It’s a mantra everywhere: exercise is good for you. If you want to lose weight, you should diet and exercise. If you want to slow aging, exercise is key. But what do you do if exercise sets off vertigo? Is the dizziness a sign you are hurting yourself even more? Should you avoid exercise? That depends on the kind of vertigo you are experiencing. Let’s go over the things to look for.
The most common form of vertigo with exercise is BPPV. Any movement that involves lying down, raising the head from the floor or tipping the head up or down can set off a brief spin in people with BPPV. That means yoga, toe touches, sit-ups, even sex! If the vertigo is less than a minute long, and if it usually follows a head movement, the best thing to do is use our vertigo exercises, available on video and in our book. These can resolve BPPV in minutes. When you have a BPPV spell, other than a risk of falling, the vertigo does not do any damage to your inner ear or body, so it is important to continue being active even though you have symptoms.
There are many other forms of vertigo, and exercising while you are dizzy will usually make the vertigo more intense. When an inner ear is damaged the room can spin for several days. During this time, moving the head quickly or trying to walk can make the spinning speed up. Sometimes just turning your head can make you vomit. If the vertigo is a constant spinning for hours or days at a time, in general exercising does not cause further damage. Doing a workout might not feel good, but it does not further injure your ear. In fact, it is beneficial. When an ear is damaged, it heals by compensation. This is a gradual rebalancing of equilibrium pathways that the brain does automatically. The more you move, the more your brain works to resolve the imbalance. So although you may feel worse when you move, the more you move, the shorter your total dizziness will be. It’s like you have so many dizziness dollars to spend. You can dole them out slowly, and take months to recover; or you can spend them all in a week by exercising constantly, and be well in days. My Olympic athlete patients with severe ear damage get well in less than a month. Couch potatoes are still dizzy after a year.
There are forms of vertigo that are worsened by movement that are a sign you should not do those movements. If you can make a vertigo spell start by assuming a certain position or making a certain movement, and that vertigo does not stop in a minute, then you should avoid those positions and movements. An example is the vertigo cause by a Chiari malformation, an anatomic abnormality of the base of the skull. Tipping the head far back, particularly while lying down, can make the world appear to scroll vertically and this will continue as long as the position is held. The vertigo is caused by pressure on the brainstem, the part of the brain that connects to the spinal cord, so it should be avoided. If you have this symptom you will need to see a physician. They will need to test you for a form of BPPV, anterior canal BPPV, that has similar symptoms but is treatable with BPPV maneuvers. If Chiari malformation is still a concern, an MRI can show the malformation and a surgical treatment can be done.