How to Treat Vertigo and Dizziness with Physiotherapy?

Vertigo has nowadays become one of the most common reasons for adults to visit their doctors. The person suffering from vertigo usually feels as if the room is spinning, even may also feel an imbalance and visual disturbances. Vertigo is caused due to the dysfunction of the inner ear or cranial nerve dysfunction. Though it is not life-threatening but can affect a person's quality of life. An exercise-based physiotherapy program can be designed to reduce vertigo. A physiotherapist uses various exercise strategies to alleviate the patient's symptoms which allow them to return to normal function. In this blog, we have briefed up about vertigo and also have mentioned a few exercises which can be easily done at home.

 

Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is the most common type of vertigo, caused by the small crystal of calcium that loosens in the inner ear, these crystals travel into the semicircular canals, disturb the fluid, and create the sensations of movement. There are 2 types of BPPV Canalithiasis and Cupulolithiasis.  Canalithiasis is in which the crystals are freely floating in the canal and Cupulolithiasis, is a condition in which the crystals get stuck to the cupula.

There are many other causes for dizziness like vestibular migraines, cervicogenic vertigo, vestibular neuritis, Meniere's disease, concussion, etc. The patient complains of dizziness while turning in the bed, lying on one side, getting out of bed, and looking up.  Symptoms last for a few seconds, whereas a feeling of nausea or increased head pressure can last for hours. 

 

Physiotherapy Treatment for BPPV

The physiotherapist examines the inner ear thoroughly with positional testing by putting the head in different positions and trying to elicit the symptoms of vertigo. Maneuvers are then used to treat the condition. These exercises can be easily performed by the patient at home:

 

Epley Maneuver

Epley maneuver is one of the most commonly used physiotherapy treatments for vertigo.

• Sit straight up in bed with the head back and legs outstretched.
• Turn the head to a 45-degree right.
• Quickly lie back with the head still tilted and hold the position for 30 seconds.
• Slowly turn the head 90 degrees to the left without lifting the neck. Hold this position for 30 seconds.
• Turn the head and body so that you are on your left side. Hold for 30 seconds.
• Slowly return to the starting sitting position.
• Epley maneuver can be done 3 times a day until dizziness subsides.

 

Foster Maneuver

• Kneel and look up at the ceiling.
• Slowing curls the body towards the knees and touching the head to the floor. Hold for 30 seconds.
• Turn the head in the direction of the ear and hold for 30 seconds.
• Swiftly raise the head to a 45-degree angle, keeping it in line with the back. Hold the position for 30 seconds.
• Keep the head turned to the affected side, and quickly raise it to a fully upright position. Slowly begin to stand.
• Take 20 minutes of rest interval in between the exercises.

 

Brandt-Daroff Exercise

• Begin by sitting upright on the edge of the bed.
• Quickly lie on the left side while turning your head to look up at the ceiling.
• Return to a seated position for 30 seconds.
• Repeat the same on the other side.
• Do 5 repetitions per side.
• Return to a seated position and wait for any dizziness to subside before standing, dizziness is normal after completing this exercise.

 

Gaze Stabilization

• Fix an object on the wall in front.
• The patient gazes at the object.
• Repeatedly move the head up and down or back-and-forth for several minutes.

 

Balance Exercises

• Walk on uneven ground.
• Walk-in a dark environment.
• Stand on a wobble board.
• Stand on one leg.
• Walk and turn.
• Bend forward and reach for an object while maintaining balance.

 

The direction of movement depends on the affected ear. Each exercise lasts for 3-5 minutes and is repeated 2-4 times.  Symptoms may aggravate during the exercises but by the end, they subside. These exercises are designed to provoke mild symptoms so that the central nervous system gets habituated to the stimuli. The increase in symptoms should be temporary, for 15-20 minutes.

 

Cervicogenic Headache: Managing your head pain with Physiotherapy Treatment

Cervicogenic headaches can give you a troublesome time and not let you concentrate on your work due to the excruciating head pain. Though cervicogenic headaches can be treated by drugs but physiotherapy treatment is one of the best-known solutions. It is safely treatable by specific physiotherapy techniques which address the neck, upper back, joints, and muscles. Cervicogenic headaches can cause pain, limited neck movements, dizziness, or nausea. The physiotherapist assesses the spine and offers treatments that can help to decrease pain and improve mobility. In this blog, we will discuss cervicogenic headaches and their physiotherapy management.

 

Neck anatomy and cervicogenic headache:

The neck is comprised of 7 cervical vertebrae stacked one on the other. In between these bones are spongy and soft intervertebral discs with joints on either side of the neck. The cervical vertebrae protect the spinal cord and allow the neck to move in flexion, extension, rotation, and side bending.  Upper cervical vertebrae help support the skull. There is a joint on either side of the cervical level that connects to the occiput of the skull and allows the motion to occur. From the sub-occipital area several nerves and muscles that support and move the head, travel from the neck, through the sub-occipital area, into the head. Headaches and pain can be due to these nerves and muscles. Cervicogenic headache has several symptoms like pain on one side of the upper neck that radiates to the temple, forehead, or eye, pain in one side of the face or cheek reduced range of motion in the neck, pain on both sides of the back of the head, Pain in the back of the head that radiates to shoulder, dizziness, nausea, sensitivity to light or sound. Symptoms can often be triggered by certain movements or during sustained postures of the neck and can last for several hours to days.

 

Physiotherapy Management

The physiotherapist conducts a proper assessment and evaluation by palpating the neck and skull and recording the neck range of motion, and strength. After the evaluation treatment plan is designed to treat the cervicogenic headache. The physiotherapist may use different interventions for the treatment of cervicogenic headaches. The interventions include:

 

Ice therapy:

Ice therapy may be applied to the neck and skull to help decrease pain or inflammation.

 

Heat therapy:

Heat therapy is used to increase blood circulation, and relax tight muscles before performing neck stretches.

 

Traction:

Traction can be given manually by hands or mechanically with the help of a machine, it helps to decrease pain due to cervicogenic headache and also decompress the neck's discs and joints to allow improved neck movement. Even joint mobilizations can be performed to improve neck motion and decrease pain.

 

Transcutaneous Electrical Stimulation (TENS):

Transcutaneous Electrical Stimulation on the neck muscles helps to decrease pain and improve the headache symptoms.

 

Vestibular Therapy:

Cervicogenic headaches can cause vertigo or dizziness, for this vestibular therapy can be beneficial. This therapy involves performing specific neck, head, and gaze stabilization exercises to improve the way the vestibular system functions.

 

Massage:

Massage helps to loosen the tight muscles which cause limitation of the neck movement thus causing headache pain. Sub-occipital release technique can be performed to loosen the muscles that attach the skull to the neck, and allow improved motion, and decreases nerve irritation.

 

Exercise:

Exercises done to improve neck motion and decrease pressure on cervical nerves include cervical flexion, side bending, rotation, and side bending cervical retraction. These exercises are done slowly, without any sudden or jerky movement. After the movement, slight overpressure is applied with hands to each neck stretching movement, and at the end, range stretches may be held for up to 1 minute.

 

Postural Correction:

Postural correction is done to prevent the pinching of the nerves in the suboccipital area and upper cervical spine area. Strategies used include the use of a supportive neck pillow when sleeping, a lumbar roll while sitting, and preventing slouched posture. Kinesiology taping is used to improve correct posture by increasing tactile awareness of the back and neck position.

 

Through Physiotherapy management you can be assured of a quick and safe way to get pain relief and return to your level of activity.

 

Top 10 Exercises for Cerebellar Ataxia Patients

Does anyone around you have difficulty in walking, holding things, or speaking? And is also diagnosed with cerebral ataxia. Then you should certainly help him/her to pursue the right treatment as early as possible. Ataxia is associated with a wide variety of health conditions, it occurs due to disease or injury to the cerebellum, an area in the brain that controls muscle movement. Any type of damage to the cerebellum causes loss of muscle contraction, especially in the hands and legs.  Interventions like drug therapy, physiotherapy, and occupational therapy are available to reduce spasticity, loss of balance, and tremors. The physiotherapist designs the treatment program which is suitable for the patient to attain the desired goal, prepared from the interpretation of the assessment and measurement results. Given below are a few exercises that can be easily done by a patient suffering from cerebral ataxia.

 

Cerebellar Ataxia

Cerebellar ataxia occurs when the cerebellum becomes inflamed or damaged. The cerebellum is responsible for controlling gait and muscle coordination. This disorder can occur due to stroke, developmental abnormalities, viral or bacterial infection, cerebellum bleeding, trauma, and many other causes. It can result in postural unsteadiness, tremors, difficulty in speech, difficulty in walking, difficulty in swallowing, involuntary movements of the eye & clumsiness, all these symptoms occur due to cerebellar dysfunction.

Physiotherapy helps restore function, reduce the activity limitations by improving gait, balance, and trunk control for individuals with ataxia.  Few exercises that can be added to the treatment plan are:

 

Lie with bent knee rotation:

Lie on the bed with face up and both the knees bent, hip-width apart and feet flat on the floor, arms are kept away from the body. Keeping the upper body and back flat, slowly begin to rotate the knees from one side of the body to the other side.

 

Kneeling press up:

Start with upright kneeling, knees under hip and arms by the sides, slowly move from a high kneeling position with hip straight, to a low kneeling position hip from down to rest on heels.

 

Quadruped weight shifting:

Start with the hand under the knees in a kneeling position, with knees, hips, and the spine in a neutral position. Reach an arm forward to shoulder height. Extend the opposite side leg backward to hip height and try to balance before lowering both the arm and leg to the ground.

 

Vestibular ball:

A vestibular ball can be used for balance exercises, with the support of a physiotherapist. The patient sits upright on an exercise ball with feet apart. The legs are then locked by the physiotherapist to prevent any fall. Smoothly shift the weight from one side to another by moving the upper body to the right and then to the left side.

 

Standing heel to toe balance:

Stand upright on one foot and the other in front, so that the heel of the front foot touches the toes of the back foot.

 

Standing lateral weight shift:

Attain a standing position with feet hip-width apart, start to shift the entire weight from one side to another, while keeping the hip, trunk, and head upright.

 

Standing anterior-posterior shift:

Attain a standing position, with feet hip-width apart, start to shift the entire weight from forward into the toes to back into the heels. Keeping the hip, trunk, and head upright.

 

Lateral lunge:

Start with the standing position, feet hip-width apart. Shift the entire body weight and the hips towards one side backward and laterally while bending the knee on the weight-bearing side. Then straighten back and return to the standing position.

 

Single leg stance:

Attain a standing position, shift the body weight onto one leg, and lift the other leg off the floor. Try to balance on the standing leg. Lower the lifted leg after some time and repeat with the opposite leg.

 

Sit to stand:

Sit in a chair, feet under the knees at hip-width apart. Place the entire body in front of the chair, shift the upper body weight forward over the legs, push up into the standing position and return to the sitting position.

 

All these exercises are to be done 3 times a day with 10 repetitions and should be done under the guidance of a well-trained physiotherapist.

 Top 10 Exercises for Breast Cancer Patients

Has anyone around you developed breast cancer? And has also undergone surgical treatment like breast reconstruction, lymph node removal, mastectomy, breast reconstruction, etc. If yes, then no matter what type of surgery the person has undergone, it's important to do exercises after the surgical intervention. After surgery pain and stiffness can cause weakness and inability of the arm and shoulder to move. Therefore to maintain mobility and strength, exercises should be included in the treatment plan. There is growing evidence about the benefits of physiotherapy for breast cancer patients. Physiotherapy interventions empower patients to do their daily activities, like dressing, combing hair, and bathing. Today in this blog, we will provide a few exercises which can be done after breast cancer surgery.

 

Benefits of physiotherapy

There is a wide range of issues that can occur after breast cancer and can be successfully treated by physiotherapy.

• Helps in the management of lymphedema by exercising.
• Helps to decrease bone loss by maximizing bone integrity.
• Helps to improve musculoskeletal dysfunction by increasing the shoulder range of motion.
• Helps to manage fatigue by designing a graduated exercise program to increase strength and energy levels.
• Helps to decrease pain by exercise prescription and acupuncture.

 

Exercises

Exercises help to decrease the side effects of surgery and also help to get back to the usual activities.

 

Wand exercise

• Hold a stick-like object to use as the wand in this exercise.
• Lie on the floor on the back with knees bent and feet flat.
• Hold the wand across the belly in both hands with the palms facing up.
• Lift the wand over the head as far as you can. Use the unaffected arm to help lift the wand until a stretch is felt in the affected arm.
• Hold for 5 seconds.
• Bring the arm to the starting position and repeat 5 to 10 times.

 

Elbow winging

• Lie on the floor on your back with your knees bent and feet flat.
• Clasp the hands behind the neck with the elbows pointing toward the ceiling.
• Move the elbows apart and then down towards the floor.
• Repeat 5 to 10 times.

 

Shoulder blade stretch 

• Sit in a chair close to the table with the back against the back of the chair.
• Place the unaffected arm on the table with the palm facing down and the elbow bent. Do not move the arm during the exercise.
• Place the affected arm on the table with the palm facing down, and elbow straight.
• Without moving the trunk, slide the affected arm forward, toward the opposite side of the table and feel the shoulder blade moving while doing so.
• Bring the arm to the starting position and repeat 5 to 10 times.

 

Shoulder blade squeeze

• Sit in a chair with a mirror in front, without resting against the back of the chair.
• Arms by the sides with elbows bent.
• Squeeze the shoulder blades together, bring the elbows behind toward the spine.
• Elbows move along but don't force the motion of the elbows. Keep the shoulders level and do not lift them towards the ears.
• Bring the arm to the starting position and repeat 5 to 10 times.

 

Side bends

• Sit in a chair with hands clasped together in front. Lift the arms slowly over the head and straighten the arms.
• While the arms are overhead, bend the trunk to right and keep the arms overhead.
• Bring the arm to the starting position and bend to the left.
• Repeat 5 to 10 times.

 

Chest wall stretch

• Stand with face towards a corner, toes about 8 to 10 inches away from the corner.
• Bend the elbows and place the forearms, one on each side of the corner on the wall. Elbows should be close to shoulder height.
•  Arms and feet should be in place. Move the chest towards the corner and feel the stretch across the chest and shoulders.
• Bring the arm to the starting position and repeat 5 to 10 times.

 

Shoulder stretch

• Stand with face towards the wall with toes about 8 to 10 inches from the wall.
• Place the hands on the wall and use fingers to climb the wall and reach as high as possible till a stretch is felt.
• Bring the arm to the starting position and repeat 5 to 10 times.

 

Seated Lateral Raise

• Sit in a chair, with arms by the sides.
• Hold a dumbbell in each hand,
• With elbows slightly bent lift the arms to the height of the shoulder.
• Bring the arm to the starting position and repeat 10 times.

 

Seated Biceps Curl

• Sit in a chair, holding a dumbbell in hand.
• Bring the hand towards the shoulder by bending the elbow.
• Bring the hand back to the starting position and repeat 10 times.

 

Pendulum

• Bend forward at the waist, with the unaffected arm supported on a chair, and let the affected arm hang towards the floor.
• Make small circles with the affected hand, let the momentum move the arm around effortlessly.
• Make10 circles clockwise and 10 circles counterclockwise.

 Physiotherapy has been observed to improve the functionality of breast cancer patients and thus improve their quality of life.