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Written by: Jennifer Buono, PT, DPT

Dizziness is one of the most common symptoms that adults report to their physician. With a wide range of possible causes including, cardiovascular, neurological, metabolic, psychological, pharmacological, as  well as, vestibular disorders, it can be hard for individuals to get a correct diagnosis. Often they will consult with 4 or 5 different physicians before determining the exact cause.

To assist providers in diagnosing the cause it is beneficial for individuals to further define their dizziness symptoms.

According to the Vestibular Disorder Association (VEDA):
● Dizziness: a sensation of lightheadedness, faintness or unsteadiness that does not
contain a rotational component.
● Vertigo: sensation of spinning of either the self or the surrounding environment.
● Disequilibrium: a feeling of being off balance or unsteady and can often be
accompanied by disorientation.
● Spacial disorientation: a sensation of not knowing where one’s body is in space.


More than ⅓ of adults over the age of 40 in the US have experienced some sort of vestibular dysfunction. One disorder in particular called Benign Paroxysmal Positional Vertigo or BPPV is the cause of about 50% of dizziness/vertigo symptoms in older people. BPPV is characterized by frequent episodes of vertigo that typically last less than 60 seconds and are associated with changes in head and body positions. For example, quick head movements can trigger vertigo symptoms, as well as bending forward, looking up toward the ceiling, moving from lying to sitting and rolling to one side in bed.

BPPV occurs when calcium carbonate crystals (otoconia), which are normally in the utricle portion of the inner ear, become dislodged and move into the semicircular canals. This movement interferes with the fluid movement in the canals which sense head motion. The change in fluid movement causes the inner ear to send false signals to the brain and the result is a spinning sensation or vertigo. The cause of
BPPV sometimes is unclear, but it can be due to an infection that affects the inner ear, head injury or it can also be due to degeneration of the hair cells that occurs during the natural aging process.

The good news is that BPPV is not life threatening and is typically easily treated. Physical therapists with specialized training can help treat BPPV with the use of positioning maneuvers, known as canalith repositioning. The most common maneuver is known as the Epley maneuver. The therapist takes the individual through a series of head and body movements to move the crystals out of the semicircular canals.

Studies have shown that in about 90% of cases, resolution of the symptoms can be attained in 1-3 treatments. Sometimes even after the BPPV has been resolved, individuals can also experience a sense of imbalance or disequilibrium for which the physical therapist can provide specific exercises that work to retrain the brain to process the information received by the vestibular system, known as vestibular rehabilitation.

If you are experiencing symptoms of dizziness, vertigo or disequilibrium don’t wait! Come and see one of the physical therapists here at Advanced Physical Therapy and fitness for evaluation and let us help you find the best treatment option, so that you can stop spinning and get back to your normal routine.

References:
Vestibular Disorders Association (VEDA) www.vestibular.org Parnes LS, et al. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ.2003  169(7):681-693.

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October is National Physical Therapy Month

#ChoosePT

Since October is National Physical Therapy Month, we would like to dispel a persistent myth about physical therapy.  That myth is that you always need to see a physician first to get referred to a physical therapist.

Current Pennsylvania law allows consumers to access certain physical therapists without a physician referral for up to 30 calendar days of care.  The catch here is knowing which physical therapists are legally allowed to practice under these “direct access” laws.  Here at Advanced Physical Therapy and Fitness all of the physical therapists have direct access licenses and are therefore legally allowed to examine, evaluate and treat patients for up to 30 calendar days without a physician’s referral.  Physical Therapist who possess this license have special training and continuing education to help them recognize “red flags” or signs or symptoms that may be indicative of a more serious condition or a non-musculoskeletal condition while examining and treating you. Unfortunately, patients’ that have Medicare or Medicare Advantage Plans must have a referral because that is a federal law.  A few insurances also require a physician referral for treatment from a physical therapist to be paid so you may want to verify with your insurer prior to making your appointment to see a physical therapist.

So, next time you hurt your back, have a stiff neck that doesn’t get better, sprain a knee or ankle being a weekend warrior, or hurt your shoulder painting that ceiling, consider seeing your physical therapist first.  Check out this YouTube video and see how physical therapy can help you manage pain:  https://www.youtube.com/watch?v=RWpnMsAjX5k&feature=youtu.be

Get started on the healing track sooner and avoid complications.  Stay active, stay healthy and choose physical therapy first!

#ChoosePT

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Kayaking fun on the waterways

Kayaking fun on the waterways

Recreational kayaking is an enjoyable activity here in central Pennsylvania due to many easily accessible waterways located close by.  It is a way to get away from the general population and experience wildlife, flora and fauna that an individual walking or biking may not be able to access.

It is important for a beginner kayaker to have a proper fitting boat and paddle to make the activity more enjoyable and decrease risk of injury.  It is also very important to be educated in basic paddling skills as well as safety measures to take as both moving water and lakes and ponds can be hazardous.

It is advantageous for both beginner and experienced paddlers to begin a conditioning program for the upper body prior to paddling season to maximize enjoyment and prevent injuries.  Kayaking is mainly an upper body activity which requires that the shoulder musculature be in good condition as well as shoulder position be optimal to prevent impingement injuries.  Forward positioned shoulders are at risk for injuries involving the rotator cuff tendons and at times the long head of the biceps tendon.  Ensuring that the shoulders are positioned back and down, and the joint has good mobility will decrease the risk of overuse injuries.  It is best not to ignore pain in and around the shoulder and think that you can just work through it.  No pain, no gain is not the appropriate approach when dealing with overuse injuries.  Shoulder stretches include a doorway stretch which improves flexibility of the pectoralis major which is a large contributor to the forward position of your upper arm.  Also, a sleeper stretch to improve the mobility in the posterior capsule of the shoulder will improve shoulder position.  I recommend holding stretches for up to 30 seconds and completing 3 times when your body tissues are warm.

Strengthening exercises for shoulders

Important strengthening exercises for the shoulders include the internal and external rotators of the shoulder joint, the middle trapezius, posterior deltoid and rhomboids in the back to help maintain good posture  There are many other exercises to help improve shoulder function and prevent injury.  We recommend seeking advice and/or treatment from the movement experts, the physical therapists of Advanced Physical Therapy and Fitness.  As always, stay active and have fun!

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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.