Latest / The Driven Athlete / Vertigo & Vestibular Rehab - Insights on Dizziness | Ep 68

Transcript

Vertigo & Vestibular Rehab - Insights on Dizziness | Ep 68 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: So this is an interesting topic.
• 0:13
  Speaker 1: Okay, that I just want to touch over briefly in a small superficial surface layer type of discussion.
• 0:21
  Speaker 1: I'm not sure if a lot of people aren't aware, but vertigo and vestibular issues can be rehabbed.
• 0:34
  Speaker 1: There's a specialty in physical therapy that purpose that specifically works on vertigo and vestibular issues.
• 0:39
  Speaker 1: Dizzy spells right, it's actually a really common thing and it seems to be more common in women that we've come across.
• 0:45
  Speaker 1: But we have some clinicians that in our area that are within our practice that we worked on this with, all right, my wife being one of them.
• 0:53
  Speaker 1: Shout out to my wife she presented nationally, at AOMT, a National Specialty Group Convention on vertigo and concussion rehab.
• 1:06
  Speaker 1: So concussion is another part of that Vertigo, concussion, vestibular rehab.
• 1:11
  Speaker 1: This is very interesting.
• 1:12
  Speaker 1: Okay, so there's a couple of mechanisms of vertigo symptoms.
• 1:18
  Speaker 1: Dizzy spells right, people get dizzy, all right, all right.
• 1:33
  Speaker 1: Bppv benign, paroxysmal, positional vertigo.
• 1:34
  Speaker 1: Bppv is short, provoked bouts of vertigo where the otoconia stones the calcium otoconia stones, all right are tiny little pebble rocks that are inside the inner ear organs.
• 1:46
  Speaker 1: The inner ear of the cochlea and the semicircular canals are tiny little circular canals that they look like inner tube rings, that there's fluid in there where gravity and your head position lets you know where you are in space.
• 2:04
  Speaker 1: For head writing, it's like I know what, which way is up, right Head writing is very important and, on the extreme end, be like cats, like the animal cat they have, like really good head writing, um, um sensory and ability to head write really well.
• 2:19
  Speaker 1: If you, if you throw a cat in the air, right, I would never do this.
• 2:21
  Speaker 1: But if you threw a cat in the air I don't advocate for this and throw them upside down, they'll always land on their feet right.
• 2:29
  Speaker 1: They know where they are in space based off of what their sensory is finding in gravity, all right.
• 2:34
  Speaker 1: So BBBV is a pathology and an issue of the little stones that float around in the semicircular canals of your vestibular system, of your inner ear, with movement of your head.
• 2:48
  Speaker 1: So as I turn left, turn right, up and down and turn sideways, I know which way gravity feels because I can feel it, and head writing and the fluid in my semicircular canals move with that gravity dependent and head based movement and there's little tiny stones called otoconia that float in those little inner tube ring rings, canals, and they flow against and with the fluid movement and there's little hairs of the in the inside of called cilia that sense what direction these fluid and otoconia are spinning.
• 3:27
  Speaker 1: So if somebody does like a one of those, like an America round or like a spinny ride, and they get super dizzy, it's because the fluid is moving very, very rapidly in their inner ear and their vestibular system, the semicircular canals, and it takes a minute for those, the momentum of that fluid, to stop spinning.
• 3:46
  Speaker 1: So it makes you feel like you're leaning one way and it's because your head is being head righted one way, thinking that that's the way the gravity is.
• 3:53
  Speaker 1: So it's sensory confusion, it's what that is.
• 3:56
  Speaker 1: So the otoconia gets and BPPV, they sometimes can get stuck.
• 4:01
  Speaker 1: If they get stuck in one spot it trips the little cilia and nerve endings to think that if it's staying like that or if it's pushing one direction, then it makes you feel like you're moving one way.
• 4:15
  Speaker 1: So you get dizzy right the room's spinning and there's sensory confusion between what your eyes are looking at, because your eyes play a role with vertigo and balance in your vestibular system and what the sensory cilia and fluid is feeling in the semicircular canal of your vestibular system.
• 4:34
  Speaker 1: Okay, so your eyes try to catch up but nothing's moving, so it's called nystagmus.
• 4:40
  Speaker 1: If you look at somebody with a BPPV or dizzy spell or somebody that gets off like a really big, intense spinny ride, their eyes will be beating really rapidly to catch up with what they feel is the room or the earth moving around them.
• 4:56
  Speaker 1: Like I need to catch up and stabilize, so that's called nystagmus.
• 4:59
  Speaker 1: So you'll notice nystagmus in their eyes, which is very interesting.
• 5:03
  Speaker 1: So benign, paroxysmal positional vertigo is a short bout of vertigo symptoms from an otoconia stone that gets stuck so we have to get it unstuck.
• 5:14
  Speaker 1: And that's what, like a Dick's Hall Pike maneuver and other head therapy exercise, movements and then also some eye gaze stability exercises and head movement exercises to challenge and habituate.
• 5:27
  Speaker 1: It's about like provoking on purpose and then you a person will habituate around what they're feeling with that so that they get better with less sensory sensitivity and sensory confusion.
• 5:40
  Speaker 1: So it habituates less confusion, sensory wise, and makes you more resilient to those stimuli.
• 5:46
  Speaker 1: Confusion, sensory wise and makes you more resilient to those stimuli.
• 5:48
  Speaker 1: It's very interesting.
• 5:48
  Speaker 1: All right, so that's BBPV.
• 5:53
  Speaker 1: There is a, uh, the three mechanisms for balance, and head writing, um, so I'm going to stick with vertigo.
• 6:06
  Speaker 1: There's the three reflexes and systems that play with head writing and vertigo, and and uh, being dizzy is the inner ear vestibular system and the VOR, which is called your, your vestibular ocular reflex, and your COR, which is your cervical ocular reflex.
• 6:20
  Speaker 1: So the VOR is the relationship between your eyes, what your eyes are seeing visually, and then what your inner ear's vestibular system, the semicircular canals, are sensing as well, and if there's a sensory confusion, it's going to make you feel dizzy.
• 6:37
  Speaker 1: Is the problem, though, if somebody comes with dizzy spells and are dizzy all the time?
• 6:41
  Speaker 1: As an example, when they are I heard this before it's very interesting If they're at the grocery store and they're painting all the spices on the spice aisle and they're looking very rapidly across these different shelves of spices and they get disoriented and dizzy, it's because there's very rapid eye movements going on and some head movement.
• 7:02
  Speaker 1: This is a very interesting example.
• 7:04
  Speaker 1: Another one we've heard in a similar situation, with the VOR being the problem is driving on a highway and then the cars that go past them or in the opposite direction is sensory confusion for them and their eyes and they get sensitive to that and it disorients them rapid things moving around you that causes like you get disoriented.
• 7:28
  Speaker 1: So the question is they come in with a dizzy spell, like I'm having dizzy spells.
• 7:30
  Speaker 1: How do we know?
• 7:31
  Speaker 1: It's not a vestibular problem in the inner ear versus a VOR problem with the visual gaze stability, like your eye gaze and you're gazing at something.
• 7:39
  Speaker 1: Is that gaze stability the issue or is it contributions from the neck and the cervical spine?
• 7:46
  Speaker 1: There's a lot of nerve endings in the upper cervical and your upper neck vertebrae and all the interplaying connections of nerves that play a role with stability of the vestibular system.
• 7:59
  Speaker 1: So there's contributions and sensory of what a person's neck position is doing and dizziness.
• 8:05
  Speaker 1: This is a very close link with suboccipital region pain and cervicogenic headaches and dizziness.
• 8:13
  Speaker 1: It's very interesting.
• 8:15
  Speaker 1: There's a lot of interplay.
• 8:15
  Speaker 1: We also can't neglect that the trigeminal nucleus is at C2, c3.
• 8:21
  Speaker 1: So the trigeminal nerve is your cranial nerve five and there's contributions to that with the vestibular system the vertigo as it relates to neck movements and neck positions and stuff and neck pain, right nucleus, all the nerve endings and the joint capsules of the cervical spine as it relates to sensory confusion and input and output conversations and communication between that and the vestibular system in the inner ear.
• 8:54
  Speaker 1: So it's very interesting.
• 8:57
  Speaker 1: So if somebody gets dizzy when they move their head a lot, their eyes are having to stabilize on an object.
• 9:03
  Speaker 1: While they move their head right, they also are moving their neck joints and their neck muscles.
• 9:08
  Speaker 1: So it's like what is the problem?
• 9:10
  Speaker 1: So if you close their eyes and have them do the same movements, does it cause pain or cause dizziness?
• 9:15
  Speaker 1: And we know it's not BBVV, then we're thinking it's a lot of COR contributions or just prolonged head position.
• 9:22
  Speaker 1: Does that cause the issue?
• 9:22
  Speaker 1: Versus, if we move their whole body around like in a spinny chair and we move them back and forth rapidly and their neck isn't moving but they still have to stabilize their eyes on an object and that's what trips their dizziness and their vertigo, then we know that's a vor problem.
• 9:40
  Speaker 1: If it's a positional thing with their head, then we know it's an inner ear vestibular problem.
• 9:44
  Speaker 1: So anyway, surface level conversation, we know that we have to tease out between is it a VOR, a vestibular ocular reflex, gaze stability problem, whether gaze stability is just more sensitive and not as resilient as it could be.
• 10:00
  Speaker 1: Is it an inner ear vestibular problem legitimately with like a head position, or is it neck related, causing cervicogenic headaches, suboccipital neck pain, neck pain in general?
• 10:13
  Speaker 1: That's creating some sensory confusion in the vestibular system too.
• 10:17
  Speaker 1: So it's just very interesting.
• 10:21
  Speaker 1: Those are the things that we have to check out and work on and if we don't, then we're not going to have a clear diagnosis and we're not going to have a clear treatment on like working on vertigo and vestibular symptoms when really it's actually coming from their neck.
• 10:33
  Speaker 1: The contributions we have to work on cervical mobility and cervical stability and some of the muscle surrounding musculature to settle that down, and that's going to help resolve headache, the cervical genetic headaches and dizziness.
• 10:47
  Speaker 1: We can't neglect that because if we don't they're not going to get better right.
• 10:51
  Speaker 1: It's just a clear diagnosis leads to a clear treatment and we can't leave any stones on turn no pun intended with otoconia versus a BPPV.
• 11:00
  Speaker 1: Then we might need to do more aggressive head positioning maneuvers, like Dick's Hall Pike as an example, to reset the otoconia and fix that issue right.
• 11:10
  Speaker 1: There's three semicircular canals on each side and we have to determine for BPPV and also when we're demonstrating nystagmus.
• 11:21
  Speaker 1: It tells us with certain testing and positions and the beat direction of the eye nystagmus.
• 11:24
  Speaker 1: It tells us, with certain testing and positions, and the beat direction of the eye nystagmus beating.
• 11:28
  Speaker 1: It tells us which side, left or right, and also which semicircular canal.
• 11:34
  Speaker 1: So they're of the three.
• 11:35
  Speaker 1: It's very interesting, it's very cool.
• 11:37
  Speaker 1: So, that being said, it can be treated.
• 11:39
  Speaker 1: We just have to intervene with the right things and do a solid evaluation to figure out where the actual problem lies.
• 11:46
  Speaker 1: So I thought it was just really interesting.
• 11:49
  Speaker 1: I wanted to share that a little bit of insights and at least bring some hope.
• 11:51
  Speaker 1: If someone's battling vertigo, dizzy spells and nystagmus issues, um, that we can help you.
• 11:57
  Speaker 1: You know, it can be helped.
• 11:58
  Speaker 1: It's actually something that can be rehabbed versus just medication.
• 12:02
  Speaker 1: But the other interesting thing with that too, that uh, one of the I forgot to mention this I have an issue with this too, with, uh, if I'm sitting at a red light I don't know.
• 12:13
  Speaker 1: You tell me if y'all have had this before I'm sitting at a red light and I'm not moving, but the car next to me is slowly moving forward and I feel like I'm, I was like, am I moving?
• 12:27
  Speaker 1: Like the light's red, and you get sensory confused, get a little bit disoriented and dizzy for a second, it's because there's sensory confusion between what your eyes are seeing and what your actual vestibular system is feeling, cause you're not actually moving, but for a second they were perceiving that we were moving, and it triggers symptoms, and so it's like a an eye gaze stability problem.
• 12:44
  Speaker 1: Um, or, of course, symptoms, and so it's like an eye gaze stability problem.
• 12:47
  Speaker 1: Or, of course, roller coasters and getting dizzy, car sickness, motion sickness right, that could be an eye gaze stability problem, not just a vestibular problem, or even neck movements.
• 12:55
  Speaker 1: It's interesting, though roller coasters your neck really isn't moving, that you're not turning your neck a lot like hopefully, but a little bit of jostling going on, but more so it's the eye gaze, where objects are whipping past you and also just going upside down and turning, and your vestibular system is getting challenged.
• 13:10
  Speaker 1: So imagine the sensory confusion between your eyes and your vestibular system with something like a roller coaster or car sickness.
• 13:17
  Speaker 1: Right, we can't neglect that the eyes play a huge role with that and the strength and stability of the muscles that control the eyes and the sensory confusion to the vestibular system.
• 13:28
  Speaker 1: So that's very interesting.
• 13:29
  Speaker 1: I'm not going to talk any more about that because I'm not an expert on this stuff, but we do know experts and we'd love to help and we can at least chat and get some insights on, maybe, what has been going on and how we can best treat it.
• 13:41
  Speaker 1: So don't hesitate to reach out and if you have any questions, the best way to reach us is probably our email at team at athleterccom, or our phone number at 561-899-8725.