menu Contact Us Dizzy Patients Health Care Providers Dizzy Culture Research Site DVD BPPV DVD Tai Chi DVD Understanding Dizziness Acknowledgements Disclaimer Quoting

Yoga and Vestibular Balance Disorders

Ackli Howell Timothy C. Hain, M.D. Page last modified: April 25, 2016

Ackli Howell wrote the material concerning the practice of Yoga. Dr. Hain made comments within concerning the purpose of the exercises with respect to balance.

YOGA CAN HELP BALANCE

The goal of physical therapy for one who is suffering from a vestibular disorder is to reduce or eliminate symptoms.  Therapy to improve the patient's equilibrium, mobility, and overall strength, flexibility and range of motion is included.  Adding yoga to a patient’s therapy routine can be very beneficial.

Some physical therapists believe that one of the best ways for a patient to heal is performing the therapy exercises she gives them in conjunction with yoga.  For some patients, the brain takes longer than anticipated to learn to compensate for impaired balance.  It can be months before re-conditioning takes hold.  In the intervening time, yoga can be an additional component to a patient's overall treatment.  The positional movements of the asanas` help reinforce the physical therapy balance and coordination exercises.

Patients with balance disorders also develop secondary symptoms such as decreased strength, loss of range of motion, increased tension – particularly in the cervical spine and shoulders, muscle fatigue and headaches.  Yoga is well known for increasing the strength and flexibility for those who practice.  In addition, the added benefit of stress relief that yoga offers helps anyone with a balance disorder as they are likely to be anxious and more fearful.  It is well documented that yoga reduces stress, depression, and anxiety.  Yoga also helps to retrain the brain because it requires a person to move their body and head together and also in opposition to each other.  This positional movement is crucial for a patient's retraining to take place.

Vestibular physical therapy has the following important components:[1]

It sounds a lot like a yoga class.  However, I wouldn’t call Virabhadrasana III (Warrior 3) a sensory integration task.  And I wouldn’t call Parivrtta Trikonasana (Revolved Triangle) a proprioception task.  But they both are.


TYPES of YOGA

After you have decided to add yoga to your therapy routine, you should then familiarize yourself with the different types of yoga.  It is important for you to select the one that is right for you.

Yoga is a physical and spiritual practice from ancient India .   Over the centuries, the practice has developed and changed into the many forms of yoga we have today.  The list below describes the most common types of yoga.  You may have heard of several of them or know of someone who practices in one of the styles.  This list is by no means a comprehensive list of all the styles of yoga practiced in the U.S. today.

In general, if you are seeking a meditative experience, Kundalini or Tantra yoga may appeal to you.  If you are looking for an intense physical workout, Ashtanga, Bikram, Forest or Power yoga classes are ideal.   If you are interested in learning the proper alignment of the poses and anatomy, Iyengar yoga may be a good choice for you.  If you like to move, but not at an intense rate, Vinyasa style yoga in which you flow from one pose to another may appeal.  If you wish to learn a variety of poses along with a mix of meditation and breath work, Hatha yoga may be your choice.

YOGA and You

Once you have selected a yoga style that you are interested in, create a list of what you would like to get out of your yoga class.  Decide if you want a more meditative experience or a physical one, a relaxing experience or a focus on alignment.  Then search websites for classes in your area.  Many local health clubs and local YMCAs offer yoga classes.  Ask for recommendations from those you know that practice yoga. 

Find out about the teachers.  Read their biographies, if posted online.  Find out what style of yoga they teach, how long they have been teaching, and how advanced their classes are.  Check if the teacher certified and registered with Yoga Alliance.  The Yoga Alliance is an association that offers a "stamp of approval" to yoga teachers who meet certain training standards.  Once, you have narrowed down the style you would like to study and the instructor(s), do the following:

Selecting the right studio and the right teacher are important factors in beginning a yoga practice and maintaining a practice.  The more you feel a part of the "community" the more you look forward to going to class and the more yoga you practice.

TAI CHI

Tai Chi is another complementary therapy that can improve balance and relieve stress and anxiety. More about Tai Chi is found here:

Yoga Sequence for Positional Movement, Alignment and Strength

  1. Supine Tadasana

First part of sequence are eye/limb positional movements to be performed supine on your back with long, slow inhale/exhale.

  1. Lumbar Arch. 

Inhale lift belly and slightly arch lower lumbar, exhale and flatten belly towards floor, navel to spine.  This is a small movement.  4x

  1. Same movements as Step 2 above, but raise arms straight overhead when arching lumbar and lower arms as belly flattens.  4x
  2. Same movement as Step 3 above, but chin moves up as arms raise and back arches on inhale and on exhale chin moves to sternum as arms are lowered. 4x
  3. Same movements as Step 4, but exaggerate the chin movements so when chin is lifted the eyes look back and overhead in the inhale. 4x
  4. Sit up.

This is a modified sit up.  Bend knees and clasp hands behind head.  Inhale.  On exhale, lift shoulders off the ground as you move navel to spine.  Inhale to down position. 4x

  1. Same movements as Step 6 but on exhale exaggerate chin movement to sternum as you lift shoulders off the ground and on inhale lift chin up. 4x
  2. Spinal Twist.

Knees bent with legs together, arms straight out at sides, shoulder width apart.  On inhale lower legs to right and externally rotate left arm while internally rotating right.  Exhale legs back to center and arms to starting position.  The arm movement is like a flipper movement back and forth.  Repeat on left side.  4x

  1. Repeat Step 8 and move head in same direction as legs.  4x
  2. Repeat Step 8 with head moving in opposite direction from legs. 4x times on each side
  3. Stretch legs out and lift arms overhead and rest hands on elbows.  Move arms slowly to left and then to right. 4x
  4. Repeat Step 11.  Move head in same direction as arms. 4x
  5. Repeat Step 11.  Move head in opposite direction as arms.  4x
  6. With arms still lifted overhead, elbows clasped, move arms in a complete circle over head keeping eyes on the wrist or forearm during the whole of the movement.
  7. Bring knees to chest, roll to right side up to table.
  8. Cat/cow 6x

Standing Poses for Stability and Strength

Forward Fold
Uttanasana (Foreward Fold). Note that this exercise is best avoided in persons who have positional vertigo.

 

  1. Uttanasana vinyasa:  urdhva hastasana to uttanasana to ardha uttansana to uttanasana to urdhva hastasana 3x
  2. To Uttanasana.  Step left leg back, bend right knee and come into anjaneyasana.  Stay in position getting balance and then raise left arm, stretch arm overhead to the right for lateral stretch as you move head and look to left.  Move arm and body back to center and stretch to right once more.
  3. Still in anjaneyasana, with left arm lifted, move into revolved prayer twist to the right.
  4. To adho mukka svanasana and lift left leg and place it between hands, bend left knee into anjaneyasana.  Stay in position getting balance and then raise right arm, stretch arm overhead to left for lateral stretch as you move head and look right.  Move arm and body back to center and stretch to left once more.
  5. Still in anjaneyasana, with right arm lifted, move into revolved prayer twist to the left.
  6. Bring right foot up to meet left and step into uttanasana.
  7. Slowly uncurl spine to Tadasana.
  8. Trikonasana on right side and then repeat on left.
  9. Vira II on right - hold the position, eyes gazing out over out stretched hand.
  10. While still in Vira II straighten bent knee and move head back to center.  Move back into the pose once again with eyes gazing over hand.  Repeat 2x.
  11. Repeat Vira II on left side – hold the position, eyes gazing out over out stretched hand.
  12. While still in Vira II on left straighten bent knee and move head back to center.  Move back into the pose once again with eyes gazing over hand.  Repeat 2x
  13. Parsvakonasana on both sides
  14. Vrksasana on both sides using wall for support.
  15. To table to Dandasana
  16. Setu Bandha Sarvangasana, supported with block
  17. Maricyansana 3 twist to both sides
  18. Sukhasana with alternate nostril breathing (exhale longer than inhale) 8 rounds
  19. Viparita Karani (as savasana)
  20. Meditation

Yoga Sequence for Stress and Relaxation

1.      Supine on bolster with belly breathing.  Roll out to right side up to Sukhasana.

2.      Sukhasana - countinuing belly breathing for several more minutes

3.      Raise right arm.  Lateral stretch to the left as you look to the right.  Repeat other side.

4.      Parsvasukhasana (cross-legged twist on both sides).

5.      Adho Mukka Virasana resting head on blanket.

6.      Tadasana

7.      Uttanasana vinyasa:  urdhva hastasana to uttanasana to ardha uttansana to uttanasana to urdhva hastasana 3x

8.      Tadasana

9.      Standing Balance

With arms out at shoulder height, shift weight to right foot as you lift the left foot off the floor.  Hold position for 3 breaths.  Repeat with the left foot.  Complete both sides 6x

10.  Tadasana with yoga mudra behind back

11.  Diagonal Standing Balance

Feet hip distance apart.  Bring fingertips together over front of hips/look to right/inhale and move right arm up at a diagonal to the body as you extend and point the left foot out.  The left arm moves downward so the arms are in a diagonal line.  Hold position for 3 breaths.  Repeat other side.  Complete both sides 6x.

12.  Tadasana

13.  Vira I on the right.  Hold the position for 5 breaths.  Then straighten knee as the head moves to look to the right, arms remain in position.  Bend knee to move into full position again.  Straighten knee and move head to look left.  Bend knee to move into full position again.

14.  Tadasana.

15.  Repeat Vira I on the left following the instructions in Step 13.

16.  Tadasana

17.  Parsvottanasana on right with blocks for support. Repeat on other side.

18.  Adho Mukka Svanasana to table.

19.  To Salabasana.  3 variations.  Lift only legs for first variation/lift only arms for second variation/full pose lifting both arms and legs for third variation.

20.  Adho Mukka Svanasana to seated

21.  Janu Sirsasana

22.  Restorative Paschimottanasana using bolster for body and head support

23.  Restorative child’s pose with bolster

24.  Restorative setu bandha sarvangasana

25.  Maricyanasana 3 twist to both sides

26.  Supine with So Ham pranayama

27.  Savasana

28.  Meditation


COMMON YOGA POSES

Shown below are common yoga poses that you will encounter in any yoga class you may attend.  Both the Sanskrit name of the pose and the more commonly used term has been given for each pose.

 

 

Adho Mukka Svanasana (Downward Facing Dog). Note that this exercise is best avoided in persons who have positional vertigo.

Virahabdrasana I (Warrior I)

Virahabdrasana II (Warrior 2)


Trikonasana (Triangle)

This posture can trigger dizziness from BPPV.

 

Setu Bandha Sarvangasana (Bridge). Like the downward dog, this exercise is best avoided in persons who have positional vertigo.

 

 

Paschimottanasana (Seated Forward Fold)


Acknowledgements:

I owe a huge thank-you to the following two people.  This paper would not have happened without them.



[1] Dizzy by Jack J. Wazen, M.D with Deborah Mitchell

© Copyright April 25, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on April 25, 2016