I’m Dizzy and I Know It: 4 approaches to resolving dizzy spells

When my husband is run down or coming down with a cold he gets dizzy spells. It is worrying to watch as he’ll do something simple like look up and then visibly sway. Luckily for him, this is remedied by me supporting his head as he lies backward over the bed looking to the right. But dizziness is usually a more complicated issue. I have a friend who’s dizziness has been attributed to vestibular migraines; I know older adults taking fall risk increasing drugs; I’m hyper mobile so I know not to stand up quickly as that makes me pretty woozy; and a very common symptom of perimenopause is dizziness. You may be thinking: these are varied and disparate things you haven’t even mentioned Meniere’s disease, labyrinthitis, stroke etc etc -  what can you offer that helps?

A year ago I would have agreed with you. But since I’ve started incorporating balance, gaze and vestibular training into my classes my students are telling me that they are better equipped to prevent falls. I don’t need to tell you that falls suck. I’m sure that you know someone who’s life has changed dramatically after a bad fall. I haven’t used a double blind placebo controlled approach but this very small tai chi study backs up my observations. And so does this slightly larger and more recent one

Of course, if you have a medical condition that is causing your dizziness then it would make sense for you to start proper vestibular rehabilitation therapy. (Nicola Harris is brilliant)

This blog post is for someone who occasionally gets dizzy spells that have been ruled out as anything serious by a doctor.

First, What is Dizziness?

Dizziness happens when there is an upset in the interaction between four body systems: the central nervous system, our visual system, our proprioceptors and the vestibular system. Each system is pretty complex. Vision requires that our eyes work together to transform light into coded nerve signals that the brain decodes into everything we can see. Proprioceptive signals (from nerves throughout our body) are what create an overall representation of our body’s position and how we are moving.

The vestibular system is the balance system controlled by linear and rotational motion sensors in the inner ear. These three systems collectively send information via the central nervous system to our body. The result is usually easy upright balance, a sense of equilibrium, and stable vision. However, if any of these elements are disrupted then  the result will be some version of spatial orientation confusion; vertigo, disequilibrium, lightheadedness or presyncope.

In that case we need to train each of these systems to bring ourselves back into balance again. The first exercises might be all that you need to try. So let’s start there.

Canalith Repositioning Procedures

Dizziness in some people is thought be caused by crystals becoming dislodged from their normal place inside the inner ear, and moving into an area responsible for sensing linear motion (saccule) or rotation (the semicircular canals).

So, some clever people have come up with exercises designed to relocate the loose crystals while also training our dizziness tolerance with gentle repeated exposure.

Note. These exercises are likely to provoke dizziness, so do all the things: go slow, have cold water to hand, breathe slowly, start small and have a friend nearby if you can.

Brandt Daroff Exercises

look diagonally upwards and lean the opposite way, breathe and return to centre and then look and lean in the opposite direction. This is repeated a few times.

The picture shows the person lying all the way down. This may be quite unpleasant though so plan to build up to this over a series of weeks.

Epley Manouevre

The idea is to be lying on your back with your head lower than your body, you tilt your head one way and breathe and stay there for up to a minute. Then roll onto that side and very slowly come upright again. My husband gets (eventual) relief from orienting his head to the side that makes him feel woozy.

Semont Manouevre

This one requires that you sit in the middle of your bed because you are going to lie at both the foot end and the head end. You start by looking left and lying on your right side. You then keep looking left, sit up and lie on your left side.

A gentler progression is to sit on a chair and rock from side to side as you keep looking diagonally up one way and then repeat on the other side.

When the Epley manoeuvre didn’t trigger any dizziness in my friend with (later diagnosed) vestibular migraines. I was puzzled. She knows that stress or being run down are her triggers and that her episodes are linked in some way to her vision.

She has started Gaze training.

Gaze Training

The point of gaze training is to practice separating eye movement from movement of the vestibular organs (head/ears); along with the highly proprioceptive neck muscles.

These exercises should be timed. To start with 20 seconds will probably be enough to trigger mild to moderate symptoms. The goal is to build up to one minute but it may take a few weeks of daily practice to get there. As the first few exercises get easy, work down the list to harder exercises.

Look straight ahead and focus on your thumb held at straight out in front of you. Bring it towards your face and away again.

Turn your head from side to side, keeping your eyes focused on your thumb held out in front of you. Build up the speed of your head movement.

Slowly move thumb up and down and from side to side while head stays still.

Move thumb up and down, side to side while moving your head in the opposite direction.

Hold two thumbs out in front of you. Keep your head still. Quickly move your eyes between the two thumbs.

Change the position of the thumbs to wider apart, closer together, and placed vertically.

Hold one thumb in front of you and let the other move out to your peripheral vision. Swap sides.

Vestibular training

When the brain is sent different signals from the left and right balance organs in the inner ear it favours information from the eyes, ankles, legs and neck to

maintain balance instead. Vestibular exercises focus on re-training the inner ear organs to communicate with the brain. The goal of these exercises is to help the brain to accurately interpret input and build tolerance to head movements again.

focusing on an object across the room walk towards and away from it moving your head from side to side, then up and down then ear to shoulder.

Try these head movements with everyday activities such as hanging out washing or unloading the dishwasher.

Keep your head still while swinging your body from side to side, or move your head to the left while swinging to the right then repeat the other way.

Moving slowly walk in a large circle around the room, first one way and then the other. Make these circles progressively smaller until you are walking in a circle on the spot.

Balance drills/ Proprioception training

The point of balance drills is to train your muscles to be able to react and stabilise you when you have a wobbly moment. Practicing being close to falling in a safe environment means that you’ll be better able to save yourself when you’re out in the busy world. When these exercises become easy, play with circling or waving your arms around, twisting your body, or coming onto tip toes, as different ways to disrupt your centre of balance. A really neat challenge is to try these exercises while throwing a ball from hand to hand above eye level 

Rock from side to side while seated trying to balance on one sit bone

Roll back and forwards while seated (on a sturdy chair)

Sit to stand with one leg in front of the other

Sit to stand with one leg in front of the other toe to heel (as if on a line)

Sit to stand onto one leg

Sit to stand walk around the chair

Sit to stand walk around the chair stepping over obstacles

Sit to stand and turn around

Sit to stand eyes closed

So there you have it. An approach to resolving your dizziness. Just know that because your central nervous system is at the heart of this one it might take a few months for the neural rewiring to take place. If your problem persists it is worth seeing a vestibular rehabilitation therapist for this one.

P

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