David visited Dynamic Sports Physical Therapy in New York City and explained that he had been experiencing occasional bouts of vertigo, which would usually come on first thing in the morning as he was getting up from bed. He said the vertigo would only develop with certain movements, but it would typically be followed by aftereffects that would leave him dizzy and nauseous for several hours. David had similar symptoms in the past that he received physical therapy for at the time, and he attempted to self-treat these new vertigo episodes with what he remembered from those experiences. Unfortunately, this did not lead to any improvements in his symptoms.
Before beginning treatment, David’s physical therapist performed a preliminary neurological evaluation of his visual system, which ruled out the possibility that issues with the nervous system were contributing to his vertigo. Next, David was run through the Dix-Hallpike and roll tests, which are designed to identify benign paroxysmal vertigo disorder (BPPV), a disorder of the inner ear that involves calcium crystals and causes brief periods of dizziness. He experienced symptoms and nystagmus—involuntary eye movements—with both the left Dix-Hallpike and left roll tests. These results strongly suggested that David had BPPV prior to seeing us and attempted to treat it himself, which caused canal conversion. That means he probably began with only one canal of the ear involved, but he caused some of the calcium crystals to travel from one canal to the other with his at-home treatments.
How we helped David overcome his vertigo
David stated that his goals were to eliminate the intense bouts of vertigo and be able to get through his day without feeling woozy or dizzy. Initially his nystagmus presented with torsion and up-beating. This usually indicates that posterior canal is involved and is treated with a type of exercise called the Epley maneuver during his initial treatment visit. After 3 Epley maneuvers were performed, he was reassessed and showed a small horizontal nystagmus during the roll test with onset of vertigo symptoms. He was then treated with another exercise called the Lempert maneuver twice to clear that canal, after which he felt better.
Most patients treated for BPPV may only require one treatment session to remove their symptoms. However, with canal conversion the patient may require more treatments. This was the case with David. After a few days of feeling significantly better, he began experiencing symptoms again. In total he required four visits to eliminate his BPPV, during which his therapist used a combination of the Epley, Lempert, and Gufoni maneuvers. It’s now been nearly two months since David has reported any vertigo symptoms and he has returned to his prior level of function.
David had this to say about his treatment experience with us: “The BPPV was debilitating for me and was really affecting my ability to work. Dynamic Sports Physical Therapy went above and beyond to make sure I could get back to living my life. They were very thorough.”
David’s story shows how certain conditions require a dynamic treatment plan that adapts based on the patient’s response, and his positive outcome is a testament to how our targeted interventions can lead to significant improvements. If you’re dealing with any balance or dizziness issues, or if pain is holding you back from living your life as you’d like, we can help. Contact Dynamic Sports Physical Therapy in New York City at 212-317-8303 to schedule an appointment today or click here for more information about BPPV.
