I had been seeing a Physical Therapist for years before the time of COVID. I have a recurring issue with the lower back, a common complaint among older people, come to find out. I’ve also messed up my neck and shoulders in car accidents over the years, so I have plenty of things to work out with my physical therapist. Or did have before the time of COVID. I haven’t been back to Symmetry Physical Therapy since before March of 2020, because as painful as my joint and muscle problems are, they pale in comparison to the kinds of problems catching COVID would mean to someone like me.
Back in 2019, when the lack of plague allowed me to leave my house for things other than the essentials, I just happened to be at my Physical Therapy appointment when I mentioned that I was having recurring problems with minor vertigo and dizziness that lasted for weeks or months at a time. He got a quizzical look at that point asked me if I had ever tried any vestibular training exercises.
I had never even heard of vestibular training before, much less tried any of the exercises. He then demonstrated a few of them for me and had me work through them. I don’t know that they had any positive effect, but the knowledge that there was PT for my vestibular problems started me on a mission to find out more about the subject.
After mentioning the subject to my Ear, Nose and Throat doctor (ENT) on my next visit (she was mortified that we had never discussed the subject before) She gave me a referral for and I went to see the specialists over at 360 Balance, which just happened to be the people that my PT had been to a seminar with and had put the bug in his ear about retraining the vestibular system after injuries like the ones that Meniere’s inflicts on sufferers.
Over the course of the next six months or so we set up a set of exercises that addressed the issues that arise from the inner ear damage that Meniere’s causes. The exercises did, in fact, stop the nagging dizziness problems that I had been experiencing all that summer of 2019, and I have not had a recurrence of those symptoms since then. Did not have them again until a few days ago.
I’ve been slacking off my exercise regimen lately. The allergens outside the house have kept me sequestered indoors more often, and even the little bit of pollen and dust that get into the house are enough to make me feel like I’ve got a permanent head and chest infection. A feeling that can persist for weeks on end. Starting sometime last week I started to feel like I was heading into another bout of vertigo, so I started taking my meds in response. I’ve managed to avoid worshipping at the porcelain altar so far (knock on wood) but I have had that nagging bit of dizziness and nausea that comes along with it that has persisted for almost the whole week since I first noticed the warning of oncoming vertigo.
So today I decided it was time to break out the PT routines and see if I was going to finally worship the god of the toilet bowl or if I was going to stop feeling this stupid constant dizziness. The results are mixed. I do feel slightly less dizzy just sitting here typing. Any kind of movement does make the dizziness worse though. There is something different about the way my inner ears are working at the moment. I can determine that much. I don’t think I’m quite through the woods with this re-arrangement that my vestibular system is going through.
At least I can sit here and type words without feeling like the room is going to take off spinning like a top. That is a good thing. I think I will go walk the dog once I’m finished writing (I did) but in the meantime I’ll outline the exercises the therapist has me doing to help ease the dizziness.
- Dynamic Standing Balance – I have a pillow that is so damn firm that it doesn’t give under the head when you lay on it. The Wife and I both hate the thing, but now I have a use for it. I place it on the treadmill near the grips in case I fall over and stand on it. Then I close my eyes trying to maintain balance for 30 seconds.
- Kick the pillow out of the way and stand with your ankles touching. Close your eyes and try to maintain balance. If you can do that for 30 seconds, move your head from side to side at a moderate pace and try to maintain balance for 10 back and forth movements.
- Vestibular Ocular Reflex (VOR) Exercise/ Gaze Stabilisation Exercise – I do both back and forth and up and down with these exercises. I set a metronome to 150 beats a minute and try to keep the mark on the wall steady for at least 15 seconds of head movement. I had to slow the metronome down today for the first set. I could not keep the mark still at that pace.
- I can’t find a name for this one. I hold my thumbs out at eye level and maintain my gaze on them. This should be done against some kind of busy background. Bookshelves or blinds are both good choices. Rotate your torso to the left and to the right, back and forth, repeatedly, maintaining eye focus on your thumbs while the background moves behind them. I find this to be one of the best exercises for quieting the periodic dizziness that I get between vertigo spells. Making the world spin on purpose while focusing on a still object counters the feeling of spinning when it hasn’t yet turned into active vertigo.
- Walking with head movement is the last exercise that they had me doing. Not just side to side, as the video demonstrates, but also up and down and diagonally (high left, low right/high right, low left) if you can pull that off without tripping all over yourself, try giving yourself mental tasks to do like naming groups of things or counting backwards from different starting points.
The hard part is making yourself do these things every other day or so. You feel fine and you think I have better things to do, so you don’t do the exercises that day. Before you know it a month has passed and you wake up dizzy for no apparent reason. Then you have to get back on the bandwagon and deal with the dizziness and the nausea until the exercises have the intended effect and you start to feel better. Now I’ve done my exercises and walked the dog. Time to reward myself with some more video gaming!
Postscript
Someone was talking up virtual reality vestibular therapy on r/Meniere’s recently. I’ve seen these systems in place and used them a few times. They weren’t VR googles, which can have time lags that cause vertigo themselves, but were half-domes set on edge and used as projection screens that you stood inside of. The therapists had me walking through a shopping experience once, which was giving me agoraphobia at the time.
I have also done VR googles and vestibular tests and exercises. I really can’t attest to an amazing efficacy or perception changes for any of these systems, though. If there were changes they were so subtle that I never noticed them.
I feel good for long stretches of time. Then I feel out of sorts for long stretches of time interspersed with days of vertigo and ear pressure. I still can’t figure out what is causing my symptoms, but at least they aren’t all the time these days.
What has helped me the most? Disability, CPAP, Betahistine & Xanax. In that order in time and magnitude, pretty much. Those are the things that made the most difference, vertigo-wise. Disability removed the daily stress. CPAP allowed me to finally get good sleep, and I could afford to have it because of the disability finding and Medicare. Better sleep meant better, clearer thinking, which led to trialing the various non-invasive treatments, which led to finding Betahistine and Xanax as effective treatments. I haven’t had to suffer through a full day of vertigo in years because of the Xanax and Betahistine.
The vestibular physical therapy, and just basic physical therapy exercises, have made it easier and safer for me to get around, don’t get me wrong. I like not having bruises all over from running into things or falling down, but in the scheme of my life that comes after all the other stuff I listed. They do help me feel normal, but I also know that normality is a delusion that we humans feed ourselves at our own peril.