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Dizziness: Increased Risk for Fractures
Journal of Orthop Sports Phys Ther 2015;45(5):413. doi:10.2519/jospt.2015.0502
Dizziness is a common problem that can affect a person at any age. There are many reasons for dizziness, some more serious than others. One common, easily treatable cause of transient dizziness is called “benign paroxysmal positional vertigo,” or BPPV. BPPV causes dizziness related to head movement and position and is due to a problem in the inner ear. Dizziness can negatively affect one's quality of life and is associated with an increased risk of falls. This may be especially problematic for older people, who have a greater chance of falling and breaking bones. Recovering from a fracture can be particularly difficult for someone who is elderly. A study published in the May 2015 issue of JOSPT investigated whether BPPV is associated with an increased risk of falls that result in fractures.
Researchers in Taiwan studied 3796 individuals who had just been diagnosed with dizziness from BPPV and compared them to 15,184 people without a history of dizziness. The researchers evaluated the risk of fractures in both groups by following these individuals for up to 12 years. The data indicated that overall, those with BPPV were at a higher risk of fractures during the 12-year period after their diagnosis. The added risk of fractures was particularly seen for the spine, ribs, and pelvis region. When looking at age groups more closely, the diagnosis of BPPV was especially related to a greater risk of fractures for both men and women over the age of 65.
Although we knew that dizziness increased the risk of falling, this study shows that BPPV-related dizziness is also associated with increased risk of fractures from those falls. Fractures of the spine, ribs, and pelvis region limit movement and activity, which increases the risk of other health issues. If you feel dizzy, you should let your health care provider know. Proper evaluation is very important, first to determine the cause of the dizziness. Many causes are treatable, including BPPV. Based on careful evaluation, the proper treatment for dizziness could decrease the risks of falling and breaking bones. For more information on the treatment of dizziness, contact your physical therapist specializing in musculoskeletal disorders and vestibular rehabilitation.
***This is a public service of the Journal of Orthopaedic & Sports Physical Therapy. The information and recommendations contained here are a summary of the referenced research article and are not a substitute for seeking proper health care to diagnose and treat this condition. For more information on the management of this condition, contact your physical therapist or other health care provider specializing in musculoskeletal disorders. JOSPT Perspectives for Patients may be photocopied non-commercially by physical therapists and other health care providers to share with patients. The official journal of the Orthopaedic Section and the Sports Physical Therapy Section of the American Physical Therapy Association (APTA), JOSPT strives to offer high-quality research, immediately applicable clinical material, and useful supplemental information on musculoskeletal and sports-related health, injury, and rehabilitation. Copyright ©2015 Journal of Orthopaedic & Sports Physical Therapy®
Dizziness from BPPV and associated falls and fractures: A diagnosis of dizziness from BPPV (A) was associated with an increased risk of falling (B) and breaking bones (C) especially for older people.
If you have been diagnosed with BPPV, here at Family and Sports Physical Therapy we are trained to treat such conditions and get you back to enjoying your previous functional activities.
Core Strengthening and the Swiss Ball
Escamilla RF, Lewis C, Bell D, et al. Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther. 2010; 40:265-276.
A study was designed to test the effective ability of 8 abdominal exercises performed on a Swiss ball to activate core musculature. The Swiss ball exercises were compared to 2 traditional abdominal exercises performed on the floor without the ball, to determine which exercises were most effective at recruiting core muscles. Testing was performed on 9 males and 9 females, with minimal body fat to assure optimal quality of the electronic measurements of muscle activation.
The 8 Swiss ball abdominal exercises performed were: Pike, Knee-up, Skier, Decline push-up, Hip extension right, Hip extension left, the Roll-out, and Sitting march. For most of the exercises, subjects were cued to maintain neutral spine, feet together, 90˚ of shoulder flexion, hands shoulder width apart. Proper performance of the exercise was given by following verbal commands. The Swiss ball is positioned under the legs approximately halfway between the knees and ankles for the Pike exercise. The 2 floor exercises used as comparison, assumed a traditional crunch position, and a bent knee sit up.
Results from the study showed that maximal voluntary isometric contractions during the Pike exercise was rated at Very High (>60%) at recruiting external obliques, and high (41-60%) for lower abdominal and internal obliques; and Moderate (21-40%) at recruiting latissimus dorsi. The Roll-out exercises was determined to be Very High (>60%) at recruiting upper abdominals, and High (41-60%) at lower abdominals and external obliques. The Traditional floor crunch proved to be ranked High (41-60%) at recruiting upper abdominals. The least effective in all exercises tested was the sitting march.
Based on these results, use of the Pike exercise is the best challenging, well-rounded core exercise for activating a maximal abdominal contraction. The degree of difficulty of the pike may not make it suitable for all rehabilitation patients with decreased upper extremity strength to properly execute the exercise. The second best exercise is the Roll-out, and is better suited for most patients that can kneel and does not appear to require a high degree of upper extremity strength.