What Makes You Dizzy Might Make You Better
Vertigo and dizziness is uncomfortable.
You may even feel anxious or fearful with a vertigo episode. Maybe you get nausea, sweating, or heart palpitations with dizziness.
These are all things any sane person would want to avoid, it’s just common sense, but if you listen to a crazy vestibular therapist like me you might hear different.
When we talk about what makes you dizzy might make you better, we are talking about habituation exercises. These are exercises that emphasize neuroplasticity, the brain’s ability to change and adapt.
Before implementing this strategy we first need to determine what is causing your vertigo. If you are laying down at night and experiencing dizziness that comes on, usually described as the room spinning, and lasts less than a minute, it could be BPPV. In this case, pushing into your symptoms WILL NOT make you better, unless you are going through the specific maneuver to treat it. BPPV is a condition where tiny crystals called otoconia get displaced into a nearby canal, when you change positions, the crystals move causing dizziness, they settle, then dizziness stops. Change positions again and the crystals may move again causing dizziness. This is a condition that is easily fixed so make sure you see a vestibular specialist to resolve it! It is a very mechanical issue, those crystals need to be led around the canal and back where they belong. Bringing on your dizziness with BPPV will not make you better, it will just make you uncomfortable. There is a structural problem that needs to be addressed. The exception is that going through the specific treatment may bring on your symptoms but should result in them going away!
Next, we need to consider cervicogenic dizziness. Muscles and joints give you a sense of where you are in space, we call this proprioception. The neck, more than any other section of joints in the body, has very close connections to the vestibular system. If there are imbalances such as muscle tightness or weakness, or poor alignment, the brain may not be getting accurate information on where you are in space. If your neck proprioception is not aligning with your other sensory systems, you’re likely to feel disoriented or dizzy. With cervicogenic dizziness, habituation exercises may make symptoms worse. If you are turning your head and reinforcing poor movement habits, you will not be doing yourself any good.
If you are having an active vestibular migraine, avoid vestibular exercises. The brain is not in a state where it will be able to habituate or adapt. Outside of an active episode, they may be helpful.
So…when ARE habituation exercises effective?
If you are still getting dizziness after BPPV is resolved, you may have some wooziness moving into the positions that previously triggered your vertigo. You will probably notice that the spinning is resolved and the quality of the dizziness has changed. When you had BPPV, the brain was trying to adapt and make sense of the information it was getting. Now that it is resolved, the brain has to adapt back to normal. Habituation exercises will teach your brain that it is ok to move into these positions again, just make sure you pace them appropriately!
If you have persistent postural perceptual dizziness or 3PD, what makes you dizzy WILL make you better. You have to expose yourself to triggering movements and environments to desensitize the brain, but you have to do it in a way that allows the brain to adapt.
