The Basics of BPPV: Positional Vertigo

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Summer is here and that brings more outside time and fair weather. Activities like gardening and yard work are frequent, and sports like golf, tennis and swimming encourage us to spend time outside enjoying all that Vancouver has to offer. But have you ever found yourself moving into a position where you are bending over, looking high up or tilting your head to one side and suddenly the outside world appears to be moving?  It can be a very unsettling feeling, even if it doesn’t last long.

 

Vertigo is the sensation of the outside world spinning.  It is a symptom, but not a diagnosis.  The incidence is quite common, as much as 1 in 15 adults will have an episode of vertigo in their life, according to an Ear Nose and Throat Doctor teaching at Columbia University.  One of the causes of vertigo that we see at Treloar Physiotherapy is a condition called Benign Positional Paroxysmal Vertigo (BPPV).  It is important to note that BPPV is not the only cause of vertigo, but it is the most common.  Here is some basic information about BPPV:

What is it?

  • BPPV is a problem that occurs in the vestibular system that causes a sensation of spinning for short periods of time when the head is moved into certain positions.
  • The crystals that are located in sacs within the inner ear break free, moving into one of the semi-circular canals of the inner ear.
  • When your head moves, the crystals float through the canal and continue to move even after you stop moving. This creates a temporary spinning sensation (vertigo) that comes on with specific head movements.

What causes it?

  • In most cases, we do not know what causes the crystals to break free and move into the semi-circular canals.
  • Very few cases occur because of a physical blow to the head (ie something that ‘knocks’ the crystals loose).

What movements trigger the vertigo symptoms?

  • Big movements that involve bending over and looking down – emptying the dishwasher, weeding the garden, bending low to pick up something under the bed, tying shoes, putting the golf ball on the tee (!).
  • Looking up at something high – getting ready to prune the tree, changing a light bulb (we don’t do this as often anymore thanks to LEDs!), a high tennis serve toss, looking up/leaning head back while washing your hair.
  • Changes of position – moving from lying down to sitting up or vice versa (ie in/out of bed, getting up/down off an exercise mat) or turning your head/rolling to one side while lying down.

How long does the vertigo last?

  • With BPPV, the vertigo sensation itself typically lasts less than 1 minute, and not more than 2 minutes (it can often feel much longer in the moment!). The symptoms will recur as the head and body move into the provoking positions.
  • There can also be a sensation of imbalance while moving/walking or mild nausea when someone is suffering with BPPV and this can occur more frequently.

How do you treat BPPV?

  • BPPV can be treated very effectively with a re-positioning maneuver – essentially using gravity and the position of your head to move the crystals out of the affected canal and back to their normal resting position. When this happens, and the crystals are ‘back in their home’ the vertigo symptoms go away.

Many people use the internet to look up home treatment for BPPV and often read about the ‘Epley Technique’.  This is the most commonly performed re-positioning maneuver for BPPV; but it does not treat all types of BPPV.  The Epley is only effective for one type of BPPV. The key to effective treatment involves: figuring out which ear has the problem (it is usually only one ear), determining what canal the crystals are stuck in, and effectively applying the correct treatment technique.  If the wrong technique is used, or done incorrectly you will not likely cause damage, but you can make yourself feel pretty rotten and it will not solve the problem.

 

A physiotherapist who has studied vestibular rehabilitation will take you through an assessment that will involve the following:

  • A thorough history of your symptoms and current challenges.
  • A safety screen to rule out more serious causes of vertigo.
  • A physical assessment to determine if BPPV is the cause of the vertigo and how to best treat it.

 

Often treatment can be done in the same session.  Assessment and treatment for BPPV does involve reproducing the symptoms of vertigo – but it’s worth it when the vertigo is gone.  Don’t let vertigo get in the way of enjoying the activities that you enjoy, especially in the summer season!

Call one of our clinics or book online (www.treloarphysio.com) to make an appointment with one of our physiotherapists trained in vestibular rehabilitation.

Written by Stacy Benmore (Physiotherapist, Treloar Physiotherapy Kerrisdale). 

Dance Pain-Free: Physiotherapy Tips to Conquer Snapping Hip Syndrome

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What is Dance Physiotherapy?

Dance Physiotherapy combines manual therapy & clinical pilates techniques to help artistic athletes – dancers, gymnasts, skaters (and more!) reach their goals. Dance physio is ideal for artistic athletes of any level who are recovering from injury, preparing for pointe work, looking to prevent injury, improve mobility or overall performance.

Dance physiotherapy can help with a variety of conditions including:

  • Knee injuries – for example jumper’s knee & bursitis
  • Back injuries – including spondylolisthesis
  • Foot injuries – for example plantar fasciitis, bunions and achilles tendinopathy
  • Hip pain & injuries – including snapping hip syndrome
  • Chronic or acute ankle sprains
  • Overuse injuries
  • Joint Hypermobility

In this blog post we will be discussing snapping hip syndrome which unfortunately, is very common in dancers, particularly when extending the leg or coming into a grand battement.

What is the snapping or clicking sound? One of the most common sounds is a deep “clunk” when extending the leg. The most likely cause of this is spinal instability and/or over-recruitment and chronic thickening of your psoas muscle (your hip flexor) 

How do I get rid of the noise/ snapping sensation? By working on mobility, stability and then gradually loading the hip. Below are some great exercises to start with!

1. Aikido or “Frog” Mobilization

Come into Aikido or frog stretch position – knees wide on the mat, bottoms of the feet together, arms or forearms resting on the mat. 

Rest in this position for 10-15 seconds, allowing for a gentle stretch in the inner thighs and opening of the front of the hip. 

From here, bring your pelvis into a forward tilt (think about rotating the top of your hip bones towards the mat), and hold for a further 10-15 seconds. Engage your deep core in this position to get an even deeper stretch through the front of the hip! 

Alternate between these positions 4-5 times.

Note: There should not be any discomfort or pain in the hips during this mobilization. If you are feeling any pinching or discomfort decrease how far apart your knees are or consult your physiotherapist before continuing. 

One of the common contributors to snapping hip syndrome is when the outer, or lateral glute muscles have increased tension in them – this can occur when glute med grips to maintain turnout in standing – rather than the deep external rotators. 

 

  2. External Rotation in Table Top

Equipment needed: pillow or small ball 

Lie on the mat, back flat and deep core engaged. Slowly bring both legs up to tabletop position (knees bent at 90 degrees) with the small pillow or ball between your thighs. 

Maintaining inner thigh activation by squeezing the pillow or ball, slowly extend one knee in parallel. Then, from the deep hip socket, externally rotate your extended leg (coming into turn-out). Hold for 2-3 seconds and then come back to parallel and then back to your tabletop position. Continue to maintain the squeeze of the pillow/ball during this entire process. 

Repeat this up to 10 times on each side.

Tip: to ensure the core & deep external rotators are working, check that hip flexors are relaxed throughout this entire exercise.

 

3. Plié Variation targeting deep external rotators

Begin standing tall, in first position. Start with a demi plié and then, maintaining your turn-out (external rotation), slide one leg along the floor (in fondu – one side continues to be in plié, the other knee extends). The foot on the extended leg should come onto the ground. Then, while maintaining your weight over your standing leg (in plié), bend your extended leg while you slide it back to first position. 

During this movement you should be able to feel your inner thighs (extended leg) and deep external rotators (standing leg).

Tip: Place one hand over the outer glutes on your standing leg – these muscles shouldn’t be gripping or over-activating as the turnout should be coming from your deep external rotators.

Note: This exercise can be completed in centre or standing at the bar (or at a counter at home!)

 

Thanks for reading! Consult your physiotherapist if you experience pain or are interested in a personalized targeted program to address your specific goals!

 

Written by Talia Berson (Physiotherapist, Clinic Pilates Instructor).

 

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Just Keep Swimming – Six Reasons Swimming is Fantastic for Your Health

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Just Keep Swimming – Six Reasons Swimming is Fantastic for Your Health

Amidst these scorching summer days here in BC, there’s nothing like a refreshing swim, but swimming has many health benefits besides being a fantastic way to cool off.

One significant aspect of water-based exercises is the hydrostatic effect of water, which has fantastic therapeutic benefits. The pressure can alleviate pain by reducing swelling and calming our sympathetic nervous system. As a result, pool-based exercises and swimming can benefit those in post-recovery (like ankle sprains, knee replacements, etc.) and facilitate a faster recovery.

But the benefits don’t stop there! Other great aspects include:

1. Low-impact exercise:

Unlike many other forms of exercise, swimming is low-impact, which puts less stress on joints. Being low-impact makes swimming an ideal activity for people of all ages, including those with joint pain/sprains, arthritis, or other mobility concerns.

2. Flexibility and balance:

Swimming enhances stability and coordination and helps those who fear falling to practice safe balance drills in waist-height water. It also improves joint flexibility through various strokes and positions.

3. Improved posture:

Swimming helps strengthen the muscles that support the spine, leading to better posture and reduced risk of developing back problems or aches.

4. Cardiovascular health:

Swimming elevates the heart rate, improves blood circulation, and reduces the risk of heart disease and high blood pressure.

5. Full-body workout:

Swimming engages multiple muscle groups simultaneously, providing comprehensive exercise for the entire body. It strengthens the arms, shoulders, back, core, and legs, improving muscle tone and overall strength.

6. Weight management:

Swimming is a calorie-burning activity that can aid in weight management and loss. It helps burn many calories while providing a fun and refreshing workout.

Conclusion

Before taking a dip or starting any exercise program (like hydrotherapy/pool-based rehab), consult your doctor and physiotherapist, especially if you have any underlying health concerns. Stay safe, and just keep swimming!

Physiotherapist Ania Stojek wrote this article.

Prune and Rake without the Ache – a quick exercise guide for Gardeners!

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Prune and Rake without the Ache – a quick exercise guide for Gardeners!

Summertime brings on gardening and yard maintenance. Here is a simple routine that will make your gardening easier by addressing the following three components to happy gardening:

  1. Strength: often you need to move things, dig, lift heavy pots, etc. which requires a certain amount of strength.
  2. Mobility: you’ll need to be able to bend your knees/spine, get into tight spots, and low down to the ground for your gardening tasks.
  3. Balance: to avoid feeling wobbly on your feet, stay safe, and avoid falling while gardening.

1. Strength

As a gardener strength in your legs and back are necessary to perform certain movements safely. The following two exercises help to develop vital leg and back strength for safe gardening:

Sumo Squat:

  • You can hold onto a bucket, watering can, bag with something heavy in it, or no weight at all.
  • Stand with feet shoulder width apart or a little wider with the object you are lifting a little in front of your feet.
  • Bend down like you are sitting in a chair and pick up the object with a nice straight back.
  • Stand back up by straightening knees and squeezing your buttocks.
  • Repeat for a recommended 8-12 repetitions x 3 sets.

Lunge:

  • Hold onto something for support if needed (chair, railing, rake) and take a big step forward.
  • Drop your hips directly down between your two feet.

 2. Mobility

Does your lower back ever get stiff and achy while gardening? Mobility work can help with that stiffness and keep you moving smoothly. Try these 2 exercises for your spinal mobility.

Seated forward fold:

  • Sit tall, with feet hip width apart, and hands on knees.
  • Start by bending your neck looking down, then roll your shoulders forward, then midback, then lower back sliding your arms down your legs as you go.
  • Bending as far down as you comfortably can without pain/discomfort.
  • Reverse it as you come back up.
  • Repeat for a recommended 3-5 slow repetitions 3-5 times.

Standing extension:

  • Stand with your feet shoulder width apart with your hands on your hips.
  • Stand up straight and gently arch your back.
  • Only go as far as it is comfortable. Hold for 3-5 seconds repeat 3-5 times.

3. Balance

With balance exercises there can be a variety of levels so find what suits you best. Try to be near a wall, corner, and/or something sturdy to hold onto especially your first few tries to keep you safe.

Tandem balance:

  • Place one foot in front of the other, so that the toes of your back foot are just touching the heel of your front foot and hold this position.
  • To make this easier try holding on to something while you get into position, you can also place the front foot slightly further forward and/or to the side of the back foot.
  • To make it harder you can try turning your head left to right or closing your eyes while you balance.
  • Try to stay balanced as long as you can and practice for 1-3 minutes.

Balance Reach:

  • Place your feet together so they are touching, or as close together as you can get them.
  • Reach out in front of you bending at the hips.
  • You can also practice reaching side to side/ up/ down.
  • To make this easier stand with your feet hip width apart.
  • To make this harder stand in tandem like the previous exercise or on one leg.
  • Try to stay balanced as long as you can and practice for 1-3 minutes.

Conclusion

This is a small sample of exercises that can help improve your gardening but hopefully it is enough to get you started!

It is important to note that these exercises may not be appropriate for everyone, please discuss with your physiotherapist if they are right for you.

Physiotherapist Danielle Carter wrote this article.