Episode Transcript
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Speaker 1 (00:00):
If you're a driven,
active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
So this is an interesting topic.
Okay, that I just want to touchover briefly in a small
superficial surface layer typeof discussion.
(00:21):
I'm not sure if a lot of peoplearen't aware, but vertigo and
vestibular issues can berehabbed.
There's a specialty in physicaltherapy that purpose that
specifically works on vertigoand vestibular issues.
Dizzy spells right, it'sactually a really common thing
(00:42):
and it seems to be more commonin women that we've come across.
But we have some cliniciansthat in our area that are within
our practice that we worked onthis with, all right, my wife
being one of them.
Shout out to my wife shepresented nationally, at AOMT, a
National Specialty GroupConvention on vertigo and
(01:06):
concussion rehab.
So concussion is another partof that Vertigo, concussion,
vestibular rehab.
This is very interesting.
Okay, so there's a couple ofmechanisms of vertigo symptoms.
Dizzy spells right, people getdizzy, all right, all right.
(01:33):
Bppv benign, paroxysmal,positional vertigo.
Bppv is short, provoked boutsof vertigo where the otoconia
stones the calcium otoconiastones, all right are tiny
little pebble rocks that areinside the inner ear organs.
The inner ear of the cochleaand the semicircular canals are
tiny little circular canals thatthey look like inner tube rings
(01:57):
, that there's fluid in therewhere gravity and your head
position lets you know where youare in space.
For head writing, it's like Iknow what, which way is up,
right Head writing is veryimportant and, on the extreme
end, be like cats, like theanimal cat they have, like
really good head writing, um, umsensory and ability to head
(02:18):
write really well.
If you, if you throw a cat inthe air, right, I would never do
this.
But if you threw a cat in theair I don't advocate for this
and throw them upside down,they'll always land on their
feet right.
They know where they are inspace based off of what their
sensory is finding in gravity,all right.
So BBBV is a pathology and anissue of the little stones that
(02:41):
float around in the semicircularcanals of your vestibular
system, of your inner ear, withmovement of your head.
So as I turn left, turn right,up and down and turn sideways, I
know which way gravity feelsbecause I can feel it, and head
writing and the fluid in mysemicircular canals move with
that gravity dependent and headbased movement and there's
(03:06):
little tiny stones calledotoconia that float in those
little inner tube ring rings,canals, and they flow against
and with the fluid movement andthere's little hairs of the in
the inside of called cilia thatsense what direction these fluid
and otoconia are spinning.
(03:27):
So if somebody does like a oneof those, like an America round
or like a spinny ride, and theyget super dizzy, it's because
the fluid is moving very, veryrapidly in their inner ear and
their vestibular system, thesemicircular canals, and it
takes a minute for those, themomentum of that fluid, to stop
spinning.
So it makes you feel likeyou're leaning one way and it's
(03:49):
because your head is being headrighted one way, thinking that
that's the way the gravity is.
So it's sensory confusion, it'swhat that is.
So the otoconia gets and BPPV,they sometimes can get stuck.
If they get stuck in one spotit trips the little cilia and
nerve endings to think that ifit's staying like that or if
(04:11):
it's pushing one direction, thenit makes you feel like you're
moving one way.
So you get dizzy right theroom's spinning and there's
sensory confusion between whatyour eyes are looking at,
because your eyes play a rolewith vertigo and balance in your
vestibular system and what thesensory cilia and fluid is
feeling in the semicircularcanal of your vestibular system.
(04:34):
Okay, so your eyes try to catchup but nothing's moving, so
it's called nystagmus.
If you look at somebody with aBPPV or dizzy spell or somebody
that gets off like a really big,intense spinny ride, their eyes
will be beating really rapidlyto catch up with what they feel
is the room or the earth movingaround them.
(04:56):
Like I need to catch up andstabilize, so that's called
nystagmus.
So you'll notice nystagmus intheir eyes, which is very
interesting.
So benign, paroxysmal positionalvertigo is a short bout of
vertigo symptoms from anotoconia stone that gets stuck
so we have to get it unstuck.
And that's what, like a Dick'sHall Pike maneuver and other
(05:17):
head therapy exercise, movementsand then also some eye gaze
stability exercises and headmovement exercises to challenge
and habituate.
It's about like provoking onpurpose and then you a person
will habituate around whatthey're feeling with that so
that they get better with lesssensory sensitivity and sensory
(05:40):
confusion.
So it habituates less confusion, sensory wise, and makes you
more resilient to those stimuli.
Confusion, sensory wise andmakes you more resilient to
those stimuli.
It's very interesting.
All right, so that's BBPV.
There is a, uh, the threemechanisms for balance, and head
writing, um, so I'm going tostick with vertigo.
(06:06):
There's the three reflexes andsystems that play with head
writing and vertigo, and and uh,being dizzy is the inner ear
vestibular system and the VOR,which is called your, your
vestibular ocular reflex, andyour COR, which is your cervical
ocular reflex.
So the VOR is the relationshipbetween your eyes, what your
eyes are seeing visually, andthen what your inner ear's
(06:29):
vestibular system, thesemicircular canals, are sensing
as well, and if there's asensory confusion, it's going to
make you feel dizzy.
Is the problem, though, ifsomebody comes with dizzy spells
and are dizzy all the time?
As an example, when they are Iheard this before it's very
interesting If they're at thegrocery store and they're
painting all the spices on thespice aisle and they're looking
(06:52):
very rapidly across thesedifferent shelves of spices and
they get disoriented and dizzy,it's because there's very rapid
eye movements going on and somehead movement.
This is a very interestingexample.
Another one we've heard in asimilar situation, with the VOR
being the problem is driving ona highway and then the cars that
(07:12):
go past them or in the oppositedirection is sensory confusion
for them and their eyes and theyget sensitive to that and it
disorients them rapid thingsmoving around you that causes
like you get disoriented.
So the question is they come inwith a dizzy spell, like I'm
having dizzy spells.
How do we know?
It's not a vestibular problemin the inner ear versus a VOR
(07:35):
problem with the visual gazestability, like your eye gaze
and you're gazing at something.
Is that gaze stability theissue or is it contributions
from the neck and the cervicalspine?
There's a lot of nerve endingsin the upper cervical and your
upper neck vertebrae and all theinterplaying connections of
nerves that play a role withstability of the vestibular
(07:58):
system.
So there's contributions andsensory of what a person's neck
position is doing and dizziness.
This is a very close link withsuboccipital region pain and
cervicogenic headaches anddizziness.
It's very interesting.
There's a lot of interplay.
We also can't neglect that thetrigeminal nucleus is at C2, c3.
(08:21):
So the trigeminal nerve is yourcranial nerve five and there's
contributions to that with thevestibular system the vertigo as
it relates to neck movementsand neck positions and stuff and
neck pain, right nucleus, allthe nerve endings and the joint
(08:45):
capsules of the cervical spineas it relates to sensory
confusion and input and outputconversations and communication
between that and the vestibularsystem in the inner ear.
So it's very interesting.
So if somebody gets dizzy whenthey move their head a lot,
their eyes are having tostabilize on an object.
While they move their headright, they also are moving
(09:06):
their neck joints and their neckmuscles.
So it's like what is theproblem?
So if you close their eyes andhave them do the same movements,
does it cause pain or causedizziness?
And we know it's not BBVV, thenwe're thinking it's a lot of
COR contributions or justprolonged head position.
Does that cause the issue?
Versus, if we move their wholebody around like in a spinny
(09:28):
chair and we move them back andforth rapidly and their neck
isn't moving but they still haveto stabilize their eyes on an
object and that's what tripstheir dizziness and their
vertigo, then we know that's avor problem.
If it's a positional thing withtheir head, then we know it's an
inner ear vestibular problem.
So anyway, surface levelconversation, we know that we
(09:49):
have to tease out between is ita VOR, a vestibular ocular
reflex, gaze stability problem,whether gaze stability is just
more sensitive and not asresilient as it could be.
Is it an inner ear vestibularproblem legitimately with like a
head position, or is it neckrelated, causing cervicogenic
(10:10):
headaches, suboccipital neckpain, neck pain in general?
That's creating some sensoryconfusion in the vestibular
system too.
So it's just very interesting.
Those are the things that wehave to check out and work on
and if we don't, then we're notgoing to have a clear diagnosis
and we're not going to have aclear treatment on like working
on vertigo and vestibularsymptoms when really it's
(10:31):
actually coming from their neck.
The contributions we have towork on cervical mobility and
cervical stability and some ofthe muscle surrounding
musculature to settle that down,and that's going to help
resolve headache, the cervicalgenetic headaches and dizziness.
We can't neglect that becauseif we don't they're not going to
get better right.
(10:51):
It's just a clear diagnosisleads to a clear treatment and
we can't leave any stones onturn no pun intended with
otoconia versus a BPPV.
Then we might need to do moreaggressive head positioning
maneuvers, like Dick's Hall Pikeas an example, to reset the
otoconia and fix that issueright.
There's three semicircularcanals on each side and we have
(11:15):
to determine for BPPV and alsowhen we're demonstrating
nystagmus.
It tells us with certaintesting and positions and the
beat direction of the eyenystagmus.
It tells us, with certaintesting and positions, and the
beat direction of the eyenystagmus beating.
It tells us which side, left orright, and also which
semicircular canal.
So they're of the three.
(11:35):
It's very interesting, it'svery cool.
So, that being said, it can betreated.
We just have to intervene withthe right things and do a solid
evaluation to figure out wherethe actual problem lies.
So I thought it was just reallyinteresting.
I wanted to share that a littlebit of insights and at least
bring some hope.
If someone's battling vertigo,dizzy spells and nystagmus
issues, um, that we can help you.
(11:57):
You know, it can be helped.
It's actually something thatcan be rehabbed versus just
medication.
But the other interesting thingwith that too, that uh, one of
the I forgot to mention this Ihave an issue with this too,
with, uh, if I'm sitting at ared light I don't know.
You tell me if y'all have hadthis before I'm sitting at a red
light and I'm not moving, butthe car next to me is slowly
(12:20):
moving forward and I feel likeI'm, I was like, am I moving?
Like the light's red, and youget sensory confused, get a
little bit disoriented and dizzyfor a second, it's because
there's sensory confusionbetween what your eyes are
seeing and what your actualvestibular system is feeling,
cause you're not actually moving, but for a second they were
perceiving that we were moving,and it triggers symptoms, and so
(12:41):
it's like a an eye gazestability problem.
Um, or, of course, symptoms, andso it's like an eye gaze
stability problem.
Or, of course, roller coastersand getting dizzy, car sickness,
motion sickness right, thatcould be an eye gaze stability
problem, not just a vestibularproblem, or even neck movements.
It's interesting, though rollercoasters your neck really isn't
moving, that you're not turningyour neck a lot like hopefully,
but a little bit of jostlinggoing on, but more so it's the
(13:03):
eye gaze, where objects arewhipping past you and also just
going upside down and turning,and your vestibular system is
getting challenged.
So imagine the sensoryconfusion between your eyes and
your vestibular system withsomething like a roller coaster
or car sickness.
Right, we can't neglect thatthe eyes play a huge role with
that and the strength andstability of the muscles that
(13:24):
control the eyes and the sensoryconfusion to the vestibular
system.
So that's very interesting.
I'm not going to talk any moreabout that because I'm not an
expert on this stuff, but we doknow experts and we'd love to
help and we can at least chatand get some insights on, maybe,
what has been going on and howwe can best treat it.
So don't hesitate to reach outand if you have any questions,
(13:45):
the best way to reach us isprobably our email at team at
athleterccom, or our phonenumber at 561-899-8725.