Individuals can experience balance problems that come in the form of general dizziness, or vertigo. Both conditions, while treated differently, can be greatly improved by working with a physical therapist.
"The vertigo that people get is usually very sudden onset. They'll often describe it as they woke up in the morning and felt dizzy when they got out of bed quickly, or they roll over in bed, and the room spins around them. It's especially pronounced when they roll over," Karen Rasmusson, physical therapist for First Choice Physical Therapy in Minot, said.
"Whereas, dizziness problems and lack of balance is more of a gradual thing, and the dizziness feels more internal instead of external. They may start to walk slower, or take smaller steps, and turning more slowly," she added.
Katina Tengesdal/MDN - - Karen Rasmusson, physical therapist for First Choice Physical Therapy, right, leads Lacey Groninger, physical therapy student, in a balance exercise. Groninger demonstrates how a patient would hold on to the counter for extra balance during the exercise.
Many may live with one condition or the other, not knowing there is effective treatment to improve their balance.
"Especially with gradual dizziness and loss of balance, people would just assume that it was something that happens as you age. But it doesn't have to be that way," Rasmusson said.
Dizziness and balance
With general dizziness, individuals will often have an internal feeling that they are off balance. To have good balance, there are three body systems that must work together effectively.
"The first thing that gives us balance is our eyes," Rasmusson said. "By looking ahead, you know where you are in relation to the horizon. The second is your inner ear, which tells us if our motion changes."
"Lastly, there's proprioception, or your body's joint awareness," she added. "We have cell receptors in our ankles, knees and hips that tell us where our body is in space. For example, if one leg is up on a curb, you don't have to look to know that one leg is higher than the other."
When individuals aren't able to balance effectively, it's often because there are deficits in all three of those body systems. As a result, they may gradually stop doing certain activities because it makes them feel off balance.
"Because they don't feel safe, people might stop doing things like taking the stairs, or going out at night because they feel they can't balance well when they can't see," Rasmusson said. "But the less they use their balance, the worse it gets."
"They may think it's normal aging, and there's nothing they can do about it," she added.
Aging individuals are more prone to falls because they aren't as able to catch their balance as quickly as they were before.
"The loss of balance is usually caused by deficits in all three systems. As they age, people don't walk as quickly, their vision isn't as good and sometimes they lose strength," Rasmusson said. "The combination of these factors means that they're not as quick to catch their balance if they do stumble."
"Most have found that they have over-relied on their vision as their main balance," she added. "As soon as you take the visual component out, they were having problems."
With regular exercises and treatment, however, balance can be greatly improved. Individuals seeking help for general dizziness and balance problems meet with a physical therapist and take home balance practice exercises to work on between sessions.
"We do activities in therapy that help the systems talk to each other better," Rasmusson said. "We'll have them close their eyes, for example, while they practice standing."
"The research shows that the more you practice your balance, the better it gets," she added. "After therapy and practicing at home, it's amazing to see how patients' balance has improved."
Vertigo and balance
For individuals affected by vertigo, the condition can come on suddenly, with the individual feeling like their surroundings are moving or spinning. Vertigo is often caused by an inner ear dysfunction. Benign positional proximal vertigo (BPPV), in particular, is caused by debris in the inner ear.
"When individuals have benign positional proximal vertigo, they will probably seek treatment more often because it is so violent," said Reed Argent, physical therapist for First Choice Physical Therapy. "It usually comes on with moving the head, versus a constant dizziness."
"Positional vertigo can be very disabling," he added. "If individuals find a certain activity brings it on, they will not do that activity at all."
For patients with BPPV, just one or two treatments can solve the problem. Patients are treated with the use of the Epley maneuver, a movement of the head that helps free the inner ear of the debris that is causing the vertigo. A physical therapist performs the maneuver in the office.
"It's one of those things that can be so disabling, but it can get almost 100 percent better in 24 hours with treatment," Argent said.
When an individual visits the physical therapist's office for dizziness and balance problems, they will complete a dizziness inventory that helps therapists determine if the problem is vertigo or general dizziness.
Once the problem is discovered and treatment begins, the goal is a greater freedom of movement.
"With treatment for dizziness problems, we're focusing on keeping people safe," Rasmusson said. "What usually precipitates going into assisted living is a fall. With balance treatment, it can help them maintain that independence."