical balance). In some cases, dehydration is related to stress, as the loss of electrolytes and healthy blood volume can cause feelings of stress, weakness, and dizziness. The opposite is also true, as stress can lead to dehydration by altering liquid intake.In addition to altering drinking patterns, stress triggers the adrenal glands to produce cortisol one of the bodys stress hormones involved in regulating blood pressure and metabolism. Chronic stress eventually exhausts the adrenal glands, leading to low electrolyte levels and dehydration. Stress can also lead to dizziness because of its effects on breathing. For example, hyperventilating when under intense stress is a common issue that occurs in some people without an underlying cause other than feeling stressed.Although stress cannot always be avoided, it is important to find ways to cope with and manage stress effectively. Learning how to deal with stress is a lifelong practice, but due to its intimate connection to dehydration, drinking water consistently is fundamentally important for reducing stress. Additionally, implementing coping strategies and reasonable self-care goals when feeling chronically stressed is essential. Key approaches include exercising, eating nutritious foods, learning and practicing time management, setting realistic goals, practicing mindfulness skills and breathing exercises, sleeping for longer periods, and prioritizing rest and activities that bring joy.These strategies can improve symptoms of stress, such as dizziness, and prevent chronic stress from developing into anxiety or depressive disorders. Overall, stress can alter various aspects of life, including the ability to stay hydrated, and being dehydrated can lead to dizziness, which may worsen stress levels. This vicious cycle can cause a healthy person to struggle with chronic dizziness if active steps are not taken right away. It is always best to speak with a medical professional if a health issue appears to be contributing to increased stress and dizziness.Orthostatic HypotensionAnother cause of dizziness that may be related to dehydration is orthostatic hypotension, which is also known as postural hypotension. Orthostatic hypotension is a form of low blood pressure that develops when a person transitions to standing from sitting or lying down. When people stand up, the body usually responds by increasing blood pressure to allow adequate blood flow to the brain and to prevent the pooling of blood in the lower half of the body. Orthostatic hypotension develops when this mechanism fails and results in dizziness upon standing. In healthy people, orthostatic hypotension most commonly occurs due to dehydration, low blood sugar, prolonged bed rest, sudden pain, or an emotional stimulus. In addition to causing dizziness, orthostatic hypotension may also cause lightheadedness, blurry vision, weakness, confusion, and fainting.Orthostatic hypotension can be diagnosed through blood pressure monitoring while sitting and standing. The criteria for a diagnosis include a decrease in systolic blood pressure (the top number of the blood pressure reading) by 20 mmHg within two minutes to five minutes of standing or a drop in diastolic pressure (the bottom number of the blood pressure reading) by 10 mmHg within the same time frame. For healthy people, treatment typically involves behavior management, staying hydrated, and increasing food intake if low blood sugar is a contributing factor.Behavioral changes include taking care to stand up slowly, especially after periods of prolonged bed rest, and sitting back down if lightheadedness or dizziness occurs while standing up. People who experience occasional orthostatic hypotension should monitor their symptoms. If they notice symptoms become more regular, they should be evaluated by a medical professional to rule out possible underlying diseases or medications that could contribute to this issue.Low Blood SugarMaintaining normal blood sugar is essential for all people, as it is the main energy source for all body processes. As previously mentioned, low blood sugar can cause orthostatic hypotension, which may lead to dizziness or fainting. Independent of orthostatic hypotension, low blood sugar can cause dizziness due to its effect on brain function. In the absence of adequate carbohydrate intake, one of the bodys primary sources of glucose (blood sugar), the brain struggles to maintain its energy supply, leading to symptoms such as dizziness, lightheadedness, confusion, and jitteriness. Common causes for low blood sugar in otherwise healthy people include diets that are low in carbohydrates, protein, fat, and fiber, as well as intense exercise and drinking alcohol. Along with avoiding alcohol and increasing food intake after exercise, healthy people can prevent low blood sugar by eating nutrient-dense foods. Low blood sugar episodes are more likely to occur after eating foods with high amounts of refined sugar, such as cookies or cakes. For people who experience occasional episodes of low blood sugar, eating foods with a high protein, fat, and fiber content promotes satiety and helps protect against rapid drops in blood sugar. Eating small meals frequently throughout the day is also recommended for people who experience low blood sugar. In addition, if someone is having an episode of low blood sugar, experts recommend eating or drinking something that will raise blood sugar quickly, such as a glass of juice or candy. Once the symptoms improve, it is essential to have a more substantial meal.It is also important to remember that frequent episodes of symptomatic low blood sugar can be a sign of disease, such as adrenal insufficiency, where the adrenal glands do not produce enough cortisol. This condition may lead to low blood sugar, low blood pressure, low electrolyte levels, dizziness, and fatigue. A medical professional should evaluate anyone who experiences low blood sugar on a regular basis.Alcohol and Marijuana UseAlcohol use can lead to dizziness by causing dehydration or low blood sugar. Additionally, alcohol use may result in dizziness by causing vertigo. Vertigo is the sensation that the environment around you is spinning. This condition is associated with issues in the central nervous system (brain or spinal cord) or the inner ear. Alcohol is known to strongly affect the inner ear by causing fluid depletion in the inner ear canals, which can make people feel dizzy. These symptoms typically result from heavy alcohol use and are more common with prolonged, heavy alcohol consumption.Avoiding alcohol is the best way to prevent dizziness caused by excessive alcohol consumption. For people who continue drinking alcohol, staying well hydrated with water while consuming alcohol can help prevent adverse effects. It is also important to avoid combining alcohol with other central nervous system depressants, such as benzodiazepines (Xanax, Valium). The combined effects can cause dangerously low blood pressure, dizziness, fainting, and potentially death.Marijuana also has the potential to cause dizziness, especially when it is used at higher doses. This side effect is due to marijuanas influence on blood pressure. The most common cannabinoid in marijuana, tetrahydrocannabinol (THC), is known to dilate blood vessels, leading to increased heart rate and low blood pressure. People often notice symptoms when transitioning from sitting to standing while using marijuana. Avoiding marijuana use helps prevent these types of side effects, but for people who use marijuana, staying well hydrated and being careful when standing after prolonged periods of sitting can help reduce dizziness.Motion SicknessMotion sickness is another common cause of dizziness in healthy people. This issue develops when the bodys external experience of motion differs from that of the inner ear, leading to dizziness, nausea, or vomiting. Motion sickness may occur in cars, buses, airplanes, boats, or other vehicles. The most effective way to prevent motion sickness is to avoid situations that cause it, but this method is not usually practical for most people who travel regularly.Ways to prevent motion sickness while traveling include sitting in the front seat of the car or bus, having a window seat on airplanes or trains, looking at the horizon, sleeping or shutting your eyes, lying down if possible, eating small amounts of food frequently, listening to music, and staying hydrated with water while avoiding alcoholic or caffeinated beverages.There are also medicines available to treat motion sickness that do not improve with the recommended strategies. Common medications used to treat motion sickness include diphenhydramine (Benadryl), dimenhydrinate (Dramamine), and scopolamine. People who are considering using these medications for motion sickness should discuss which option is best for them with a health professional.Most importantly, some of these medicines are not recommended for children. Additionally, while motion sickness medications tend to cause sleepiness in adults, they can make children more awake. Therefore, discussing motion sickness treatment with a childs pediatrician before starting these medications is especially important.SummaryDizziness is incredibly common and has a variety of causes in healthy people. Understanding the causes can help people avoid dizziness by managing risk factors and intervening early when possible. However, the causes described here are preventable, treatable, and often not a sign of disease; it is best to discuss symptoms with a health professional, especially for symptoms that do not improve after implementing commonly used strategies.Importantly, people with prolonged or worsening dizziness should be evaluated by a medical professional who can help identify the underlying cause of dizziness, rule out potentially life-threatening health problems, and provide recommendations that help improve their symptoms. Additional signs that require professional advice include severe, sudden headaches, abrupt hearing changes, confusion or slurred speech, and facial numbness or weakness.Physical Therapy May HelpFor people who experience chronic dizziness, physical therapy can also be helpful. Physical therapists are experts in safe body movement and can provide guidance regarding techniques that can help reduce troubling symptoms, including imbalance. They can also perform testing to help determine an underlying cause for chronic dizziness. Based on their evaluation, physical therapists will create a personalized treatment plan in line with your recovery goals. Depending on the results, they may refer you to a physician or a specialist.The goals of physical therapy include improvements to:BalanceStrength and flexibilityGate stabilizationFYZICAL Therapy and Balance Centers offers various programs to treat dizziness balance problems, including fall prevention and balance retraining, vestibular rehab, and gait training and balance programs. They also have state-of-the-art equipment, like the Safety Overhead Support (SOS) system, that allows people to exercise without any fall risk. At FYZICAL, expert physical therapists will work with you to choose the safest and most effective treatment program for your symptoms. Call FYZICAL today to learn more about the benefits of individualized physiotherapy for chronic dizziness and balance problems.

For more information on the author Fyzical Therapy & Balance Center Fort Myers, CLICK HERE.Waking up feeling dizzy can be a disorienting and scary experience, but if it happens infrequently, there is probably no cause for concern. Occasional dizziness is very common, and there are several reasons why you may feel dizzy, woozy, or off balance in the morning. However, if you frequently wake up with dizziness, it may be time to make an appointment with a doctor to rule out serious health concerns.There are several forms of dizziness, including imbalance, lightheadedness or wooziness, vertigo, and dizziness related to anxiety or fear. Vertigo is a unique type of dizziness in that it includes a spinning or rotating component. You may experience any of these forms of dizziness when you wake up.Physical therapy is an effective way to manage dizziness symptoms, regardless of the cause. The providers at FYZICAL are highly trained and have experience in helping people overcome dizziness and get their mornings back on track. Using evidence-based methods, our holistic therapies provide an effective strategy to minimize dizziness without the need for medications or surgical approaches.What is the cause of dizziness?Dizziness is not a disorder, but rather a symptom that can be caused by many things. For people who are experiencing dizziness when they wake up, dysfunction in the circulatory system or peripheral vestibular system may be the cause. Some medications can also cause morning dizziness, as can alcohol and recreational drugs. Even dehydration or low blood sugar can make you feel dizzy.To understand dizziness that occurs when you wake up, it may be helpful to understand how our bodies keep us balanced under normal circumstances and where things can go wrong.The circulatory systemWithout adequate blood flow, brain cells dont receive the fuel they need, and you will feel dizzy or lightheaded. The circulatory system plays a crucial role in maintaining normal brain function. The brain is an energy-intensive organ, using about 25% of the oxygen you breathe and about 60% of the glucose (sugar) that you eat. In some cases, there may be adequate blood flow but there is not enough oxygen or glucose to sustain brain function. Disorders like sleep apnea can prevent your brain from getting enough oxygen while you sleep, and going to bed on an empty stomach can cause low blood sugar-induced dizziness when you wake up. People with diabetes are at particular risk for low blood sugar that can lead to dizziness and pre-syncope (feeling like youre going to faint) or syncope (fainting).The vestibular systemMost of us rarely think about the ear as anything other than our hearing organ, but the ear contains one of our most important balance organs, the peripheral vestibular system. There are three section of the ear: the outer ear, which is made up of the ear lobe and the canal; the middle ear, which includes the bones of hearing and Eustachian tube, which regulates pressure; and the inner ear, which is composed of the cochlea and the peripheral vestibular system.The peripheral vestibular system also plays a role in maintaining proper blood flow. Because it senses your spatial orientation, it influences blood flow. When the brain receives signals that you have gone from lying down to standing up, for example, the cardiovascular system changes how it directs blood flow in order to accommodate your change in position.The peripheral vestibular system plays a major role in helping us maintain consistent balance. The peripheral vestibular system is housed in the inner ear, and has two important components:Otolithic organsThe otolithic organs, or otoliths, are tiny inner ear structures that sense linear motion (up/down, left/right, forward/backward) and transmit information about our spatial orientation to the brain. The otoliths are found under a sticky gelatinous membrane that contains embedded calcium carbonate crystals. Every time you move, the membrane also moves, and the embedded crystals activate inner ear hair cells that go on to send information about the speed and direction of your motion to the brain. If these hair cells are activated erroneously, the brain receives incorrect information regarding whether and how you are moving, which leads to a feeling of imbalance or dizziness.Semicircular canalsThe inner ear has three semicircular canals that are filled with fluid. When you turn your head to the left or right, tilt your head toward your shoulder, or nod up and down, the fluid moves through the canals, sending information about your rotational movements to the brain. When inner ear fluid is displaced inappropriately, you will experience the characteristic spinning sensation known as vertigo.The peripheral vestibular system of the inner ear sends information to the central vestibular system, which is located in the brain. Under normal circumstances, the brain integrates information from your peripheral vestibular system with information from other systems (visual, motor, sensory) about your movement, and you maintain balance and equilibrium. If the peripheral vestibular system is active when you arent moving, the brain receives mismatched information from the different systems, causing you to lose equilibrium.Although dizziness can be caused by central vestibular system dysfunction, the majority of cases of dizziness are caused by abnormalities in the peripheral vestibular system. Physical therapy is an evidence-based treatment strategy that can treat inner ear disorders and provide long-term improvements to balance and equilibrium.Waking up dizzy in the morningWaking up to a spinning room or without normal equilibrium is never a good way to start your day. There are a number of potential causes for waking up feeling dizzy, and many of them can be prevented with some simple lifestyle changes.DehydrationDehydration is one of the most common reasons why people are dizzy when they wake up. When you're dehydrated, you actually lose blood volume. This makes your blood pressure drop, resulting in insufficient delivery of oxygenated blood to the brain. This can make you feel dizzy when you are lying down, and the dizziness will worsen when you go from lying down to standing up.A common factor in dehydration-related dizziness in the morning is alcohol. If you woke up dizzy and nauseous or in a room that was spinning after a night of imbibing, alcohol is a likely culprit.Low blood sugarIn order to maintain normal function, the brain depends on a sugar called glucose for energy. When you eat, glucose is transported from your digestive system to your blood stream and delivered to the brain. If you skip dinner, you may experience dizziness the next morning because your blood doesnt have sufficient amounts of glucose to keep your brain working properly. Low blood glucose is also called low blood sugar or hypoglycemia.DiabetesDiabetes is a condition that affects blood glucose (sugar) levels. People with diabetes are missing an enzyme that allows glucose to get into the bloodstream, so diabetics have an increased risk for low blood sugar in the morning, which can lead to dizziness and fainting. Sleep apnea and other obstructive breathing conditionsAnything that interferes with your breathing will reduce the amount of oxygen that gets to your brain, leaving you feeling dizzy or woozy. A common complaint among people with obstructive breathing conditions is, I woke up in the middle of the night feeling dizzy. While sleep apnea is the most common type of obstructive breathing condition, others include chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma. Even having a common cold could interfere with normal breathing while you sleep.Orthostatic hypotensionIf your morning dizziness sets in when you first sit up or get out of bed, you may be experiencing orthostatic (or postural) hypotension. This is a condition that is caused by inadequate blood flow to the brain and occurs when people get up too quickly after they have been sitting or lying down. Dizziness or lightheadedness related to orthostatic hypotension lasts for just a second or two, so if your dizziness is persistent, there is probably something else contributing to it.MedicationsSome medications are known to cause dizziness, and you may wake up in the middle of the night or in the morning feeling lightheaded or faint. Blood pressure medications like ACE inhibitors, beta-blockers, and calcium-channel blockers can all cause dizziness. In addition, drug interactions may leave you feeling dizzy.Benign paroxysmal positional vertigo (BPPV)Benign paroxysmal positional vertigo, or BPPV, is a disorder of the inner ears peripheral vestibular system. When we move, crystals in the inner ear activate tiny hair cells that send information about our movements to the brain. These are normally attached to a membrane so they cant accidentally activate hair cells. Age-related degeneration or head trauma can cause these crystals to become detached, and they activate hair cells at inappropriate times. This signals to the brain that we are moving even when were not.If you regularly experience vertigo when waking up, you may have BPPV. People with BPPV often get vertigo when they roll over in bed or turn their head. BPPV can also affect just one ear, which would cause dizziness only when you turn or roll to one side. BPPV-related vertigo lasts for 15-20 seconds, and BPPV can also cause lightheadedness, nausea and vomiting, nystagmus (rapid, involuntary eye movements), and fainting.Other causes of dizziness in the morningLabyrinthitis: This is inflammation in the inner ear that affects nerve signaling between the peripheral vestibular system and the brain. It may be caused by an ear infection or head trauma, and usually resolves within 3-6 weeks. Some people with labyrinthitis may be especially prone to dizziness after a period of lying down, especially if they sleep in a position that allows fluid to accumulate in the affected inner ear.Mnire's disease: Mnire's disease is a rare disease that is still poorly understood. It is associated with severe vertigo that can last for several hours. Other symptoms of Mnire's disease include tinnitus (ringing in one or both ears), intermittent hearing loss in one or both ears, and a sensation of fullness in the ear.Anxiety: If your dizziness always occurs on the morning of a big day, anxiety could be the cause. There are several helpful exercises that can help you control anxiety and minimize dizziness without resorting to anti-anxiety medications.When to see a doctorIn most cases, occasionally waking up feeling dizzy is not a serious cause for concern. However, if you are regularly experiencing dizziness or vertigo when you wake up, it is recommended that you make an appointment with your doctor.If your dizziness is accompanied by any of the following, seek immediate medical treatment:Chest painTrouble breathingRapid heart rateConfusionSlurred speechSevere headacheNumbness in the face, arms, or legsDouble visionOngoing vomitingHow to stop feeling dizzyFor many people, drinking plenty of water, eating a healthy diet, and making sure to get some exercise to promote blood flow are sufficient to prevent dizziness. If you are taking prescription medications, ask your doctor whether they could be causing your dizziness.One of the most effective ways to manage dizziness is physical therapy. Nearly all of the root causes of dizziness respond well to physical therapy, and providers who are experienced in treating dizziness can tailor an exercise plan to meet your needs.The experts at FYZICAL are highly trained and skilled in treating different forms of dizziness. Our holistic, whole-body approach doesn't depend on medications or surgery, and many people find that the benefits of physical therapy go beyond helping them overcome dizziness.FYZICAL offers free assessments that can help you understand your dizziness and anxiety and create a tailored exercise program that will help you manage your symptoms.

For more information  on the author, Fyzical , CLICK HERE!Balance Therapy - The Mission of Changing LivesBrian Werner built a $2 million balance and physical therapy practice in less than 10 years thanks to his detailed evaluation tests, elaborate therapy systems, and revolutionary equipment. Now he's rebranded his business in hopes of helping millions more who suffer from dizziness.An 82-year old man sits in a black, oversized chair. We'll call him John Smith (HIPAA laws don't allow us to reveal his true name). He looks like he could be your father or maybe grandfather, a favorite uncle or kindly neighbor. Large black straps come over each shoulder locking into another strap stretched across his midsection. The space-like goggles placed neatly over his eyes give the appearance that he's ready to be launched into orbit. The chair is affixed to a gyroscope-like structure that appears as if it was built on a sci-fi movie set.A press of a button and John's seat turns him sideways then upside down. He will be spun and contorted for only a few minutes and he's cured. It's easy to envision a crowd of children with snow cone stained lips at a state fair lining up to take a turn on this apparatus. But this is no carnival ride. It's an Epley Omniax Chair. It's John's chance to stop feeling like he's riding a merry-go-round when he sleeps at night. The Epley Omniax Chair is one of many devices and procedures that Brian Werner, PT, MPT, uses at his recently rebranded Fyzical Therapy and Balance Centers in Henderson and Las Vegas, Nevada. The chair helps patients suffering from the effects of Benign Paroxysmal Positional Vertigo (BPPV) and other vestibular disorders return to normalcy. His clinics specialize in diagnosing and treating patients with all types of peripheral and central nervous system disorders of the balance system.Biggest Problem Among the Elderly in AmericaWerner has a passion for helping those who struggle with dizziness. After earning his Masters in Physical Therapy from Northern Arizona and working as a PT for several years, he helped open and operate several balance centers starting in Las Vegas in 2001. "By 2005 I got the entrepreneurial seizure," Werner laughed. "Once you've worked 80 hours a week for someone else, you want to try and do your own thing." Balance disorders are the third most common complaints to primary care physicians and in emergency rooms. They're the number one complaint in the elderly population. Thirty percent of the elderly in this country will suffer from vertigo; that's 12.5 million Americans. And as many as 475,000 hip fractures annually are the result, a devastating accident that 25 percent of seniors die from within a year of it happening. The stats are only going to grow larger. "Baby boomers are growing older. The stats aren't going to change. That means more people will be going to doctors with balance or dizziness problems. I knew there was going to be an increased need for this type of specialized care," Werner said. "I'm one of the first to drive a business model towards it in the nation."90% + of Problems IdentifiedPatients undergo a series of evaluations upon arriving at Fyzical. Doctors of audiology conduct comprehensive hearing and inner ear testing. Next, a Computerized Dynamic Posturography (CDP) test is administered. It identifies with objective evidence where patients' balance problems are stemming from: Is it in their eyes, their proprioceptors in their lower extremities, or is it coming from the inner ears? Last are the Video nystagmography Test (VNG) and Vestibular Autorotation Test (VAT). These examinations look for postural instabilities in the eyes or nystagmus of the eyes. "As your postural stability in standing and walking is controlled by your balance system, your eyes are also controlled by the same systems," Werner explained."In the past, we treated based upon subjective information supplied by the patient, as we didn't have the technology or really know how to measure the balance system well. Now, we practice evidence-based medicine," he added. "We can identify what's causing the balance problem in 90%+ of the patients just by a battery of three or four tests."The Latest in Balance TechnologyMany of Werner's patients suffer from loose crystals brought upon by BPPV. The Epley Omniax Chair aligns the ear's semicircular canal to be parallel with the gravitational pull of the earth allowing maximum force to reposition the crystals quickly and efficiently, thereby reducing the nausea that comes with the standard maneuver. The chair is ideal for patients like John Smith, who are elderly and have certain physical limitations. "I met with Dr. Epley and we became friends. I believe we were one of the first in the world to get the final versions of his chairs," Werner shared. "The guy who invented the Epley maneuver invented the chair why wouldn't you want it? What he's using with his patients is what we're using with ours on a daily basis." Not everyone needs the Epley Omniax Chair. Other forms of treatment at Fyzical include vestibular rehabilitation, which is repositioning maneuvers, adaption training, and habituation exercises.Balance retraining physical therapy is also offered, a combination of vestibular rehabilitation with orthopedic management or standardized physical therapy. "That's the beauty of the model we've developed. There's the balance program and there's pain management. We want it to be a seamless program between the two," Werner urged. "That's perfect because most of our patients are older. They don't walk in with one problem. They have multiple problems. We can take care of them all."First to Use a Safety Gate SystemFear can neutralize and make ineffective even the most dynamic therapy treatments. If a patient is afraid of falling while training, he or she may never fully recover. Werner identified this issue and developed a way for his patients to maximize their treatment sessions while providing reassurance that they're completely safe. "I was a gymnast through high school and college. When gymnasts practice, they're at times in harnesses and attached to ropes in case someone falls. That way they can minimize injuries," Werner said. "I came up with the same principle as it pertains to therapy." Werner employs a safety gate system at Fyzical. Patients wear a full-body harness attached by dynamic ropes to a ceiling-mounted trolley system that slides along a track. Patients can perform a full array of exercises while sliding along the 100 to 120-feet of track. And they're easily switched from one track to another as they progress from one phase of therapy to the next."The patient needs to experience the very edge of their ability and at the same time know they're not going to get hurt. Our safety gate system is there as a precaution. They'll still fall, but they fall in their harness and not to the ground," Werner clarified. "Patients get so much more out of their therapy by being able to push themselves without being afraid. We're one of the first in the U.S. to use this approach."