401 | Solving Vertigo & Dizziness for Optimal Health with Dr. Paige Day

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

[00:00:28] So before hopping into our interview, I just need to let you all know as our podcast listeners that we have a massive discount on our GenHealth annual membership. Last month, we were focused on building strength, building that top-end strength in the body. And now this month, we're moving into high-intensity work, building that explosiveness, building that power. This is one of the most important things when it comes to building longevity in our movement, longevity in our body.

[00:00:57] And I know high-intensity workouts can be scary for some people, but that is the brilliance of Jen when she cues people through getting back into jumping, getting back into step-ups, getting back into that explosive movement that some people might not be doing anymore, but it is so important. So as our podcast listeners, I want to give you an extra little bonus discount on top of the already incredible discount that our annual membership is at.

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[00:01:50] All right, let's get into our interview. Dr. Page, thank you so much for taking some time and being here with us. We have not had enough. Have we had anyone on vestibular PT? I think a couple people that have been more in just like the general neurologic realm, but not specifically a vestibular expert. Right.

[00:02:10] And I think this is something that not enough people know they can get help from and some of the symptoms and things that they might go to see a vestibular physical therapist for. So I'm really excited to dive in. So thank you for being here. Yeah, you're welcome. Thank you for having me. So first off, why the interest in the vestibular system and what drove you to become an expert in this area?

[00:02:36] Yeah, it was one of the few things, as you guys know, in school that kind of had a quick fix to it, especially BPPV. So much of what we do orthopedically and in neuro takes weeks and months to see good, solid progress. And I found it so fascinating that with vertigo, you can fix somebody in one treatment if you're lucky.

[00:03:02] And so I really started to go down that route. I thought it was very fascinating. I would see it on clinicals and then doors opened and I realized there were so much more to the vestibular system than just BPPV, which is the crystals loose in the inner ear where they get dislodged. And we have several different canals.

[00:03:25] They can be in multiple of the canals, but it takes a repositioning maneuver of the head to circulate those crystals back through to get someone feeling better again. But I realized that there was so much more to the inner ear, which we call the vestibular system than just that. And once I started diving in and learning more, I just couldn't stop. I was fascinated from the beginning. I mean, very fascinating. And actually, vestibular PT was one of my one of my favorite professors.

[00:03:54] He taught neuro and I absolutely loved just like you're saying, you know, there's there's a could be such a quick solution if you identify the right cause. And I think that's the other thing that's really important to note is because I've even had a PA friend who said, you know, oh, yeah, if we get someone who complains of vertigo or positional vertigo, you know, I give them this YouTube video of some things that they can do.

[00:04:20] And I'm like, but you don't, you know, refer to vestibular PT because they're, as you said, specific positional stuff that can be done. So can someone understand if they are experiencing some level of vertigo, like whether it's just when they're walking around or when they lay down and they turn their head to a certain direction and the world starts spinning? Like when or who should do you think someone should see right away? Is it a vestibular PT? Is it going to their doctor?

[00:04:50] Is it getting on medication? Like what is the route? Can I, before you answer that question, because I don't think we have, and I'm sure a lot of people listening. Might be familiar with what the vestibular system at large is. Could you give like your 60 second, like this is what the vestibular system actually is. Yeah. So it is a sensory system in our inner ear and it detects motion. It detects linear motion and angular motion. And then it's one of our primary balance systems.

[00:05:20] So when it's working right, we don't know that we even have a vestibular system. And it's not until something goes awry that we notice something is definitely off, but it's very vital in nearly every single thing that we do. So I'm pausing quick from the episode to talk about an aspect of our health that not enough of us pay close enough attention to. And that is our hydration. I'm not just talking about drinking enough water, though. I'm talking about refueling and replenishing the electrolytes that we're losing throughout the day without even knowing it.

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[00:06:42] So to answer your question, what should someone do if they lay back in bed and they feel this rush of dizziness, classically a room spinning dizziness, where should they go? I wholeheartedly believe they should see a vestibular PT that's going to know the various canals and the various positioning maneuvers.

[00:07:03] Even just yesterday, I had a patient that has new onset BPPB and he called around to five or six places and most of them said, well, it was either going to be a three or four week wait or they just do the diagnostic testing. In his case, probably what we call the Dix Hall Pike, but they wouldn't do the treatment. So if someone can find a vestibular PT, they're going to get the diagnostic testing and the treatment in one place. And so it's just going to be more comprehensive.

[00:07:31] It's kind of crazy to me that they just said, well, just do the diagnostic, but not the treatment. Because if you know what the diagnostic is, the treatment is literally a few minutes right off of that. And so again... It's crazy. I know. I think, unfortunately, it comes down to insurance. A lot of ENT practices used to treat that, but now insurance doesn't cover it or doesn't reimburse them very well. So it's just not something that they can take the time to do.

[00:07:58] Another one of my complaints about the medical system that people literally won't treat someone just because an insurance company might not reimburse for that treatment. That just is like what baffles me that we are forced to make those decisions in our medical system when we know how to help somebody. I know. And then too, with that, there are so many nuances. So classically, we thought I should have my model with me, but we have three canals on each side, so six total.

[00:08:25] And we used to believe that the posterior canal was the most common, and we would say it was 80% to 90% of cases. But we now know through research that it's only 47% of cases, and the horizontal canal makes up the other 46, with the anterior canal being potentially what's remaining. Some researchers will say that the anterior canal cannot have BPPV unless you're a gymnast or you do a lot of yoga or Pilates and you spend a lot of time upside down.

[00:08:53] Just because it's oriented vertically, if the crystals come out, they're going to drop right back down. However, the horizontal canal that's just as affected as the posterior canal is a completely different diagnostic test. It's a completely different maneuver, and you very closely have to look at the eyes to see what direction are they moving, the intensity. Finding the affected ear is more difficult.

[00:09:17] So I definitely recommend seeing a vestibular PT that understands all of those things, because otherwise, someone lays you back and you have nystagmus, they might just think, yeah, it's posterior canal, and then you're not really getting the true treatment. And so I saw you write on your page that vestibular dysfunction is super common, and it's, again, something that's often not diagnosed or misdiagnosed off the bat.

[00:09:41] I think I saw a graphic you had that said one-third of people that are over 40 years old likely or do have vestibular dysfunction. So what type of symptoms might somebody be feeling if they're in that group of people that are undiagnosed and are just frustrated with what's going on? Mm-hmm. Outside of the acute, you know, they had a sinus infection or the flu, and they have what we would call a neuritis, where there's inflammation to the nerve that supplies their vestibular system.

[00:10:11] Outside of that kind of initial acute condition or a BPPV, the crystals being loose, we have chronic conditions or central conditions. So not only do we have our inner ear, but that inner ear then talks to our brainstem, and that's where our central vestibular system lies. And there can be a lot of processing issues at that level. So when people have had dizziness for years on end, it's probably an issue lying there in the brainstem,

[00:10:38] where in the inner ear, mechanically, it's functioning just fine, it looks just fine, gets to the brainstem, and then it's not received well. And then the output is then things like feeling overwhelmed, brain fog, supermarket syndrome. So not being able to complete your grocery shopping because you can't handle the fluorescent lights and the noise and the crowds and being in busy areas.

[00:11:02] Even things like playing with your kids or watching them play, seeing that motion, being at sporting events can be very triggering to people with these kind of chronic central issues where they just have this heightened sensitivity to vestibular stimulation, which often also you will see what we call a visually induced dizziness. And that's where a lot of those seeing that motion comes in will trigger symptoms of dizziness and brain fog, being overwhelmed, all of that.

[00:11:32] Wow. This is probably very eye-opening for a lot of people listening, like saying like, oh my gosh, like I've experienced a lot of those symptoms, but I've never known who to see. And when someone starts working with a vestibular therapist, what is kind of the process of what they would be doing or what a vestibular therapist would be looking for to help? Yeah. So my approach specifically is more holistic.

[00:11:56] So traditionally, you would think of just head-shaking exercises, which I incorporate, but I also incorporate whole body movement because the vestibular system detects motion. And if we're not moving our body, we can be sensitizing that system. So we need to be loading people. We need to be doing squats. We need to be doing lunges, planks, all of that kind of stuff. So it really ties into the whole body. So the approach that I take is I first screen people.

[00:12:23] And so I do eye-tracking, ocular motor assessments to make sure they can follow the pen or bounce their eyes back and forth between two targets. And if they are accomplishing that well, that's kind of screening for something that could be more sinister in the brain going on. So things like brain tumor, MS, stroke.

[00:12:45] Once that's ruled out and I'm not worried about does this person need to be referred on for an MRI or other testing, then we continue on with specific vestibular testing. So I can do quick, high-velocity head movements and have them keep their eye on the target. And if their eyes can stay on the target, that's great.

[00:13:04] If they can't, depending on which way I'm thrusting the head, can show me a unilateral difference between left or right ear, saying that, okay, maybe it's the right ear that's not firing as fast. Or maybe it's the left ear that's not firing as fast. I also play a lot of stimulating games with people to see how does this kind of motion, you know, does unloading the dishwasher bring on symptoms for them?

[00:13:30] Okay, let's recreate that motion and let's add some visual stimulation. Let's add some noise. Let's do different things that might be happening in their daily life to see how their vestibular system is taking in that stimulation, how they're dealing with it. So I run them through a various course of testing and then from there put together a program that will benefit them and be tailored to them.

[00:13:55] And how does this more like functional or holistic approach, you kind of briefly mentioned, but how does that compare to what you might normally see from like a traditional medical approach in someone treating someone who's coming in with vestibular type symptoms? Yeah, depends on where they go. So if they're, you know, going to their primary care or ENT or someone more medically trained, the answer for them is probably going to be, well, you look fine.

[00:14:25] Try this medication, try that medication, which for some people, that's what they choose to do. And a lot of people, that's not the route they want to go. So then they go to physical therapy and it depends on the therapist training. And a lot of times in a classic, maybe hospital based outpatient setting, they may not have enough time to spend with this patient. And so they're just running them through exercises and then sending them out the door.

[00:14:51] Or the difference in my holistic approach is that I spend a whole hour with my patients. And so if they come in and they're 8 out of 10 on the symptom scale, there is absolutely no point in making their symptoms worse that day. So I focus more on let's regulate their nervous system. So maybe I'll do some cupping or some manual therapies or different kind of anxiety relieving techniques just to get them down a little bit out of that state.

[00:15:17] So that when we do work on movements that maybe stimulate them a little bit, it's not going to set them so over the edge that they can't function the rest of the day. So I just have the time to be able to offer them for those functional, holistic treatments. That's so great. I mean, and really taking in all different kinds of approaches in order to see what is best for the person in front of you, which is ultimately, hopefully the goal. Right.

[00:15:44] Now, I know something that you also work with a lot is vestibular migraines. And I want to understand this a lot more. What is a vestibular migraine? Yeah, my favorite thing to treat. It is, it's different than migraine. So we think of classic migraine and we think of someone that has to sit in a dark room with an ice pack on their head and can't have any noise. A vestibular migraine is different in that there doesn't have to be a headache component.

[00:16:13] So it can be completely painless and they're going to have more of a moderate to severe dizziness. And that dizziness doesn't have to be, I just got off a miracle round, but it can be, I just feel overwhelmed. I feel sinus pressure, earfulness. Some people will say pop rocks in their head, head pressure. It's kind of this, I just don't feel right in my head. And they'll, they'll term that dizziness. So dizzy is really an umbrella term for so many other things.

[00:16:43] So it's dizziness, but also having a visual aura. So maybe some visual snow or squiggling lines through their visual field or light sensitivity or sound sensitivity. So one of those three migraine features with dizziness. So it's really, it really impacts people's lives and it primarily affects females at a rate of five to one. And just a couple of years ago, that was six to one.

[00:17:10] So we are seeing more males with this condition and it's onset in the twenties, thirties, forties. So it's affecting a younger population. So Dawn, back to what you said earlier, that one in three people over 40 have a vestibular condition or dysfunction. And that's not even including the people in the twenties and thirties that are experiencing vestibular migraine, which currently is listed as the second leading cause of dizziness.

[00:17:38] And what we know is that 50% of people with vestibular migraine go undiagnosed. So if we take that into consideration, I would say that it's actually the number one cause of dizziness. And it's just very largely unknown in the medical community. And I was going to say, just as you said, that 50% of people go undiagnosed. Because vestibular migraine, even just hearing that term, most people would be like, no clue. I'm sure it has to do with a headache.

[00:18:05] But if someone comes in to any traditional provider, even a physical therapist with those symptoms, they might be clueless. And so even if they are seeking out professionals, this is going to go untreated. So what, like again, vestibular migraine, that's the symptom. That's kind of what we're labeling this group of symptoms. What kind of causes people to start developing this vestibular migraine? Yeah. So there's typically a personality profile.

[00:18:35] So someone that's more inclined to be stressed out, potentially type A personality. But we also see a hormonal component. And we don't exactly know the relationship. So is it the hormone that set it off? Is it the migraine, the vestibular migraine that changes the hormone itself? But we know that high cortisol plays a role. Stress is the number one trigger in vestibular migraine.

[00:19:03] And I think about people in their 20s, 30s, 40s. What's happening in their lives? A lot of those people, it's childbearing years or they have young kids. They're trying to excel in their career. So it's a very stimulating, stressful time in their life. Maybe they're trying to get ahead financially, whatever it is. So that age group has a ton of stimulation at them all the time. A lot on their plate, a lot to manage, a lot of stress. So to me, that can be an indicator.

[00:19:31] But also people that have a sensitivity to motion. So even as a kid and as an adult, that kind of tells us that their brain, even as a child, didn't tolerate vestibular information very well. And then we see that later show up as things like vestibular migraine. Wow. And so what is the process? So say someone comes in and they're having this vestibular migraine.

[00:19:56] And it's usually not just one time, I assume, that they're having these migraines. So how often is someone usually experiencing these things? And what is the process that they are needing to start to take to address? Especially it's hard to like, OK, I'm going to lower my stress levels when, like you said, there is they're living in such a lifespan at the time in that era where things are just so stressful. Yeah.

[00:20:24] So it varies with everybody. Some people come in and they are having episodes three, four times a week. That's a lot. That's really bad. That's a lot. You have people that come in that maybe are managing OK and they're having vestibular migraine episodes once or twice a month. But even outside of the episodes, they can still have symptoms. They're just not at their peak.

[00:20:51] So getting someone to, yes, manage their stress and their anxiety. But kind of the process is to gently expose them. It's like exposure therapy. It's a graded exposure to the stimulation that triggers their symptoms. So you want to do it in a very gradual way, in a gentle way. You know, if we throw a lot of stimulation at them and they cross their threshold and they are just too far gone in symptoms, that's counterproductive.

[00:21:20] But if we gently expose them to their triggers and getting them to track their triggers and know what their triggers are is another key component of it. But if we gently expose them to it, then we can work on different nervous system regulation techniques to get their brain to say, OK, we've been familiar or we are familiar with this.

[00:21:42] This feeling, the output then doesn't have to be dizziness, brain fog, feeling overwhelmed, short-term memory loss, word-finding difficulties, all of those cascative symptoms that can happen. So give an example of, as you talk, nervous system regulation, which I love that as a tool to add in because sometimes you can't fully control the external stresses, whether it be a kid or work or stimulation in the grocery store.

[00:22:10] But we can have these tools that help regulate the nervous system. And that's one thing that I love and always has fascinated me about the nervous system. It's supposedly this thing that automatically responds to our environment around us. But we do have ways to volitionally control what our autonomic nervous system is doing. So what would be an example of one or two of those regulation techniques you give people? Yeah. So one that's pretty common that a lot of people have heard of is the 5-4-3-2-1 technique.

[00:22:41] And I'll explain that in a second. But if we think about our vestibular system as a sensory system, because it is, we think of our five senses that we know of, sight, sound, touch, taste, and smell. Number six is then our vestibular system. So if we know that our vestibular system is struggling, and essentially it's lost in space, its job is to detect where we are in space at all times.

[00:23:06] And so when the output is symptoms of whatever kind you have, because your system is lost in space, if we say, okay, let's use our other five senses to help ground ourselves and orient ourselves. So the 5-4-3-2-1 goes through five things you can see, four things that you can touch, and you're going to interact with that, that texture, that temperature.

[00:23:32] Three things that you can hear, two things you can smell, and one thing you can taste. And that just kind of gets you out of your head and into your body. And that can be very effective. And people can utilize all of that, 5-4-3-2-1. They can utilize some of that. If they're in the grocery store and they can't maybe do all five, maybe they're just going to firmly place their hand on their cart or touch a few items and get that sense of touch involved.

[00:24:01] Even something like a breathing technique, a box breathing, a color breathing technique. I've even had people do a long inhale. And as they do that, they're seeing themselves kind of as a tree trunk with roots that are spreading out, anchoring into the ground. They're really anchoring themselves. And then that long exhale. So combinations of those different things can be very helpful. Yeah.

[00:24:26] And in general, I mean, even if you're not experiencing, you know, vestibular symptoms at this time, but learning how to control and better regulate your nervous system is something that I think every single person can benefit from. And when it comes to different just stages in life, especially as a woman, and you understand this, having been pregnant and having kids, I, you know, I've actually had BPPV twice now.

[00:24:53] So once when I was just working out and I turned to the side and everything started spinning, I was like, whoa. And then another time when I was pregnant and in my second trimester, last pregnancy. And luckily I have an amazing smart husband, PT, who helped me out. It was a one visit treatment. It was a one visit treatment. But why?

[00:25:18] And then when I started looking into it a little bit more, I started to notice that this is a little bit more common in pregnancy, that someone might experience BPPV or experience dizziness. And again, someone might not know who to turn to or what to do or why that's happening. Is there a particular reason why in pregnancy or maybe even postpartum that that factor of what's happening within our inner ear and our vestibular system might be more affected?

[00:25:47] So there are theories, but we don't know for sure. We can't say for sure. But the biggest thing it comes back to for females, childbearing years and pregnancy is hormones. And we don't really know the relationship, but we know that it is there. And we do know that in the first one, two and three months postpartum, we see an uptick in dizzy symptoms return.

[00:26:12] So we can even have the opposite in pregnancy where someone that has dizziness before pregnancy, they feel better in their pregnancy. And then postpartum, it comes back and almost worse. So you may even think about, okay, in pregnancy, your activity levels are different than they were pre-pregnancy. Changes in blood volume. Maybe you're not spending as much time in the sun.

[00:26:40] Vitamin D is a factor in BPPV. So there are a lot of theories, but we can't say this is what caused it. Unfortunately, it'd be great if we could. I think we should be very happy about that. But it's definitely more common in females, especially childbearing years. And you said yourself that you didn't start to experience dizziness until after you had kids. Why do you think that that kind of happened for you as well?

[00:27:09] I wish I knew. Yeah, after my first daughter, no issues. I never had issues before. After my second daughter, I found myself being sensitive to the exercises I was putting my own patients through and saying, oh my gosh, I need to take a break for a second. And then feeling overwhelmed. I mean, we went to the Pentatonix Christmas concert last Christmas. That was amazing. It was so good.

[00:27:35] But I walked into this arena and normally be fine. And I was like, oh my goodness, I had to use some of my own techniques on myself to be able to tolerate the concert. And I thought, this is so strange. This has never happened to me before. So some sort of hormonal component, but also having two young kids, increasing stress, all of that. And then I'm pregnant with my third kid right now. And one of my very first symptoms was intense dizziness.

[00:28:05] Wow. It was insane. I had never had that either. So I definitely have become one of my own patients. But using the techniques that I teach all the time has definitely helped. Yeah. That's another exciting and frustrating and rewarding part about working with nervous system related things and disorders is you don't always know. You can't always be certain as to the root cause or what really happened.

[00:28:32] And you almost have to play detective and do a little trial and error to find out what that treatment plan is going to be. You just talked about BPPV a little bit, which I think is... I always laugh because when I had one experience in a hospital, northern Minnesota, where I'm from, kind of a rural area that did not have a lot of physical therapists or people trained in neuro or vestibular in general.

[00:29:01] And it was kind of funny because I just finished my first year of school and we actually had just had our vestibular unit. And my clinical instructor was probably in her last few years of her career and essentially would hand the reins to me when anything neuro-based or neuro... And I just remember, I have this vivid memory of her looking at me almost like a little kid like, is it BPPV?

[00:29:31] And I just kind of would chuckle because like you said, there's so much else that can be going on there. And the V in BPPV stands for vertigo. And I've seen a few things you've posted that have said vertigo in itself can be a problematic diagnosis. Because if you just say, oh, yep, this person has vertigo, send them over to the PT or wherever they get sent after that. Like vertigo is just the symptom. Yeah.

[00:29:58] You know, vertigo is just this symptom of, you know, sensory, you know, issues with their sensory system that cause some sort of dizziness. But it can be caused by so many different things, like you said, including the vestibular headaches or BPPV. So, what do we need to better serve these people who are given vertigo diagnoses? Yeah. You're right. Vertigo is a symptom, not a diagnosis. And I'll see that a lot on a referral.

[00:30:28] Vertigo. Well, that doesn't tell me anything. That just tells me how they're feeling. But then I still go through my whole test to determine, is it a BPPV or is it not? And even just yesterday, I had someone in that has seen several providers, had the Epley maneuver, which is to treat the more classic kind of vertigo, BPPV. And wasn't helping, wasn't helping.

[00:30:54] And so, I started to go down the line of, well, do you have a history of migraine? Yes. Have you had head trauma or concussions in the past? Well, yeah. And you start to put these pieces together. Did you have car sickness or motion sickness as a kid? Yes. And definitely still now. I can't go on a plane. I can't go on a boat. Riding passenger in the car is horrible. So, you start to put these pieces together and you think, well, everyone else thought it was BPPV, but we seem to be chasing it.

[00:31:23] And when you're chasing it, then I start to think, maybe it's vestibular migraine. Because vestibular migraine, it can be a BPPV mimicker. So, it does have a positional vertigo component to it. If you take people that have known vestibular migraine and you put them in a positional test when they're in an episode, 100% of them will have positional vertigo, nystagmus.

[00:31:48] So, and the nystagmus is a fast jerk beating of the eyes, which helps tell us that, yes, they are having some sort of positional vertigo, whether it's from crystals or not. And so, you really have to tease those things out. So, I think when people are having any sort of dizziness, just getting to a vestibular specialist that's going to be able to help them walk down the right path and get them the right treatment is going to be very beneficial.

[00:32:14] We also know that if someone goes three weeks without treating their BPPV, if it's true BPPV, they are more likely to develop another condition called 3PD, which is a persistent postural perceptual dizziness. And so, more than 50% of the time, people feel this false sense of motion and there's a lot of anxiety with that. And that's a newer vestibular diagnosis, but that can be very, very problematic and take a long time to treat.

[00:32:43] And that can just stem from an untreated BPPV. So, I think it really goes back to just getting them to an educated provider to help them get on the right track. I mean, so incredibly huge because especially with anything kind of vertigo related or someone experiencing those symptoms of vertigo, I know that it can impact, you know, different systems and different parts of their life as well.

[00:33:10] What are some things that may be impacted, you know, whether it's emotional, you've brought up hormones, whether it's sleep, whether it's like, what are some other areas that people should be cognizant of? And then what are just simple ways within someone's life that they can start to maybe utilize some key components to just try to help even on their own? Yeah. So, anxiety becomes a big component of that.

[00:33:38] There's a cycle called the dizzy-anxious cycle. They feed off of each other. A lot of people go to a provider and they're just told, well, you just have anxiety because everything checked out. Well, no, they don't just have anxiety. They have anxiety because they're not feeling well. And so, that plays a big role. People will isolate. They won't go out to eat at restaurants. They will avoid family functions and friend gatherings.

[00:34:03] So, kind of those avoidance patterns, they will stop working out because they are afraid to move. They don't know how to move. I actually created a couple online programs because of that and for those reasons. And we know that the vestibular system detects motion. So, as I stated before, if you don't move, you're going to sensitize yourself. And so, unknowingly, people are doing that and they put their invisible neck brace on and they don't turn their head.

[00:34:31] But I would say the number one thing you can do is move your body, take that invisible neck brace off, move your head, walk, and just live your life as normally as you can. And try not to let the fears and the anxiety and the unknowns limit you because those will actually limit you. And it helps you become that personal detective of yourself.

[00:34:57] Like, if you go on a walk, you can start to understand where your limits are and understand what type of walk. Am I going uphill, downhill? Start paying attention to those details, like you said, for that gradual desensitization that you would do in the clinic. You know, people can start to have that self-exploration on their own. I want to ask a question because I'm kind of, my PT brain's going.

[00:35:23] And I'm seeing some parallels between people who have pain and people who have vestibular issues. On an acute scale, it might be relatively easy to treat early on, again, depending what people have and what they're dealing with.

[00:35:40] But the longer that you may have vestibular symptoms, and if someone's been experiencing this for six months, a year, two years, even with BPPV, I've never heard of 3PD before. And that sounds like something that, hey, untreated, you're going to develop more neurologic patterning. And that's what we see with pain. People who start to have chronic pain, you develop these different neurologic pain patterns. Is that a similar case with vestibular problems?

[00:36:10] Absolutely. Chronic pain and vestibular conditions are very similar. They both change the brain when you've had that long enough. Yeah, I would say that's a very, very good similarity. And so that's just yet another pitch for people if they're noticing any of these symptoms, especially if they're relatively new, to get to a provider.

[00:36:32] Because untreated, undiagnosed, it just is going to start to cascade potentially into more physiologic things that would be a result of the struggle. You know, I might spend an entire hour with somebody just talking to them about what their symptoms are and what their condition is. And we haven't done a single treatment. And they walk out and they say, oh, I feel better already. Just because they have some education and it goes so far.

[00:37:00] And back to what we were talking about, different areas it can affect. It can also affect, you know, your mood. People can fall into a depression because of this. They can have body image issues because of this, because they stopped working out the way that they were. And now they gain some weight and they don't know how to handle that.

[00:37:17] And one of my programs called the Vestibular Wellness Collective is a collection of a bunch of different professionals in their own right that have come together to provide knowledge for people that need maintenance with dizziness. Or just need a program to help them move again in a vestibular healthy way. So, got a dietician in there talking about, you know, so you gained weight. Now what? How do we approach that?

[00:37:45] I have a PT in there that does pain neuroscience education. And so, she talks about how chronic pain changes the brain and how that's very similar to how chronic dizziness changes the brain. And I have on-demand Pilates classes in there. So, people can, you know, if they're feeling high symptoms one day, they can click on this class and it's going to be a low mat class. It's still going to get them moving, but it shouldn't drive their symptoms over the edge. And then, you know, maybe they're feeling better. So, they're going to do this harder class.

[00:38:15] So, a lot of on-demand classes in there. I'm in there. I used to be a group fitness instructor and a personal trainer and then my PT background. So, got a lot of different movement pieces in there with the education of, you know, why is this movement good for your vestibular system? What are we doing in here? And then, there's also a community aspect to it, which to your listeners, I'm providing free access to the community where people can join and learn more about what does the vestibular system do.

[00:38:44] And there's other people in there asking questions and I'll go in and answer them. And I hop in and do lives in there and it's just very valuable to have a community of support that feels what you feel and understands what you're going through because vestibular dysfunction is invisible and a lot of people just don't understand it. Totally. Wow. That's so incredibly valuable to have all of that.

[00:39:06] And that is that holistic approach because it's not just, you know, you, but you're getting other providers and other aspects of health that can be impacted and how people can really utilize. And they utilize more to gain more control of their symptoms and their life, really. So, that's really incredible. Where can people go to find these programs to find, to learn more from you and work with you potentially? Yeah. I want to highlight one other program that I offer is a one-on-one coaching program.

[00:39:35] So, as we know, vestibular education is very limited and across the nation, across the world, it's hard to find a provider either in your area or that understands. And so, I created a one-on-one coaching program that's a little more hands-on and people get direct access to me. I currently have a client all the way in Japan. So, this can be done worldwide. But both of those programs can be found on my website, which is the-dizzydoctor.com. And doctor is spelled out all the way.

[00:40:05] They can also find me on Instagram at the dizzydoctordr. And they can send me a message or find my programs there and find what fits for them. And I also do free 15-minute phone consultations if someone is like, hey, I have these symptoms. Is this program right for me? Does this fit for me? I can help walk them through that. Because I do want it to be a good match. I want it to be a good match for them.

[00:40:32] I want it to be a good match for me so that we can see the best benefits. Amazing. Amazing. Dr. Paige, thank you so much. Thanks for offering free access to community, to our audience. We'll have all your programs and that community linked up in the show notes. We appreciate you bringing your expertise. I learned a lot in this episode. And I can't wait for so many more people to learn from you. Yeah. Thank you.

[00:40:57] And I am appreciative to you guys having me on and helping spread awareness of vestibular dysfunction. Just an eye-opening interview, really, with all the people out there that are likely suffering from vestibular dysfunction, but don't even know it. If you resonated with this or if you know someone out there who's experiencing these types of symptoms, please pass it along. Also, go leave us a rating and review on your favorite podcasting platform. That helps us out so much.

[00:41:25] And we've been focusing on building strength with our GenHealth community these past few weeks. If you're somebody who's ready to dive in, we have a massive discount on our annual membership, and we're going to be starting the full body low impact program on GenHealth. There's three phases of that. That's 90 full days of progressive strength training that you can dive into with a huge community. And even though it's at discount right now, you can get a bonus discount if you use code OPTIMAL10 at checkout. Come join the GenHealth community.

[00:41:54] We have monthly webinars. We have massive accountability. And we will always be there to help you through your movement journey. And of course, we'll see you next time on the Optimal Body Podcast. We'll see you next time.