The balance of human body is maintained by the inner ear that responds to gravity by sending signals to the brain. It is more common in older people. Vertigo is caused due to damage to the inner ear. The actual cause lies in interference with the normal ion-water homeostasis in the ear that leads to several inner ear diseases. Due to this reason, vertigo is treated with exercises that help in restoring the equilibrium of the body.
In-office exercises for Vertigo patients
The CRP or Canalith Repositioning Procedure is also known as the Epley maneuver or the modified liberatory maneuver and is employed commonly for the treatment of posterior canal vertigo. CRP maneuver involves a sequence of movements of the head in 4 positions, each being performed after an interval of 30 seconds.
The Semont maneuver is another procedure where the patient is rapidly made to move from lying on one side to the other side.
Gufoni maneuver, Lempert maneuver and the Vannucchi-Asprella liberatory maneuver are the exercise used for treating horizontal canal vertigo. Lempert maneuver involves the head movement in a series of 90˚ angles and repeating again after an interval of 10 to 30 seconds.
Some other exercises performed by a physician while treating vertigo may include:
- Logical modified maneuver or the deep Dix-Hallpike maneuver for the anterior canal vertigo
- The reverse Semont maneuver
- The reverse Epley maneuver
Home exercises for Vertigo patients
There are certain routine exercises or postures that should be followed by the vertigo patients at home.
It is advised to vertigo patients to move their heads in upward and downward directions as well as in sideways directions initially in a slower speed and gradually increasing the pace. Once the condition is improved, exercises should be repeated with closed eyes.
Eyes should be moved in all directions; from side to side movements to up and down movements that should be done quickly. You may also focus on your finger by looking at it at an arm’s distance and then moving it in all directions moving your eyeballs simultaneously in the corresponding direction.
It is advised to shrug your shoulders forward and backward and then sideways. One should also try to pick up objects from ground while sitting and then siting up.
One should perform alternative sitting and standing exercises initially with open eyes and then with closed eyes.
Patients with vertigo are advised to walk across the room with open eyes first and then with closed eyes. Patients are then advised to walk up a slope in the same way. Finally the same is to be repeated on stairs.
Exercise with ball
Vertigo patients may pass a rubber ball from one hand to another under the knee.
Exercises like Brandt-Daroff exercises are recommended that comprises of repetition of vertigo-inducing movements 2-3 times a day for up to three weeks. These exercises can be learnt once and afterwards performed at home easily. According to a study, if the prescribed schedule is followed regularly, Brandt-Daroff exercises may reduce vertigo movements in upto 95% cases. There are some complications or adverse effects of this exercise as well.
Forced prolonged positioning
Forced prolonged positioning is another homer exercise recommended for horizontal canal BPPV that causes vertigo but does not respond to other head maneuvers. This exercise is performed by asking the patient to lie in the bed for a minimum of 12 hours with their heads tilted toward the unaffected ear. This causes the canaliths to gradually move out of the canal.
Self-canalith repositioning exercise
There is another self-canalith repositioning exercise that could be performed at home daily to increase the effectiveness of the treatment. During this exercise, patient is asked to sit upright and turn his/her head at 45 degrees to the left. Immediately after this, patient is asked to lie down quickly on his/her right side for 10 seconds. Then the patient is asked to return back to an upright seated position and turns his/her head at 45 degrees to the right, lie down quickly on his/her left side for another 10 seconds and finally return back to upright seated position.
Post treatment instructions
There are high chances of recurrence or residual dizziness in patients with vertigo. Thus the patients are advised to sleep with two or more pillows in an elevated position and to avoid sleeping on the affected side. They are also advised to wear a cervical collar and to avoid exercises that involve head rotation or looking up or down. These precautions help in reducing the risk of returning back of repositioned debris.