Human Performance and Rehabilitation Centers, Inc.

Feeling Faint? Everyday Activities Can Make You Dizzy.

Dizziness can be caused by many things: side effects of medication, low blood pressure, low blood sugar, and anxiety. Dizziness following bending over to tie shoes, lying down in bed, looking in the blind spot, and walking down a grocery aisle are all frequent causes of dizziness related to a vestibular disorder. Vestibular dizziness symptoms may include everything from the room spinning to a feeling of off balance or unsteadiness.

There are three major systems in the body that help you maintain your balance. Vision helps to locate the horizon and objects in a person’s path. Sensory mechanics in the feet and legs help identify the type of ground underneath a person’s feet. The last system is the vestibular system which is located in the inner ear behind the ear drum. The vestibular system is what causes motion sickness, makes the stomach turn on a roller coaster, and what jolts a person awake when dreaming of falling.

The vestibular system has three main functions: stabilization of visual images (keeping eyes on a target), maintaining postural stability (especially with head movement), and providing spatial orientation. These three functions are controlled by coordination of the central vestibular system (brain and brain stem) and the peripheral vestibular system (shown to the left). There are two main parts of the peripheral vestibular system. The three fluid filled semicircular canals that detect angular head movement such as shaking your head to say “yes” and “no”. The vestibule contains the otolith organs which detect vertical and horizontal acceleration, like riding in a car and an elevator. If either of these systems are disrupted in any way it can cause dizziness. Two of the most common vestibular issues are benign paroxysmal positional vertigo (BPPV) and unilateral vestibular hypofunction (UVH).

BPPV is caused when otoconia (calcium carbonate crystals) from the vestibule fall into the semicircular canals. This causes movement of the fluid in the canals, which in turn moves the hair or ampulla, which triggers the sensation of movement. When someone with BPPV lies flat, bends forward, or looks up, this movement causes the crystals in the canal to move, moving the fluid, and then the hair, which triggers the sensation of spinning in the brain. This can be fixed by moving the crystals out of the canal by performing specifically sequenced positions which can treated by a medical professional familiar with vestibular rehabilitation in as little as 1-2 visits.

Unilateral vestibular hypofunction usually occurs following a viral illness, head trauma, or a vascular incident, such as a stroke or blockage, that decreases or eliminates the receptor input of the vestibular system to the brain. This causes less intense sensation of dizziness, more commonly characterized as feeling off balance. Common complaints of UVH are off balance or slight dizziness when turning a corner, picking something up from the floor, walking in the grocery store, or driving. Rehabilitation for UVH can take between 6-8 weeks with therapy to improve gaze stabilization (maintaining vision on a target), postural stability (maintaining standing balance), and decrease motion sensitivity.

Regular Headache or TMD?

It’s been a long day that started with a pounding headache and a rough day at work. A great movie is on TV and the start to a perfect night of relaxation is complete with a warm bag of popcorn. As I settle in and the movie begins, I take the highly anticipated first bite and…OUCH! What was that? The pain is from my mouth but it’s not a normal toothache. The pain in my face and jaw travels up to my temple and ear. My headache has not only returned, but has intensified! I’m experiencing signs and symptoms of temporomandibular disorder (TMD). Can you relate? The National Institute of Dental and Craniofacial Research estimates over 10 million Americans are affected by TMD. This disorder impacts many within our own community and HPRC is here to help inform, educate and treat to restore a healthy and desired lifestyle.

Background: Anatomy and Function

Temporomandibular disorder involves the temporomandibular joint (TMJ) and/or the surrounding musculature. The TMJ is a hinge joint that connects the jaw to the skull, just in front of the ear on both sides of the head. Movement at the TMJ allows for up and down and side to side motions of the jaw for talking, chewing and yawning. The cervical spine and surrounding musculature influence the position and control of the joint.

What Are the Signs and Symptoms of TMD?

Common signs and symptoms are, but not limited to:

  • Pain in the jaw, face, temple region, neck, shoulder and/or ear at rest or during movement
  • Limited jaw motion opening, closing and/or side-to-side
  • A “stuck” or “locking” feeling in the jaw, “clicking” or “popping” when opening and closing the mouth that may or may not be painful
  • Headaches
  • Fatigue in the jaw, head and/or neck region

These symptoms may be temporary, recurring or chronic.

What Causes TMD?

The exact cause of TMD is not clear, but clinicians do believe signs and symptoms arise from problems in the surrounding muscles, the joint itself, stiffness in the cervical spine and poor ergonomics/posture. A rapid onset may occur after an injury, such as a blunt force to the face or whiplash. Other contributing factors include:

  • Grinding/clinching teeth at night
  • Osteoarthritis or rheumatoid arthritis in the TMJ
  • Dislocation of the disc in the TMJ
  • Work, home or emotional stress
  • Recent prolonged and/or high-level dental work
  • Recent cervical injury or surgery
  • Diet (i.e., nuts, ice, tough meats)
  • Overuse/habits (i.e., bubble gum, biting nails, chewing the end of a pen/pencil)

Treatment Options

The most effective treatment for TMD typically involves a collaborative team effort between the patient, a physician or dentist and a physical therapist. As the patient, the following steps may be help in easing symptoms:

  • A soft diet
  • Ice applied outside (ice packs, frozen vegetables) and inside (popsicles, pieces of ice) the jaw
  • Avoid extreme jaw motions that hurt and/or create popping
  • Reduce stress and learn relaxation techniques
  • Keep your teeth slightly apart and jaw relaxed during daily activities

A physician or dentist will evaluate you for TMD, as well as for other possible issues in the teeth, jaw, head and neck. X-rays or an MRI may be performed if found necessary to further examine hard and soft tissues. Medication may be prescribed to help with inflammation. Dentist and oral surgeons can prescribe a helpful tool to reduce the effects of grinding at night called a night guard or splint. These custom made appliances prevent the upper and lower teeth from coming together while sleeping, thus reducing the grinding forces that contribute to TMD.

Physical therapists play a key role in the collaborative effort to get you back to a healthy, desired lifestyle. A licensed PT at HPRC will evaluate and treat all factors contributing to your TMD to reduce symptoms today and to prevent recurrences in the future. Treatments include:

  • Manual techniques (i.e., stretching, mobilizations and manipulation of the TMJ and cervical spine)
  • Exercise instruction (stretching and strengthening of the musculature surrounding the TMJ and cervical spine)
  • Patient education (detailed activity modifications, postural instruction and relaxation techniques)
  • Modalities that help reduce pain and improve tissue health.

Dry Needling: Let’s Get to the Point

Therapy that includes the word “needle” is an attention-grabber, but for a growing number of patients, dry needling is a game changer for managing pain and increasing mobility.

We’ve seen great results using dry needling in a variety of patients, including a chronic migraine sufferer in her 50s who was able to stop taking the prescription drugs she’d relied on for years after just a few sessions. In another case, dry needling helped a high school soccer player hindered by severe hip and glute strain regain his performance and play without pain. We’ve also used the intervention in a breast cancer survivor in her 40s who was eager to regain arm movement after a double mastectomy and reconstructive surgery. Dry needling was an individual component of a complex therapy regimen, but a very important one. It helped our patient regain the ability to raise her arms above her shoulders and meet her goal of competing in a local charity dance event.

Because of its success rate and its ability to treat numerus pain-related conditions, dry needling has quickly become a popular therapy intervention across the country. Availability depends on state laws. HPRC was the first physical therapy provider in the region to offer dry needling several years ago, and we continue to be a leader in the field. Several of our PTs have become certified in this technique, completing 50 hours of additional training. Used in concert with manual therapies, this safe and effective practice is being used routinely across the U.S. to treat a range of common and unusual conditions.

How does dry needling work? What’s happening in terms of the body’s neuromuscular function is complex, but the short version is that small filament needles are carefully inserted into trigger points, areas we commonly refer to as “knots” in the muscle. They’re located below the skin’s surface within the muscle and connective tissue. Dry needling differs from acupuncture in that it’s based on medical principles supported by research, as opposed to an Eastern form of medicine that focuses on the body’s energy. Dry needling elicits a muscle twitch response that can be temporarily uncomfortable, but this is far outweighed by the benefits normally seen.

Before we begin dry needling, we locate trigger points through careful assessment and palpation. Trigger points occur when an overstressed muscle tries to heal itself, creating a ball of angry tissue that can trigger pain in other parts of the body. By inserting a needle into a trigger point, we force it to let go of that tension, effectively “resetting” the muscle and nerves and restoring their function. One of the most hopeful aspects of dry needling is that the targeted pain isn’t likely to return; there’s a good chance we’ve eliminated it long-term.