Are There Rocks Loose in My Head?

Have you ever woken up and sat up in bed only to feel as if the room is spinning rapidly around you whirling you into a state of nausea and disequilibrium? Where did this come from? What happened last night that brought you into this unwanted tilt-a-whirl? These sensations can be explained simply, you have rocks loose in your head.  No, I am not implying that you’re crazy, but these loose ‘rocks’ cause a common vestibular impairment called Benign Paroxysmal Positional Vertigo (BPPV).

 

What is BPPV?

Let’s start simply by defining these four words:

-Benign: Not harmful in effect

-Paroxysmal: Intensification of symptoms

-Positional: of, or relating to, or determined by position

-Vertigo: a sensation of whirling or loss of balance

Based on these definitions, BPPV is a non-harmful intensification of whirling, spinning, or loss of balance that occurs with a change of position.

 

What are the symptoms of BPPV?

Like with all other diseases, injuries and impairments every person’s symptoms are different however, these are common symptoms of BPPV:

-Dizziness

-A sense that you or your surroundings are spinning or moving

-Loss of Balance or Unsteadiness

-Nausea

-Vomiting

 

When and Where do these symptoms occur?

Put simply, these symptoms can occur anytime there is a change in a person’s position. Common position changes that increase symptoms include:

-Lying down in bed

-Rolling over in bed

-Sitting up in bed

-Bending over

-Looking up

-Quick head movements

-Going from sitting to standing

Who gets BPPV?

BPPV does not discriminate; both men and women can experience episodes of BPPV. However, you are more likely to get BPPV due to the following

-Head Injury/Trauma

-Ear surgery

-40 years or older

-Recent ear infection or inflammation of the vestibular nerve (vestibular neuritis)

 

How do you get BPPV? (Refer to Picture Below)

BPPV

BPPV occurs when Calcium Carbonate crystals (otoconia), which are a normal part of our anatomy, break off of a gelatinous membrane in one of the organs of balance located in the inner ear called the Utricle. These crystals collect and settle in one of the semi circular canals.

Is BPPV Treatable?

Yes! BPPV is treatable with physical therapy. Here at Holland Physical Therapy we perform an extensive examination and evaluation of your symptoms and test for BPPV along with other vestibular disorders. When a client tests positive for BPPV, they can be treated right onsite with a technique to reposition the displaced crystals back to the Utricle. The following image demonstrates both the maneuver and the repositioning of the crystals within the inner ear.

Epley-Maneuver

If you are suffering from these symptoms or have further questions about BPPV, please come in to see us at Holland Physical Therapy for an evaluation and treatment!

Ankle Sprains and Chronic Ankle Instability

(CAI) Part I

Ankle sprains are among the most common of all traumatic injuries. It is estimated that 1 out of every 10,000 people in the US sprain an ankle daily or 23,000 ankle sprains per day. Of those, only around 50% are estimated to seek treatment from a healthcare professional. However, up to 70% of patients will suffer from repetitive ankle sprains and chronic pain after injury. (CAI) With all injuries, ankle sprains included, it is important to figure out injury severity, determine if imaging is necessary, and how is the injury BEST treated?

One question is; when do you need treatment, and what type of treatment is needed? Initially, it must be decided if your sprained ankle is only a ligament injury (most common) or whether you need an x-ray to rule out a fracture. There is good research behind a Canadian developed clinical prediction rule called the Ottawa Ankle Rules. Essentially, if you can’t walk a few steps immediately after the injury, or in the ER, and there is tenderness to palpation on the inside or outside of the ankle on the malleoli, then you need a x-ray. Other- wise there is a low likelihood that a fracture is present.

Most inversion ankle sprains involve the lateral (outside) ligaments of the ankle. It has been theorized that due to the position of the fibular head getting positioned too far anteriorly (forward) that chronic ankle pain and instability are more likely. One study looked at this theory in regards to self reported chronic ankle instability (CAI). Of the two test groups,the position of the fibular head in the CAI group showed on average a 2.4 cm position anterior in comparison to the uninvolved ankle by way of fluoroscopy (real time moving x-ray). Essentially, in patients with CAI and pain, that even after the injured ligaments have healed, if the fibular position isn’t addressed, then the likelihood of CAI and pain are more likely.

In regards to treatment, there are hands on manual therapy techniques that address the fibular head position. At Holland Physical Therapy we treat one patient at a time using evidence based, hands on, manual therapy techniques. Exercise is an integral part of treatment for ankle sprains, but the ankle joint mobility and fibular head position have to be addressed to give complete resolution of symptoms. Part II will look at more research behind treatment for ankle sprains. Call us at 616-355-4284 or visit us at www.Holland-PT.com to get evaluated.

Ford Reinink PT, DPT

Director of Clinical Operations for Holland Physical Therapy

http://holland-pt.com

Questions To Ask Your Physical Therapist During Treatment

Why Should I Go To Holland Physical Therapy for Treatment?

To pick where to go for physical therapy, it all begins with your connection with your PT. If you are hesitant about going to physical therapy, call or come in to Holland Physical Therapy, and ask to speak with me. I’ve always told the PT students that I mentor that patients “don’t care what you know, until they know that you care.” The best PT’s not only can connect with patients and make them feel comfortable, but offer a high quality of care.

To get the best outcome, a physical therapist needs to be able to relate to people and make the therapy program work for patients’ lifestyle, available free time, and their budget. 

Questions to ask your PT:

What is wrong with me?

  • Seems like a standard question; your PT should be able to tell you what they think is going on, in very clear and understandable terms
  • If they can’t tell you what is wrong, that means that the care you will receive will not be specific for your issues, and it might be what I call “cook book therapy” where every patient is doing relatively the same thing

What can I do to help myself?

  • Home exercise programs (HEP) and activity modifications are a hallmark of outpatient orthopedic PT care. Initial HEP programs focus on pain and symptom relief while a long term HEP should be geared towards functional activities, strengthening, and prevention. See our website FAQ for more on the HEP frequency  
  • Successful outcomes involve teamwork of your PT showing you your HEP, performing skilled manual therapy, and the patient following through and performing the program

What will we do while I’m in PT?

  • The best use of time and money is by your PT performing skilled manual therapy techniques (joint and soft tissue mobilization) to decrease pain from the first visit on 
  • Then, your PT showing you how you can strengthen, stabilize, and maintain range of motion with a skilled HEP
  • One thing you should not do in physical therapy is perform exercises over and over when you could be performing them at home. However, occasional HEP review with your PT watching your form is necessary

How will I know when I don’t need to come to physical therapy anymore?

  • That is different for every patient, but number one is, obviously, when your pain is gone
  • However, once pain relief is achieved, it all comes down to patient goals and prevention of further issues. For example, goals of a marathon runner are different from someone who just wants to garden and walk without pain
  • We look at your range of motion, strength, and most importantly, how you move, and faulty movement patterns that could contribute to pain later
  • Movement patterns and posture, are the single biggest reason for tissue breakdown and pain. Most issues are not from major trauma, but by straining tissue repeatedly until it starts to break down and eventually cause pain

The bottom line is that good PT’s listen to the patient, perform a skilled physical exam, and design a specific and unique program to work on all of the patient’s needs.

At Holland Physical Therapy we are highly trained, passionate about what we do, and we LISTEN and CARE about our patients. I have found that when I truly listen to my patients, both in what they say and in the manner in which they say it, that my outcomes are a lot better. 

Call us at 616-355-4284 to schedule an appointment or visit us at www.Holland-PT.com.

 

Ford Reinink PT, DPT
Director of Clinical Operations

Physical Therapist in Holland