Dizziness is common in people over 20 and it can be a big problem in your daily life. Feeling
unsteady, lightheaded, or like the room is spinning is alarming, and makes day to day tasks
difficult. The good news is that dizziness often has treatable causes, and your physical therapist can be the perfect person to help.
Understanding Dizziness
Dizziness isn’t a specific problem – it’s a symptom that can come from a lot of different issues. Feeling dizzy most commonly comes from issues with your inner ear, but it can also come from your vision, joint or muscle issues in your neck, migraines, changes in blood pressure, head injuries, or other neurological problems.
How Physical Therapists Help
To understand dizziness and how a PT can help, you have to know a little about how balance
works. Your brain uses information from your inner ears, your vision, and input from your joints about their position and movement to keep you balanced and stable. Typically all of this information paints the same picture for your brain. If your brain gets conflicting information – say your inner ear sends different information than vision and your joints – that often results in a feeling of dizziness, unsteadiness, or vertigo. Your physical therapist will ask questions about your history, then perform testing on all of the systems that help you stay balanced to figure out the cause of your dizziness.
Your treatment plan will vary depending on what your PT finds. Some typical examples include:
● Exercises: Your PT may prescribe specific exercises to improve your balance, strengthen or
stretch specific muscles, or to help retrain your brain to interpret sensory information. These can include gaze stabilization exercises which help your eyes and inner ears work better together, habituation exercises that help your brain get used to different types of input, and balance training on different surfaces.
● Canalith: repositioning maneuvers (CRM): If your dizziness is caused by benign
paroxysmal positional vertigo (BPPV), a specific type of inner ear problem, your therapist
may perform maneuvers to reposition tiny crystals within your ear canal, alleviating your
vertigo. They can also teach you how to do these at home.
● Education: Your therapist will educate you about your condition, how to manage dizziness,
and exercises you can perform at home. They may also help you modify activities that cause
dizziness, or train you on ways to work through it. Dizziness doesn’t have to interfere with life. Physical therapists can help reduce your dizziness, improve your balance, lower your risk of falls, and improve your confidence in your daily activities.
Spring into Action: Changes in Weather Change Your Activity Level
Spring is in the air, and that means more than just blooming flowers and chirping birds. It’s a natural nudge to shake off the winter blues and be more active. Research that looked at the seasonality of physical activity proves this is true. Across a wide variety of countries and populations, people are most active in the summer and less active in the winter.
Since it’s likely that your physical activity levels are starting to trend up, we wanted to give you a few fun ideas to try, and some tips on how to navigate the change.
Embrace the Great Outdoors:
• Trade the treadmill for the trail: As the weather warms, escape the gym and head outside.
Explore nature with hikes, bike rides, or even a walk or jog around the park. Soaking up the
sunshine not only boosts your vitamin D levels but also enhances your mood and motivation.
• Turn your park into your playground: Public parks offer tons of fitness opportunities. Utilize the equipment for bodyweight exercises, join a pick-up game of basketball, play around of disc golf, or find an outdoor fitness class.
Incorporate Seasonal Activities:
• Get active with seasonal sports: Participating in spring sports leagues like volleyball, softball, pickleball or tennis is a fun and social way to get moving. You’ll meet new people while engaging in friendly competition and getting some exercise.
• Cultivate your green thumb: Gardening is a surprisingly active hobby. Digging, planting, and tending to your garden provides a full-body workout while connecting you with nature.
Navigating The Changes
• Spring clean your activity plan: Just like your home, your exercise routine might need a spring cleaning. Evaluate your current program, identify areas for improvement, and think about what new exercises or activities you’d like to add.
• Don’t spring forward too fast: Spring is an exciting time with longer days, better weather and new opportunities. Don’t take on too much too fast. Injuries from overuse and overtraining start to get more common in our clinics when people ramp activity up too fast.
• Celebrate your progress: Track your progress and acknowledge your achievements, no matter how small. This will keep you motivated and focused on your goals.
Spring is a season of growth. Let it be the catalyst for your own personal transformation. By embracing the outdoors, incorporating seasonal activities, and refreshing your routine, you can spring into action and experience the joy of a healthier and happier you.
If you’d like someone to evaluate your current plan or develop a new one for you, we’d be happy to help! And of course, we’re always here for aches and pains from too much too soon, or weekend warrior injuries from those spring sports.
References:
1. Sex- and age-specific seasonal variations in physical activity among adults. Journal of Epidemiology & Community Health 2010;64:1010-1016.
https://jech.bmj.com/content/64/11/1010.short
2. Impact of Seasonality on Physical Activity: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(1):2. https://www.mdpi.com/1660-4601/19/1/2
3. The Effect of Season and Weather on Physical Activity: Systemic Review
https://www.sciencedirect.com/science/article/abs/pii/S0033350607001400
4. Seasonal Rhythms and Exercise https://www.sportsmed.theclinics.com/article/S0278-5919(04)00120-6/fulltext
5. Exercise Assessment and Prescription in Older Adults Webinar
https://learningcenter.apta.org/products/exercise-assessment-and-prescription-in-older-adultsand-individuals-at-risk-for-functionaldecline?_gl=1*2t7olk*_ga*MTEwNjIzMzg2MS4xNjgxODQyODcw*_ga_ZZJK74HXNR*MTY5NzIwMjg2OC4xMi4xLjE2OTcyMDI4ODEuNDcuMC4w&_ga=2.227565085.1495021570.1697197738-1106233861.1681842870
6. Exercise Attitudes https://www.apta.org/article/2023/03/31/exercise-attitudes
PTs Fuel Healthy Movement With Nutrition
Physical therapy and nutrition are often seen as separate, but the truth is, they are deeply
intertwined. To get the most out of PT, especially after an injury or surgery, integrating both is
crucial. Here’s why:
Food Fuels The Body
During recovery from an injury or surgery, your body is working to heal itself. The activities and
exercises you’re doing in PT are designed to help it along. To take advantage of all the work
you and your body are putting in, proper nutrition is critical.
Protein provides the building blocks for tissue repair and muscle growth. Carbohydrates provide
energy and help support your immune system. Your body also needs healthy fats to regulate
inflammation and to build certain cells. Being short on any of these critical components will slow
your recovery down.
You also need enough micronutrients, like vitamins and minerals. For example, vitamin C is
needed to make collagen, which goes into bones, skin, and connective tissue. Vitamin D helps
your body absorb calcium, which is important for healing fractures, or surgeries involving bones.
Iron helps your blood cells carry oxygen throughout your body, which is needed for healing in
general. Again, being low on any of these micronutrients will affect your healing.
Your Weight Affects Your Health
Being overweight directly affects your health. It puts you at higher risk for cardiovascular
disease, stroke, osteoarthritis, back pain, diabetes, sleep apnea, and more. All of these are
conditions that you might see a PT directly for, or that will impact your healing. Eating a healthy
diet is the most effective way to reduce body weight. Combining a healthy diet with exercise is
even better for your health.
As an example, an 18-month study of 450 people with knee osteoarthritis showed that the group
that lost weight through a diet and exercised had less pain, better walking speed, and lower joint
forces in their knees than groups who either only lost weight, or only exercised.
How can a physical therapist help with nutrition?
While PTs are not authorized to provide individual diet plans or medical nutritional advice, they
can still help with your nutrition.
• PTs can screen for potential nutritional deficiencies or imbalances that may impact your
progress in PT or your overall health. This might involve screening for malnutrition,
sarcopenia (muscle loss), or assessing dietary habits affecting energy levels, healing, or
muscle building.
• Your PT can educate you on the importance of nutrition for various aspects of
rehabilitation and recovery. This includes explaining how specific nutrients like protein,
vitamins, and minerals contribute to tissue repair, muscle building, energy production,
and pain management.
• They can offer general guidance on healthy eating patterns, portion control, and
choosing nutrient-rich foods to support reaching your specific physical therapy goals.
• PTs recognize that overall health and well-being involve various factors, including proper
nutrition. They can encourage you to adopt healthy lifestyle habits that include a
balanced diet alongside regular exercise and proper sleep hygiene.
Finally, your PT can recognize when your nutrition needs exceed what they are able to provide.
In that case, they can refer you to and collaborate with a registered dietician or other qualified
healthcare professional for help in dealing with complex nutritional needs or recommending
specific dietary changes.
By combining the power of physical therapy and nutrition, you can achieve your
recovery goals faster and feel your best!
References:
1. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and
Clinical Outcomes Among Overweight and Obese Adults With Knee
Osteoarthritis: The IDEA Randomized Clinical Trial Effects of Intensive Diet and
Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among
Overweight and Obese Adults With Knee Osteoarthritis: The IDEA Randomized
Clinical Trial | Obesity | JAMA | JAMA Network
2. Ottawa Panel Evidence-Based Clinical Practice Guidelines for the Management
of Osteoarthritis in Adults Who Are Obese or Overweight Ottawa Panel
Evidence-Based Clinical Practice Guidelines for the Management of
Osteoarthritis in Adults Who Are Obese or Overweight | Physical Therapy |
Oxford Academic (oup.com)
3. Strategies for optimizing nutrition and weight reduction in physical therapy
practice: The evidence Strategies for optimizing nutrition and weight reduction in
physical therapy practice: The evidence: Physiotherapy Theory and Practice: Vol
25, No 5-6 (tandfonline.com)
4. Body mass index and risk of knee osteoarthritis: systematic review and metaanalysis of prospective studies Body mass index and risk of knee osteoarthritis:
systematic review and meta-analysis of prospective studies – PMC (nih.gov)
5. Nutrition: A Portion of PT’s Menu of Services Nutrition: A Portion of PTs’ Menu of
Services | APTA
6. Considerations for PT’s Role in Nutrition Considerations Related to the PT’s Role
in Nutrition and Diet | APTA
7. Nutrition and PT a Powerful Combination – Nutrition and Physical Therapy: A
Powerful Combination | APTA
How Physical Therapy Helps People with Parkinson’s Disease
Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, balance, posture, and coordination. It can also cause non-motor symptoms such as pain, fatigue, mood changes and cognitive impairment. While there is no cure for PD, there are treatments that can help manage the symptoms and improve the quality of life of people living with PD.
Physical therapy is one of these treatments. PT can help restore or maintain physical function, mobility, and independence. Physical therapists are trained professionals who can assess, diagnose, and treat movement problems related to PD. They can also provide education, advice, and support to people with PD and their caregivers.
Benefits of Physical Therapy for People with PD
Physical therapy can help people with PD in many ways, such as:
Improving muscle strength and endurance. Both age and PD can weaken and decondition muscles. A physical therapist will prescribe exercises using light weights or resistance bands to improve strength. More strength helps with balance and mobility.
Enhancing amplitude of movement. PD can cause people to reduce the size and speed of movements. This can affect walking, speech, facial expressions, and gestures. Physical therapy can help increase the amplitude of movement by teaching overexaggerated physical movements, such as high steps and arm swings. This is a way to retrain the muscles and brain to compensate for the reduced movement that Parkinson’s can cause. The LSVT BIG program is a specific set of exercises and activities that has been shown to improve mobility and quality of life.
Reinforcing reciprocal patterns. Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. PD can affect these patterns, which makes walking slow and unstable. Physical therapy can help to reinforce reciprocal patterns by using machines like a recumbent bicycle or elliptical machine. Practicing walking with arm swings is another activity that can help restore reciprocal movements. This can improve coordination, rhythm, and fluidity of movement for people with Parkinson’s. Dance and tai chi are other activities that involve reciprocal patterns.
Improving balance and posture. PD commonly impairs balance. Your brain uses a complex mix of what you see, your inner ear and sensations from your feet and joints to maintain balance. Physical therapy can help to improve balance using exercises that challenge stability, such as standing on one leg or walking on uneven surfaces. PT will also focus on specific components of the balance system by doing things like having a person close their eyes to focus on the sensations from the feet and joints. Physical therapy can also improve posture by correcting any muscle tightness or weakness that may cause stooping or learning sideways.
Increasing flexibility and range of motion. PD also often causes muscle stiffness and rigidity. Physical therapy can help increase flexibility and range of motion with stretching exercises that target specific muscles. Common areas of issue are the hip flexors, hamstrings, and calves. Stretching regularly can also help to reduce pain and spasm.
Providing education and self-management advice. Physical therapy can help people learn more about PD and how it affects their movement. A physical therapist can provide tips on how to maintain safety when exercising, how to cope with fatigue or pain, how to use assistive devices if needed, and how to prevent or manage complications such as falls or freezing.
Sounds Great. Is There Proof?
Yes. Research backs up all these claims. One meta-study (a study that combines the results of many other studies) that covered 1827 participants found that when compared to no intervention, PT significantly improved:
• gait speed
• two- and six-minute walk test scores
• Freezing of Gait questionnaire
• the Timed Up & Go test
• Functional Reach Test
• and the Berg Balance Scale
These results indicate improvements in mobility, endurance, strength, and balance. Gait speed is an especially important measurement. Physical therapists often consider gait speed a “vital sign.” This is because low gait speed has been linked to:
• declines in functional mobility
• higher rates of hospitalization
• higher fall rates
• cognitive decline
• increased disability
• and higher risk of death
A larger meta study that included 191 studies with 7998 participants found that PT significantly improved motor symptoms, gait, and quality of life. Specifically:
• Resistance and treadmill training improved gait.
• Strategy training improved balance and gait.
• Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.
Conclusion
Physical therapy is a valuable treatment option for people with PD, as it can help to improve or maintain their physical function, mobility, and independence. Physical therapy can also enhance their quality of life, confidence, and well-being. If you have PD or know someone who does, consult with a physical therapist who specializes in PD to see how they can help you.
References
(1) Physical Therapy for Parkinson’s Disease – Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/physical-therapy-for-parkinsons-disease.
(2) Physical Therapy and PD | Parkinson’s Foundation. https://www.parkinson.org/library/fact-sheets/physical-therapy.
(3) Physical and Occupational Therapy for Parkinson’s: What to Expect. https://bing.com/search?q=physical+therapy+for+parkinson%27s+disease.
(4) Parkinson’s Disease Treatment Physical Therapy. https://www.parkinsonsdaily.com/parkinsons-disease-treatment-physical-therapy/.
(5) Physical, Occupational & Speech Therapies | Parkinson’s Foundation. https://www.parkinson.org/living-with-parkinsons/treatment/physical-occupational-speech-therapies.
(6) Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities – https://pubmed.ncbi.nlm.nih.gov/32917125/
(7) Physiotherapy versus placebo or no intervention in Parkinson’s disease – https://pubmed.ncbi.nlm.nih.gov/24018704/
Physical Therapy is a Tree With Many Branches
Starting a career in physical therapy is like climbing a tree. Everyone starts with the same trunk, but pretty quickly, you have to make some decisions about which way you’re going to go. What kind of people do you want to work with? Where do you want to practice? And how far up the tree do you want to climb? You’ll get to grow professionally – learning more, getting better clinically, and maybe even improving your sales and business skills, but that’s not all. Physical therapy gives you a chance to grow personally too.
Pick your people
You can pick the type of people you want to work with – sports physical therapists work with athletes, helping them recover from injuries and improve performance through exercise and hands-on techniques. Geriatric physical therapists work with elderly patients on mobility problems, pain or managing chronic conditions. Pediatric physical therapists work with infants and children providing developmental assessments and helping them improve their gross motor skills.
Pick your place
You can also pick where you work – there are physical therapy jobs in nursing homes, hospitals, outpatient clinics and schools. Physical therapists provide care wherever people need it. So far, we’ve only mentioned the more common places you’ll find PTs – if you want to specialize further, you may find yourself working only in the ICU with critical care patients, in a factory doing industrial rehabilitation and ergonomics, in a women’s health clinic, or even working in a preventative, public health role.
Grow professionally
Most physical therapy careers start in a general role, working with all types of different patients. If you work in a large health system, you may even rotate between settings. But as you find the type of people you like to work with and the setting you prefer, you have the option to improve your skills and focus on a specialty area of practice. Again, you have lots of options on how to do this. You could:
● Take an internship position or join a fellowship program
● Attend workshops or conferences
● Read journals and textbooks
● Collaborate with your colleagues and mentors
● Take courses in other areas of medicine
● Study abroad or take courses online
Grow personally
Your clinical skills aren’t the only thing a career in physical therapy can grow though – you’ll grow personally as well. You have to learn to have compassion and empathy when you work with ill or injured people. You have to work as a part of a team. You need sales skills – most people aren’t going to want to make changes in their routines, or do the exercises you prescribe at home. You’ll learn to work with people who have different opinions and different viewpoints from all kinds of cultures and backgrounds.
You may also have a chance to improve your business skills. You could advance out of the clinical setting and into a management role. Some PTs start their own practices, or a company in a field related to physical therapy like wellness, performance, injury prevention or population health for large corporations.
Wherever you start in physical therapy, you’ll have a lot of options on where you end up. Chances are you’ll explore more than one branch of the physical therapy tree. That’s OK, having the chance to grow and change is part of what makes PT so exciting!
Physical Therapy Isn’t Just For Pain. It Can Keep You Healthy For Life.
You know that physical activity is good for you. The benefits are well researched and the list is impressive.
Here’s just a sampling:
● Releases endorphins to make you feel good and fight depression
● Helps control weight
● Prevents diseases like stroke, diabetes and some forms of cancer
● Improves sleep
● Helps you live longer
Recent studies even show that physical activity strengthens your immune system, with a protective effect against COVID, and that staying active through middle age protects your brain as you age.
Physical activity is a wonder drug. If it was a pill, you’d buy it and take it every day. But even though activity is free, less than 25% of Americans meet the CDC recommendations for activity. We clearly need help.
Physical Therapists Are The Experts in Human Movement
To be active, you need to be able to move. Physical Therapists do more than help you recover from surgeries or major injuries. They are the experts in human movement. Sure, you could see a strength coach to lift weights, hire a personal trainer, go to a yoga class to work on your flexibility and balance, and see a chiropractor for adjustments. But that seems like a lot of people when a PT can help you with all of these things and more. Nobody knows more about human movement or looks at your health the same way a PT does. Your PT can help you with every aspect of movement including strength, range of motion, flexibility, endurance, balance and coordination.
As medical professionals they can help you with injuries or other issues. Your PT can work with your doctor to help use activity to manage things like diabetes, cholesterol levels or blood pressure instead of prescriptions. Your PT is also trained to work with people of all ages, so you can develop a long-term relationship and they can continue to adjust and modify your routine as you age or your goals change.
Stay Healthy For Life
Staying active has a long list of benefits both now and in the future. But chances are you’re not moving enough to make the most of those benefits. Most people need help. Physical therapists are the most qualified professional in existence to help keep you healthy now and in the future. So don’t think of your PT as someone you see when you need help with pain or an injury. Think of them as your partner and coach working to help you stay healthy for life.
Will COVID-19 Change the Typical PT Patient?
People usually see a physical therapist for pain or loss of function. Think of the person who has
back pain, the injured athlete or the person who’s had a stroke. They all want to improve how
they move and complete tasks. Now, there is good reason to wonder if physical therapists will
start seeing more people who are not in pain or having difficulty moving. Why would these
people come to a PT? To improve their overall health and wellness.
There is strong evidence suggesting that movement is a valuable predictor of future health
and resilience against disease. Physical therapists are movement specialists, so taking
advantage of their expertise makes sense if your goal is to become healthier and live longer.
Here are some examples of the power of movement when it comes to predicting future health:
Gait Velocity
Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over
1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also
less likely to be hospitalized and less likely to have adverse events like falls.
If you’d like to test yourself, measure out a straight, flat course to walk between 10′ and 30′ long.
You’ll also need 5′ or so at the beginning and the end for acceleration and deceleration. Walk
the course at your typical speed and divide the length of the course by how long it took you to
walk it (distance/time). That’s your gait velocity.
Get On and Off the Floor
A series of studies suggest that if you can go from standing to sitting on the floor and back to
standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s
called the sitting-rising test. Here’s how it works:
You start standing, and without support you sit down on the floor, then stand back up. You start
with a score of 10. Every time you put a hand, knee, forearm or the side of your leg on the floor
you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of
over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in
the next 6 years when compared to people who scored higher. Score 3 or less and you’re 5
times more likely to die in the same period. Overall, each point in the test is worth a 21%
decrease in mortality from all causes.
Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk
of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the
sitting-rising studies was death from anything. So while we know that exercise and healthy
lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that
being able to move may provide much more wide ranging protection than we previously thought.
