Some advanced VRT for folks who want a challenge
I already walk backwards in the park so I guess pretending to pee like my dog wonât raise too many eyebrows!!!
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Perhaps it would be best not to try it, in the park, just in case though?
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Want a challenge? I already have my daily challenge, thanks. Itâs called âStaying Uprightâ!
Letâs be serious now. This MAV monster is an odd beast. As long as I can stand upright, I can feel as off balance and as queer as you like but I can still do toe-to-toe walking forwards and backwards, pass the Romberg test and carry out a Tai Chi Right, or Left, foot kick. Surely that means itâs all an illusion. Without mirrors!
Doesnât this show that thereâs nothing wrong with my balance âunderneathâ, itâs just somethingâs misfiring, false messages creating an illusion of movement. Just my thoughts. Doesnât make getting around any easier though. Just more frustrating.
I personally believe its about sensory noise and decompensation. Sure, your outright facility is not massively impacted, but your anxiety level IS raised (especially if you are not used to it) because you brain is slightly doubting the information itâs receiving and you have lost a little confidence. Itâs a subtle and not so subtle thing.
The exercise, the VRT are all there to try and re-compensate. If you are fully compensated you would not feel any imbalance or dizziness. I believe that what lies behind MAV is an unstable state, making it much more difficult for you to compensate, and hence the chronic imbalance. You can absolutely minimise this though by keeping active. Iâve noticed that Ami helped me and reduced dizziness, but didnât do a lot for the imbalance. That has improved with time of its own accord.
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I agree VRT does not help everyone with MAV. I think there are many underlying reasons for MAV. I highly recommend VRT only if your tests like VEMP found inner ear damage. If you aced all the tests then donât worry about VRT. The only reason the docâs have me on VRT is because of the VEMP result. If your MAV is hormone triggered VRT will not do squat.
Also i do VRT only when i am not in a migraine state. Also stop doing it if it causes migraine again 
I have found general exercise more helpful. There are couple of good papers on how VO2 max can help reduce migraine(VO2 = stamina for continuous cardio).
Thanks for your response. Agreed many underlying reasons. I think MAV is probably a âdustbinâ diagnosis, somewhere the mysterious âtheyâ put all the balance case leftovers âtheyâ donât know what to do with. I think there may well be a female MAV syndrome thatâs linked to hormones. I can see several distinct patterns and there may be a true MAV condition but I find it hard to believe such a variety of symptoms can still be ONE condition. I am pretty sure mine is hormone related. Hoping one day, with time, it might sort itself out and settle down and end years of living this sort of âhalf lifeâ.
Canât say I came out ace in any tests. Never had any, not in 15 years. Just a CT scan, MRI and a few âfollow my fingerâ, âwalk across the room and back for me if you pleaseâ, âstand on one leg, thank youâ. And lots of balance experts (pls save somebody save me from âexpertsâ in future) who didnât know what they were talking about and had no idea what they were looking at. Oh and a GP who was and still is slightly more useless than the neighbour one might chat to over the garden fence.
These days I just walk. Hope to get back to Tai Chi one day. I Avoid VRT. I do have a job knowing whether I am in a migraneous state or not. 24/7 dizziness and I donât get any headaches so it is difficult to tell. Sometimes it gets much more acute. Is this a new attack, or a relapse. Who knows. MAV continues to frustrate.
Agreed. Itâs total sensory overload. Hyper (migraine?) brain - central sensitisation . Unstable migraine and off we go again.
How exactly did the Ami Help you. You say it helped the dizziness but not the imbalance. Whatâs the difference?
For over 3 yrs now I have had 24/7 dizziness. I feel I am moving, rotating clockwise. Is that dizziness or imbalance. I have had the rotational vertigo where the room spins everytime you open your eyes or move (attacks would last up to 72 hours) and also to mimic BPPV and the swimmy head dizziness type too. I take propranolol IMHO enough to slay a horse and have been told, if the Prop is helping but not enough (the last few weeks, the 24/7 dizziness has ceased but returns with any sensory overload) to add in Ami. As I am very med sensitive, particularly to anything even slightly sedating - 2 diazipam taken once years ago for a back complaint and I knew nothing for 10 hours - Iâm not convinced.
The propranolol stopped virtually all the visual vertigo, reduced the photophobia dramatically, cut the severity of acute attacks by more than 50% and eventually stopped the 24/7âs or almost (took a year), I feel better in myself and my balance underneath seems normal, stable and is still continuing to improve very slowly and in minute steps.
Just over a year ago the migraine specialist neurologist I saw described my dizziness as âdisequilibriumâ migraine-related and compounded by lack of compensation due to reduction in activity. I was at the time still under the orthopaedic surgeon having broken my shoulder 2 months previously, an injury which was treated by immobilisation. Now, long since back to my normal amount of activity, I am still not where I want to be but very dubious about combining drugs. More propranolol is unfortunately not an option.
And here-in lies one of the big challenges in vestibular medicine: interpretation and description of symptoms.
Imbalance: a feeling of being off kilter, centre of gravity off, yes, âdisequilibriumâ, feeling less coordinated in ones moves
Dizziness: a sort of fuzzy, lighter-headed (not quite âlightheadedâ) feeling
Neither ⌠Iâd describe this as a âfeeling of false motionâ. Itâs pretty common with vestibular conditions. Iâve had ârockingâ and âpush-pullâ.
You had an upper body injury? Accident? This occurred after MAV onset?
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Itâs funny you ask about an upper body accident. I had a car accident in 2011 that messed my neck up (bulging disc in c5-c6 which is now degenerative⌠I only know this since I was rear ended again in Nov 2017 and they did a scan of my neck to tell me that) pretty good and my mother was talking to me yesterday and said she thinks this (MAV) may have slowly occurred over time due to the car accident. I didnât start getting the migraine ocular vision effects until a year (2012) or so after the accident and then the catalyst for me was the THC as the Big Bang in end of May 2017 which brought on the dizziness and then the MAV symptoms a couple weeks later where eating certain foods set me off. Itâs like thereâs a delay as to when it occurs.
Oh and those symptom definitions are very accurate for how they should be explained.
Not wishing to diagnose you but my Dr. told me that Secondary Hydrops is a condition which can develop up to 10 years after trauma. In my case it took less than 6 months.
I know definitions - of balance/vertigo etc, are important and not uniform. Did you know itâs different again in the US.
What I have then is âImbalance, unsteadinessâ. Not fuzzy. No, not light headedness, not unreal, not woozy. Interestingly I have had a couple of periods when for 3-4 days it stops completely and all is normal. As it was reducing from full rotational 24/7 gradually towards steadiness I had phases of the rocking type - another vertigo manifestation I think. And a period where it felt as if my knees were rocking to and fro, being pushed from behind, quite violent at times that was and the rest of me felt steady. My knees would be moving even whilst I was sitting down, rather as if they were trying to get up without me? Then the imbalance stopped and now that, or very slight rocking starts presumably with too much sensory input.
A feeling of false motion. Thatâs at the route of it all. First neuro-otologist, the one who gave me my diagnosis placed great emphasis on whether or not it was âvertigoâ. Was it rotational. It was, so it was vertigo therefore it was MAV.
The upper body injury after MAV onset. Yep. Many years after. I had periods of episodic MAV from 2003 until 2014 when it became chronic - 24/7 and then in in 2016, Exactly one week before Christmas 2016 walking across a field and not feeling any dizzier than normal I caught my foot under a bramble branch which was posing most successfully as a tripwire and hit the ground face down. Fractured my shoulder. Is there some significance?
Interestly I got up from the ground, walked a 1/4 of a mile back to the car and noticed I wasnât dizzy. Not at all. Even in A&E at the hospital the lights did not trigger the dizziness and I didnât have an acute attack later either, most unusual. For a while I thought the shock of the fall had somehow stopped the dizziness Iâd had for 2 years for good. I wasnât at all dizzy for more than 2 full days. Then back it came. I guess adrenalin might have kicked in to save the day, donât know. It stopped instantly for those 2 days and came back as instantly afterwards.
You find you can minimise the imbalance by activity. I wonder how does this work. Yesterday I was feeling very unsready but walked up and down the tarmac drive at home for a good 20 minutes. Felt worse for about 10 minutes when I came back into the house but within half an hour was feeling much better (steadier) than I had for a couple of days. I felt that much better for the rest of the day. One wonders why. This morning back to my previous baseline, not bad but not as good! Unfortunately The same didnât apply today and I tried twice, a good 15 minutes each time. Umm.
VRT therapist told me I must walk outside everyday if only for 10 minutes. Usually I keep fit walking with the dog, be outside for maybe an hour and often more, and walk varying distances, never as much as 2 miles but usually in that region. Have been doing this even when 24/7 dizzy constantly as often as possible. The migraine consultant I saw advised a short walk daily as it helps compensation and because it is important to try to keep fit. Whilst I appreciate there is also a strong psychological advantage I continue to wonder how it all works.
Maybe I just woke up this morning feeling contentious but I suddenly found myself thinking of this thread and the words of the last physio I saw. About three months ago I started doing some of these exercises. Three in fact all stand on one leg and âŚ, Swing the other leg around in an arch or look left and right or pass a parcel above your head from hand to hand. Prior to attempting these I already knew I could stand on one leg and do a right or left kick (years of doing Tai Chi) but was surprised to find these new variations still posed a challenge. Bearing in mind variations for changeable MAV symptoms within a week or so I could swing a leg and pass a not too heavy parcel. The looking changing head direction was much more problematic and varying day to day or even throughout any given day. Exercises slipped my mind for a week or so and when I next tried I had slipped back a bit as expected.
The last physio I saw said I have extremely strong legs and ankles. Amazingly so apparently. When I explained these, and similar exercises, to her as possibly âhelping my Balanceâ , she said all they will do is further strengthen my legs and ankles and I believe her. Incidentally recommencing these exercises this week I notice my ankles are rocking madly until they ache so obviously taking the brunt of the balancing.
Not a bad thing having strong legs and ankles and in its own way improves my balance because strong legs do help keep me upright. My brain is finding another root to achieve whatâs necessary. The VRT I once did made me more dependent on my feet and my vision. Nothing seems to encourage my ears to become any more involved than they previously were. Perhaps itâs just a case of old dogs and new tricks.
Whilst thinking about balance exercises generally, not just these, I could put a strong case for my ability to perform such exercises being purely a learned response but perhaps thatâs enough contentiousness for the one post. And as the early morning fog is now beginning to clear perhaps I will go for a walk to further strengthen those legs. Helen
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Quite surprised me to find nobody else seems to have much by way of balance problems considering VM is supposedly a Balance Disorder. Well nobodyâs joined in this thread. I appear to be talking to myself.
Looking at it dispassionately the subject is fascinating. Pre MAV I knew virtually nothing about it and indeed I never gave it a thought. I was in such ignorance in fact the first time I visited the doctor post my first ever BPPV like vertigo attack he gave me some tests, stand on one leg/follow my finger etc, and when he then said âYour balance is appallingâ I remember thinking afterwards on the way to work in the car what a strange comment for him to have made and I wonder what thatâs got to do with vertigo.
I continue to practise the three enhanced stricter base balance exercises in the original post, ie the three stand on one leg ones. The one that defeats me time and again is the look left n right one. Presumably due to visual dependence. I am the same outside walking. Then yesterday having had a busy day baking I suddenly noticed somehow something balance wise had improved. I suddenly felt quite a bit better in a way I cannot describe. Better 3D? Better spatial awareness? Certainly better balance. It didnât last overnight. Just a sudden blast of âwellnessâ which I have recently experienced once or twice before. Whilst it was with me I tried the three exercises and did them perfectly without a wobble. In fact I turned my head left n right in the widest possible arc I have ever attempted slowly but repeatedly without as much as a resultant wobble.
Just reading an old thread, Iâm not actively doing VRT as I tried it for several weeks, doing the Cooksey Cawthorne exercises my private physio gave me, plus the ones my practice nurse gave me, to no avail. This was fairly early on after my symptoms started last year. Iâve read a lot about MAV and VRT and the consensus seems mixed here.
However I have been working on my balance, in fairness my balance isnt bad,I can stand on one leg easily, eyes closed is more of a challenge but doable. One I saw was to stand with one foot directly in a line with the other and when you can do that, do it with eyes closed.
Dr Hain uses this one to diagnose Bilateral Vestibular Hypofunction as those patients pretty much lose their balance before 6 seconds. I was very worried I might have this condition as there are similarities with MAV but I can manage more than 6 seconds comfortably.
Weirdly walking backwards round my house doesnt provoke disequilibrium. Nor moving sideways, crab style. One that I continue to find challenging is when Iâm out walking, which I do a lot of, is turning my head right then left. This one always makes me feel unbalanced.
Does anyone else do any balance training exercises?