Do you ever get dizzy when rolling over or sitting up in bed? Experiencing a room-spinning sensation may be a sign of Benign Paroxysmal Positional Vertigo, or BPPV for short. Onset can occur at any age, but may be more common over the age of 50. Onset in earlier ages is likely due to a head injury and can be overlooked when treatment is occurring for concussion since dizziness may be a side effect of the concussion.
So what is BPPV? BPPV is a condition in which particles (otoconia) have invaded the semi-circular canal, causing bothersome vertigo as the particles move through the canals and stimulate the inner ear system. Side effects can include nausea and vomiting and symptoms are typically worse in the morning.
The Epley’s Maneuver is over 90% effective at treating posterior canal BPPV and can be done in a single physical therapy treatment session. Some patients experience nausea and even vomiting during treatment because the treatment does require moving the head into the most symptomatic positions so it is recommended to take prescribed medication for nausea and bring a driver for any residual dizziness following treatment.
A typical treatment duration for patients suffering from BPPV is one or two visits over the course of a week or two. I’ve experienced a high success rate for full resolution with patients, often in only one visit. Less common types of vertigo can also be treated with physical therapy, but may require a higher frequency or duration of sessions and a physical therapist will determine a recommended course of treatment during the initial evaluation.
So, when the room starts spinning, talk to your doctor about physical therapy right away. I’d love to answer any questions you may have about your vertigo here at Pacific Physical Therapy.
Alicia Gilfoy PT, MPT has been treating patients with vestibular conditions for 9 years and has taken additional coursework to ensure a comprehensive diagnosis and treatment plan for her patients.
Patellofemoral Pain Syndrome (PFPS for short) is a common condition where pain is present behind and/or around the knee cap. It is twice as common in women as men and has a high occurrence in those who are involved in athletic activities. Physical therapy is an effective treatment to reduce this type of knee pain. Initially, it was theorized that the weakness in the quadriceps, specifically the vastus medialus oblique fibers were to blame for the symptoms because the kneecap would not track correctly and be pulled too far towards the outside of the knee by the rest of the quadriceps muscles. A research article published in Journal of Orthopaedic & Sports Physical Therapy1 tested the theory that hip weakness may actually play a greater role in the prevalence of pain in the affected knee. The kneecap is located in a groove at the lower part of the long femur bone in the upper leg. Rotation of the femur is controlled by muscles at the top of the hip. The author’s theory suggests that the lack of control of the femur bone during functional activities is what causes the inflammation and pain.
In the study mentioned above, patients were divided into two groups: Group A performed 4 weeks of quadriceps strengthening and Group B performed 4 weeks of hip abduction and external rotation strengthening. The group that performed the hip strengthening activities showed lower pain scores at 4 weeks than the group that performed quadriceps exercises. Both groups were then transitioned into a functional strengthening program that included both quad and hip strengthening and both groups saw additional improvement from 4 weeks to 8 weeks.
Here at Pacific Physical therapy, we understand the importance of getting pain relief sooner. It is our responsibility as physical therapists to form our treatment plans around relevant research to give our patients the results they want as soon as possible. Call or stop by today to find out what you can do about your knee pain.
Alicia Gilfoy, PT, MPT is a physical therapist who has been treating in the outpatient orthopedic setting since 2007.
“Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females with Patellofemoral Pain Syndrome: A Randomized Clinical Trial” (J Orthop Sports Phys Ther 2011;41(8):560-570.
I constantly have patients who come in and ask me about how to pick out the correct running shoes. They often say they are going to a store where “They watch you walk on a treadmill” to help you pick the right shoe. It is important to realize that the way we walk or our “gait” is very different on a treadmill than when we are walking on the ground, so that will not be a reliable way of finding the proper shoe for you. What I tell my patients and what I will tell you is that it is much simpler than you think to make sure you purchase the right shoe for your foot.
- When you run the forefoot will widen or “splay”, so you will want to make sure that the toe box is large enough for your foot, meaning you should have at least ½ inch of space between your toes and the end of the shoe, as well as making sure that the sides of your forefoot are not in contact with the shoe (You can check this by pulling out the insole and stepping on it to ensure your foot is not wider than the insole). This often equates to a buying a shoe a half size larger than what you normally wear. Be careful, each shoe manufacturer’s sizing is a little different so make sure you double check.
- Speed dating with shoes
- We often go to the shoe store and think that the most expensive shoe on the rack must be the best one! That is not correct at all. The best shoe for your foot is the one that you barely notice is there. Here is my #1 tried and tested technique for selecting a running shoe
- Try and find the shoe that feels like you are not wearing a shoe
- If you feel pressure in your arch, feel your toes squished, or unbalanced in your shoe, that means that it is not the right one for you.
- Grab 7 or 8 pairs of shoes
- Put a different shoe on each foot and then walk around for 5 minutes, the shoe which is most comfortable leave on your foot and then select a different shoe to replace the less comfortable shoe. Repeat this process until you have gone through all of the shoes. By the end of this routine you will have compared all of the shoes to one another and will have found the shoe which is most comfortable and will produce the best fit.
- Don’t switch “Cold Turkey”
- When going from an old pair of shoes to a newer pair of shoes, make sure that you take some time to acclimate to the new shoe. Spend a week or two going on shorter runs and transitioning away from your old shoes.
Hope this information has been helpful, if you need any help selecting running shoes or would like to see if your fit is correct, or would like help getting started on a running program don’t hesitate to make an appointment with us at Pacific Physical Therapy.
Brett Palmer PT, DPT has been treating orthopedic and sports rehab patients for 5 years. He has taken over 300 credits of additional continuing education courses to ensure he has a comprehensive diagnosis and treatment plan for his patients.