The term “vertigo” is often used incorrectly as a synonym for dizziness. When vertigo is lumped together with dizziness, confusion and poor treatment often result.  Correct utilization of the word vertigo will allow patients to receive fast and appropriate clinical assessment by practitioners, so let’s clarify the difference.

Vertigo is clinically defined as the patient feeling as though the environment is rotating, or as though they are rotating within the environment. This is the only time the word vertigo should be used.   The most common type of vertigo for which patients seek treatment is BPPV (Benign Paroxysmal Positional Vertigo). BPPV is caused by otoconia (or “ear rocks/crystals”) that become displaced and move into the wrong portion of the inner ear. BPPV is easily treatable utilizing canalith repositioning maneuvers. Proper physical therapy assessment is often the most successful way to treat BPPV because physical therapists can accurately diagnose the location of the displaced crystals and typically can resolve the vertigo symptoms within the first visit.

Dizziness should be defined much more globally and can include: vertigo, lightheadedness, imbalance, and disorientation.  Other symptoms are often prevalent as well when a patient reports dizziness and should be relayed to a healthcare professional. This includes hearing changes, loss of balance/falls, blood pressure changes, historical head injuries, and nervous system changes. How often, how long, and to what severity these symptoms are occurring is also pertinent information that should be given to health care professionals. Properly defining what subset of dizziness, as well as any other corresponding symptoms the patient is experiencing, will best allow practitioners to direct appropriate care.

The cause of vertigo is unsolved. What we do know is crystals form in a person’s ear; these crystals can get lodged in one of the three rings within the ear canal, causing the imbalance. Certain positions, collectively known as the Epley Maneuver and created by Oregon ophthalmologist Dr. John Epley, help move the crystals to a location in the ear that does not affect balance. There are other maneuvers that can also be done to help alleviate vertigo, but the Epley maneuver is one of the more commonly practiced — and is the method I practice for treatment. After successfully treating hundreds of patients with vertigo, and seeing a 90 percent success rate of diminish symptoms after only 1 visit, I invite you to improve your quality of life with a visit to our office.

HARTZ Physical Therapy is happy to assess all patients that report dizziness. Our therapists are specially trained to treat a wide variety of dizziness disorders, including forms of vertigo, and are always willing to refer to another specialist, if indicated. Many insurance plans allow you to be seen as a Direct Access patient and therefore, do not require a physician’s referral prior to beginning physical therapy.


Woman with vertigo. Young patient suffering from dizziness

In recent years, high profile professional sports have made concussions the topic of frequent discussion and helped fuel public interest on their appropriate management.

WHAT IS A CONCUSSION?   A concussion is a change in brain function following a force to the head that may be accompanied by a temporary loss of consciousness.  It is identified in awake individuals with measures of neurological and cognitive dysfunction. A concussion, therefore, is actually a mild form of traumatic brain injury and something that needs to be taken very seriously. Outdated misconceptions such as, if you didn’t lose consciousness it’s not that serious of an injury, are thankfully being replaced by more education and awareness.

According to the American College of Sports Medicine, concussions have increased at all age levels of sports participation over the last few years. Therefore, it is very important that all athletes, regardless of age, are aware of post-concussion symptoms. Parents also need to be educated so that they may closely watch a child after injury for signs of impairment. A child should be monitored for days if a concussion is suspected even if he/she reports feeling okay.

HOW CAN I IDENTIFY A CONCUSSION?   Symptoms of a concussion may reveal themselves in many different ways and can occur days after the initial trauma. Immediate signs of a concussion include loss of consciousness, confusion or disorientation, vomiting, and/ or amnesia. Delayed symptoms include headaches, dizziness, feeling tired, nausea, and cognitive difficulties. If a concussion is suspected during a game or practice, the athlete should stop play immediately. Previously, athletes could be cleared to return the same day, but neurologists have determined that it is not possible to make accurate immediate assessments after the injury and it is too dangerous to risk returning too soon. Athletes under age 18 are managed more conservatively because recovery time after a concussion has actually been shown to be longer in adolescents than adults.

TREATMENT OF A CONCUSSION: If a concussion is suspected, an athlete should take the following precautions:

  • EVALUATION BY A MEDICAL PROFESSIONAL who is educated in concussion management. MRIs and CT scans are rarely able to diagnose a concussion, therefore testing will include a thorough clinical exam that includes symptom assessment, physical exam, neurological exam, and a balance exam.
  • PHYSICAL AND MENTAL REST in an effort to reduce chance of further injury and to allow for the brain to fully heal. It is even recommended that the injured athlete refrain from activities including school work, TV, and other device use that may stress the healing brain.
  • MONITORING of the young athlete for changes in mood, sleep habits, headaches and other symptoms is essential. Return to sports participation is considered once the athlete’s symptoms have resolved.
  • A CONCUSSION REHABILITATION PROGRAM that involves progressive and gradual return to physical activity could be an important step for full recovery. This program is often advanced under the guidance of a physical therapist educated in concussion management and starts with basic light aerobics such a walking, biking, and/or swimming. If the athlete continues to have no symptoms with a specific phase of activity they may advance to a more advanced phase. An example of such a progressive therapy program would be:
  1. Light aerobics but no resistance training
  2. Sport-specific exercises of variable intensity but no head contact
  3. Light sports practice, drills and progressive resistance training
  4. Full contact practice
  5. Return to competition

If you are an athlete or the parent of a young athlete, it is important to become educated on concussions, their symptoms, and their treatment so that athletes and the medical community can work together to reduce the chance of a long-term injury associated with head trauma.


TMJ – Jaw Pain

Image courtesy of marcolm at

Image courtesy of marcolm at

What is TMJ?

TMJ is the acronym used to describe the temporomandibular joint. This joint is a hinge that connects the lower jaw to the temporal bone of the skull. (The temporal bone is in front of the ear on each side of your head.) Why is this joint so important? Well, it’s flexible, letting our jaw move up and down (for things like talking, eating, yawning and more!). If there is a disorder of the TMJ, you may experience varying levels of pain. These disorders of the temporomandibular joint are referred to as TMD.

What Causes TMD?

The cause of TMD is not conclusive; however, there are some suggested causes such as:

  • Injury to the jaw or muscles of the head and/or neck,
  • Grinding or clenching teeth,
  • Stress (regularly tightening face/jaw muscles),
  • Rheumatoid arthritis in the TMJ

What are TMD symptoms?

  • Pain while chewing
  • Swelling of the face
  • Limited flexibility in being able to open your jaw
  • Popping noises when opening or closing your jaw and/or the jaw being stuck in a slightly open position

Think you’re experiencing TMD symptoms?

  • As a precautionary measure, start eating soft foods to minimize the effort spent on chewing. Additionally, avoid chewing gum and yawning.
  • Learn your options in treating TMJ prior to signing up for a surgical procedure. There are varying treatment measures that can be taken – including physical therapy. (Remember, direct access helps you get treatment, fast.) Learn about more treatment options here.

-Wayne McKinley, PT, OCS