Dizziness and Yoga

by Baxter

Looking Up in Jersey City by Brad Gibson

I recently heard from an old friend who lives up near Glacier National Park (must be quiet up there, what with the park closed—come on Mr. Boehner!). She was wondering what to do about recurring vertigo and yoga. And she is certainly not alone! I know so many people with vertigo, or dizziness, and once it kicks in, doing yoga can be a challenge. 

Because there are many possible causes of “vertigo” or “dizziness,” I’m going to write today about one of the most common causes, known as benign (paroxysmal) positional vertigo. It’s benign because usually there is not a life-threatening underlying cause for this kind of dizziness. The exception is if the dizziness is causing someone to fall, which we have discussed (especially in relationship to osteoporosis) in other posts. It’s paroxysmal because it comes on suddenly. It is positional in that the mild to intense spells of dizziness seem to be triggered by body or head position or movement. Common complaints I've heard are that rolling over in bed brought on the dizziness (and can cause it if done in that direction again) or simply turning the head in a particular way can stimulate dizziness. Dizziness spells can have an intense period that does not last more than a few minutes, but can have a lingering general feeling of dizziness and wobbliness. And although dizziness is the primary complaint, other symptoms can include: the feeling that you or your surroundings is spinning, unsteadiness, loss of balance, blurred vision when dizzy, nausea or vomiting. So although you are not likely to get into serious trouble, BPV can certainly be disruptive to your everyday activities.

In fact, I have known more than a few friends and students who have to modify their activities of daily living for a few days until their symptoms settle down. And because the risk of falls and injury is real, I often recommend that you modify your yoga practice until the symptoms begin to more fully resolve. You can do floor practices on your back (unless that is a trigger), do seated poses on the floor or a chair, and if you are going to do standing work, do the poses with your back to a wall and avoid holding poses very long. Inversions can be tricky, as they could also aggravate BPV symptoms, so either do easier versions of them, such as Legs Up the Wall (Viparita Karani) and Chair Shoulderstand, or leave them out entirely until you are feeling better. Try your restorative poses with your head slightly elevated. See how you feel right after each pose and after a short sequence to determine if they are helpful and/or safe to continue to practice.

Western medicine often utilizes medications that help lessen the symptoms of dizziness or nausea (if you get that, too), and also sometimes recommends a manual adjustment technique called the Epley maneuver. A doctor or physical therapist does this with you lying supine on an exam table with your head held by the practitioner, who quickly extends your head and rotates to one side, then the other.  Often, one or two times with the maneuver can help to resolve your symptoms. The theory behind it is that crystals normally found in the inner ear can become dislodged from their normal location and block flow of fluid that helps with normal balance. The maneuver is thought to dislodge the crystals and let the inner ear fluid flow normally. You can see it done here:

There are also some versions of this that you can administer to yourself, and we've heard good feedback from people who've tried it. And I suppose it is conceivable that movements of the neck in certain yoga poses, like Trikonasana (Triangle pose) or Ardha Matseyendrasana (Half King of the Fishes twist) could have a similar effect, but no one has studied them to date. In fact, I’d recommend seeing your doc first thing for three reasons:

• to make sure there is not a more worrisome cause for your dizziness
• because BPV can come back from time to time and it is good to know what your options for treatment are
• because the doctor could perform the Epley maneuver, which may possibly resolve your problem quickly

Then there is the occasional student who will note the onset of dizziness during an asana class. This has happened very infrequently in my experience, but it does happen. I usually have the student immediately sit down on the floor with their back to the wall for support for a few minutes. If their symptoms resolve completely, I’ll invite them to gently try a few more poses, if the sequence is not full of balance poses or inversions, and see how they do. If they seem to have BPV, they need to sit out the rest of class. I have worked with these students at times to develop an individualized approach to their public classes so they can avoid movements that trigger their vertigo and can allow them to continue to enjoy most of their regular practice. Hope that helps way up there in Glacier and anywhere you find yourself!

To learn more about benign positional vertigo, visit mayoclinic.com.

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