Hello everyone! Welcome back to another week here at ARC Therapy. We took a bit of a hiatus the last few weeks to round up some new material that we are excited to be sharing with you upcoming. For the next few weeks, we will be providing information on dizziness and imbalance and other possible symptoms of vertigo.
Vertigo, or BPPV (benign positional paroxysmal vertigo) can be classified as a disturbance in the vestibular sensory system that can present as dizziness with or without nausea as well as balance and coordination deficits. The vestibular system is comprised of otoconia, or little crystals, that sit within semi-circular canals within the inner ear. These crystals can become dislodged through sudden movement such as rolling over in bed, or something more vigorous such as riding on a roller coaster. When they become dislodged, the free- floating crystals become sensitive to gravity during head movement. We will provide information on our role as physical therapists in the proper treatment of this condition within the clinic with canalith repositioning and gaze stabilization exercises in our future posts; however, in this post we will discuss some interesting information coming from research studies on the role of vitamin D and estrogen with vertigo.
A research study from the Journal of Neurologic Physical Therapy (JNPT) from the American Physical Therapy Association (APTA) looked at the role of vitamin D and estrogen in the occurrence and reoccurrence of vertigo. Calcium plays an important role in the uptake and mineralization of otoconia which helps keep bone density and strength at healthy levels. Studies have found a correlation between decreased calcium absorption and metabolism and low serum levels of vitamin D, found in patients with osteopenia and osteoporosis, and incidences of vertigo. In addition, these studies suggest that restoring normal calcium metabolism through medication and diet can help reduce occurrence and reoccurrence of vertigo. For these patients with osteoporosis, the study suggested that it may take more visits with your physical therapist performing the canalith repositioning exercises due to the impaired calcium metabolism.
Another interesting finding from the study looked at the role of estrogen and rate of occurrence of vertigo. Estrogen is the key hormone which helps to regulate bone metabolism by decreasing bone remodeling and resorption while maintaining healthy bone formation. The study found occurrences in both male and female patients; however, a higher incidence of vertigo was found in female patients who were peri and postmenopausal. It found that with a regulated hormone replacement therapy program, it can lower the occurrence and reoccurrence of vertigo.
Although the information provided from these studies provided some promising new information in the treatment of vertigo, it did suggest that further studies needed to be conducted to validate the efficacy of these findings.
In conclusion, new research is coming out on various forms of treatment and prevention of vertigo outside of the canalith repositioning and gaze stabilization exercises. It is important during the history section of the physical therapy examination to provided your therapist with vital information regarding your past medical history, current medications, diet, and any other related information that could help us determine if a referral to a physician is needed for vitamin D, estrogen, or calcium decencies. If it is determined that any of these conditions exist, there may be some alternative treatments found in these research studies to help in the treatment and prevention of vertigo.
Hope everyone enjoyed this week’s topic and remember to check back in soon for future posts regarding the physical therapy exercises that can be prescribed in the treatment of vertigo. As always, be safe, stay healthy, and continue living and happy and active life!
Jeong, S., & Kim, J. (2019). Impaired Calcium Metabolism in Benign Paroxysmal Positional Vertigo. Journal of Neurologic Physical Therapy, 43. doi:10.1097/npt.0000000000000273