I was fortunate to take a course on tempromandibular joint (TMJ) dysfunction this past weekend. The more I learn from other experienced clinicians and the more I practice, I keep coming back to the notion that everything in the body is connected. It is a rare person who just has a problem with their TMJ. Isolated treatment to 1 joint may partially solve the problem or reduce symptoms. More effective treatment is about treating the system. Jaw, ear, head, neck, upper back, lower back, pelvis and feet— they are all connected. To optimize the system, you need to address how the part interact with each other dynamically throughout the day. I use lots of tools to do this— integrated movement activities, manual therapy, functional training and much more. Each person is unique and each treatment should be unique as well. — Lisa Eaton, DPT, OCS
Most of our patient report some visual symptoms associated with dizziness. The pathways for this are known and well-established. The inner ear (or vestibular system) has strong and direct connections to the eyes to produce the vestibular-ocular reflex (VOR). The VOR is what allows you to hold your gaze steady on an object and move your head. Additionally, we know that the top 2 levels of your cervical spine input directly into the visual system to help control eye-head motion. If there is an impairment in either of these systems, visual symptoms can result.
However, we also see a lot of patients who have visual symptoms that are probably a result of eye strain. Most people are visually dominant. When the eyes are strained the whole system for balance and orientation in space is put under more stress. As the computers have evolved to be a larger and larger part of our daily life, physical therapist have evolved to address the ergonomics of the work station. Now, it looks like we have to evolve again to address the issues of overworked (and under appreciated) eyes.
Dr. Erik Peper writes an interesting blog post on the epidemic of eye strain and how to treat your eyes with care while you still can. (see below) As in all things, small amounts of change can make a big difference over time. I would encourage everyone to try to give their eyes a much deserved rest for a week and see how they feel.
Falling is preventable! KOUW.org reports on a personal story and warnings to the increase risk of falling as you age.
Get involved with Balance Awareness Week!
Here’s a link to an interesting article on Balance found in the New York Times
Here is the link to an interesting study that came out in 2006. About 50% of BPPV cases have an unknown etiology. This study starts to shed some light on the potential triggers to BPPV.
“High levels of anxiety, depression and somatization were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders.”
This point of this study is not to suggest that stress CAUSES BPPV, but rather, in some people, stress can be a trigger which may set off changes in the otolithic membrane. These changes can lead to BPPV. This is important for a few reasons. One, patients with recurrent BPPV may need to address psychological issues to get BPPV under better control. Two, patients are often wondering “why me?” when they get BPPV. If they can point to a stressful event as a possible trigger, it can help ease the anxiety around the diagnosis. As a healthcare practitioner, healing the whole person is often the biggest challenge, but is absolutely critical for helping people optimize their quality of life.
24% of people 50 and older will die within 1 year of fracturing a hip. Hip fractures are almost always related to falls. And, falls are preventable. Balance can improve at any age with skilled balance training, and if needed, vestibular rehabilitation. Don’t wait until it is too late. Schedule a balance assessment today.
For patients participating in vestibular rehab, there is often a fine line between working aggressively on your exercises to facilitate recovery and overdoing it (and paying for it). Figuring out what is just enough, but not too much is as much an art as a science. Here are some basic guidelines for monitoring your response to exercise and activity.
1) Know your baseline. It is important to get in touch with how you feel when you are at your best. Admittedly, this may not be that great if you are in the early phases of recovery. For many people, waking up is the best time of the day. No matter when it is, take account of your symptoms on a 0 to 10 scale, with 0 being no symptoms and 10 is the worst you can imagine.
2) Exercises and activities help your brain adapt, compensate or substitute in ways that will decrease your dizziness and improve your stability. It is counterintuitive, but doing what makes you dizzy is often the best road to recovery, BUT… The key is moderation. Once you know your baseline, exercises and activities should take you 1-2 points higher than where your symptoms were when you started.
3) Recovery is also key. Once you have stopped your exercises, it is important to return to baseline fairly quickly, usually about 1 hour or less. This assumes that what you do afterwards is fairly benign. If recovery takes many hours, maybe it would be best to do less per session, but try to get in more sessions.
Tomorrow night (Oct 4th), I will be returning to Bastyr University Grand Rounds to lecture on “Vestibular Assessment from a Primary Care Perspective.” This is a lecture I have given before to Bastyr students nearing the completion of their training as naturopathic physicians and it is a topic near and dear to my heart.
Dizziness is one of the most common reasons for seeking medical care. It is critically important that primary care providers are skilled in recognizing the presentation of common vestibular problems. One of the most common complaints for patients with dizziness and vestibular problems is the time it takes to get a good diagnosis and appropriate treatment. By giving this lecture to future primary care providers I am hoping to help them get their patients to the right kind of care sooner.