The following exercises are suggested to maximise your capacity to regain normal balance after severe vertigo.
There are three mechanisms which control balance: i) the eyes ii) the ears and iii) position receptors in the joints. The eyes are the most important. When something happens to the balance organ, it provides the brain with a lop-sided signal (see below). The eyes try to correct this, initially by an illusion of rotation and later by making it difficult to focus or read. As the ears begin to improve, so does the vision.
The balance organs in the ears are a bit like the engines on each wing or aeroplane. As the pilot, you are used to having both engines run smoothly. If one engine is faulty, it may be necessary to shut down. The pilot then has to readjust all the controls to get the aeroplane to fly straight and level and with only one engine. After damage to the balance in one ear, your brain has to readjust the controls. The older the person, the more used you are to having both ears working normally and the harder it is to adjust the controls. The older you are, the more vital the exercises become. The sooner after the onset of vertigo that you start the exercises the better but they will be of use at any stage.
Medication such as “stemetil” reduces the nausea and vomiting but also slows down the body’s compensatory mechanisms by fooling it into believing the balance is better than it really is. Try to minimise such medication once the nausea has ceased
The balance exercises were first suggested by Sir Terence Cawthorne and F S Cooksey over half a century ago for people who had undergone surgery which destroyed the balance organ. They are just as useful for people who have vertigo for other reasons.
The balance exercises can be started from the first onset of the vertigo but you may well find that you are several stages down the road to recovery by the time that you receive this leaflet. Nevertheless the same general principles apply. This is physiotherapy for your balance. The balance organ has been damaged and you are trying to beef up the contributions from the eyes and the joins as well as getting the maximum out of what remains of the balance may temporarily worsen. Try not to lose heart and persevere.
Stage 1: Immediately after the event
The room will be moving, especially when moving your head quickly and you may feel nauseated. Eye movement and limb movements are as much as you can do at this stage. It will be too difficult to move the head around.
1. Practise looking up and down, and from side to side and then focusing on objects around the room. If a partner is available, focus on his/her finger held 3 feet away and follow it as it is moved slowly side to side in front of you.
2. Move your arms and, legs around in the bed without moving your head. Bend your toes up and down and bend and straighten your knees. The same for your fingers and elbows.
Stage 2: Once things have settled sufficiently to allow you to sit up in bed or in a chair
1. Bend you neck forwards and then from side to side. Start slowly but try to increase the speed so that you can just maintain the vision without any spinning occurring. Repeat this with both eyes open and shut.
Stage 3: head and body movements whilst sitting. Once you are no longer confined to bed
1. Pass an object e.g. a ball widely from hand to hand.
2. Pass the ball under each knee in turn.
3. Try juggling the ball by throwing about a foot into the air and then catching it again. It is important to relax between each movement to regain composure.
Stage 4: Standing exercises.
Once you feel able to stand unaided you may feel that you are tending to fall to one side unless you make an effort to stop it. Have someone with you at first to support you, just in case
1. Try to stand still first with your eyes open and then shut (it will be more difficult with them closed).
2. Once you can stand without help try walking up and down on the spot (like a soldier marking time) hold onto the bed.
3. Once you have mastered this try doing the same thing just with a finger on the table to support you.
4. Then try marching on the spot and just tapping on the table.
5. March on the spot without holding anything (have someone with you the first time).
6. Try turning round completely, first with your eyes open and then with them shut (have someone with you the first time).
Stage 5: Walking exercises
1. Walk up and down the room holding on to the wall first if needs be.
2. Find a mark on a wall about 12 feet away. Walk up to it and touch it with your finger.
3. (Supervised at first) walk towards the mark on the wall with your eyes closed, judging the distance and direction. Line it up first by pointing your arm at the mark as if you were holding a gun. Note by how much you miss the mark. Repeat the exercise and make a real effort to get closer to the mark.
These exercises will tire you out at first. It is important to remember this. You will have days when you seem to make no progress at all. It is important not to let this get you down.
Stage 6: Initial outdoor exercises
1. Walk outdoors with a companion at first. Initially a stick might give you a bit of extra confidence. It will be easier on a quiet street. Lots of movement around you e.g. traffic or crowds may be a bit overwhelming at first. Just walk up and down the street.
2. Try to lengthen the walks each day.
Stage 7: Intermediate outdoor exercises
1. Try to find a local park or other flattish open countryside. Try to look at the trees etc while you are walking.
2. If you are near a sandy beach, try walking on this. The soft sand minimises the help that you get from your joint position receptors and makes your eyes and ears work harder. A deep pile carpet will have the same effect.
3. Try the same with your eyes closed (have a partner with you the first time).
4. Walk 50 yards on the beach with your eyes closed towards a particular spot. If you do not live near a sandy beach be careful not to do this over rough ground. See how close you were to the spot you had picked and how straight a line you managed.
Sports
Vestibular rehabilitation exercises are designed to help recalibrate the complex interaction of sensory and motor functions required for good balance. Tai Chi and yoga also challenges this same complex interaction, helping improve balance, mobility, posture and flexibility. Swimming helps neck movement and co-ordination. Golf helps balance and co-ordination and for the more adventurous try jogging or aerobics.
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