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Regaining Balance: Physical Therapists Offer Relief for Dizziness

Dizziness is a common problem affecting between 15% and 20% of people each year. It significantly impacts daily life, causing feelings of unsteadiness, lightheadedness, or sensations of the room spinning. These symptoms can be alarming and significantly hinder the ability to complete even basic tasks. The good news is that dizziness often has treatable causes. The fact that physical therapists can be a key player in treating dizziness surprises many people.


Understanding dizziness:

Dizziness isn’t a specific disease but a symptom with various origins. Inner ear issues are a frequent culprit, but vision problems, neck or muscle issues, migraines, blood pressure changes, head injuries, and neurological problems can also contribute.

What do physical therapists have to do with dizziness?

PTs are known as movement and musculoskeletal experts, but they also frequently treat balance problems. That’s how they play a role in treating dizziness. Balance relies on a complex interplay between the inner ear, vision, and sensory input from your joints. When this information becomes conflicting, the brain struggles to interpret it, leading to a feeling of dizziness or vertigo.

Physical therapists assess all these systems to pinpoint the underlying cause of dizziness. This tailored approach leads to an effective treatment plan. That plan might include:

  • Exercises: These might be designed to improve balance, strengthen specific muscles, or retrain the brain to process sensory information correctly. This could involve gaze stabilization exercises to help the brain and vision work together, habituation exercises to desensitize the brain to specific triggers, and balance training on various surfaces.
  • Canalith Repositioning Maneuvers (CRM): If benign paroxysmal positional vertigo (BPPV) is the culprit, specific maneuvers can reposition tiny crystals within the ear canal, alleviating vertigo. Patients are also often taught to perform these maneuvers at home.
  • Education: PTs teach patients about strategies to manage dizziness and exercises they can independently perform. Additionally, therapists can help modify activities that trigger dizziness or teach ways to work through them.

Dizziness can stop people in their tracks. However, physical therapists offer effective treatment options to get people moving again. PT helps patients regain balance, perform daily activities confidently, and reduce fall risk.

Relief Through Movement

Physical Therapy for Chronic Pain

Chronic pain can be a debilitating condition, limiting your mobility and impacting your daily life. The CDC estimates that around 50 million Americans experience chronic pain, and 17 million have substantial reductions in activity because of pain. Beyond limiting activity or your ability to work, chronic pain has been linked to depression, Alzheimer’s disease, and substance abuse.

Chronic pain is complex. There’s no single intervention to treat it, but physical therapy should be part of the mix. Here’s why:

How PT Approaches Pain:

Physical therapy often provides relief that’s just as effective as medication but without the potential side effects. Here’s a breakdown of how PT tackles pain and its effectiveness:

Identify the Root Cause: PT goes a step further than medication that masks pain. Therapists assess your posture, muscle strength, flexibility, and joint mechanics to pinpoint the source of your discomfort.

Address the Underlying Issues:  Based on the evaluation, PT focuses on strengthening weak muscles that support your joints, improving flexibility for a better range of motion, and correcting any imbalances or postural problems that might contribute to pain.

Use A Multi-Faceted Approach: A PT treatment plan will be customized based on the evaluation. In addition to therapeutic exercise, a PT might use various techniques. Examples include:

  • Manual Therapy: PTs use massage, joint mobilization, and trigger point therapy to address muscle tension, improve circulation, and alleviate pain.
  • Modalities:  Techniques like ultrasound, heat therapy, or electrical stimulation can reduce inflammation, promote healing, and manage pain.
  • Aquatic Therapy: A warm, therapeutic pool supports your body and joints while offering gentle resistance. This can often make it easier to start moving again after being in pain for an extended time.

Educate and Empower Patients: PTs equip you with the knowledge and tools to manage your pain independently. This might include learning a new exercise routine, how to modify activities, or how to modify your daily schedule when you’re feeling better (or worse) than normal.

It’s also becoming increasingly likely that you’ll learn how pain works. Research shows that combining pain education with physical therapy is an effective treatment.

If you’re struggling with chronic pain, call your physical therapist. They might have the key that will unlock a pain-free life.


  1. Chronic Pain Among Adults — United States, 2019–2021 | MMWR (cdc.gov)
  2. The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials, Physiotherapy Theory and Practice, 37:4, 461-472 DOI: 10.1080/09593985.2019.1633714
  3. Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis, Physical Therapy, Volume 102, Issue 9, September 2022, pzac081 Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis – PubMed (nih.gov)
  4. The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review https://onlinelibrary.wiley.com/doi/abs/10.1016/j.pmrj.2018.09.029

Spring into Action:

Changes in Weather Change Your Activity Level

Spring is in the air, and that means more than just blooming flowers and chirping birds. It’s a natural nudge to shake off the winter blues and be more active. Research that looked at the seasonality of physical activity proves this is true. Across a wide variety of countries and populations, people are most active in the summer and less active in the winter

Since it’s likely that your physical activity levels are starting to trend up, we wanted to give you a few fun ideas to try, and some tips on how to navigate the change. 

Embrace the Great Outdoors:

  • Trade the treadmill for the trail: As the weather warms, escape the gym and head outside. Explore nature with hikes, bike rides, or even a walk or jog around the park. Soaking up the sunshine not only boosts your vitamin D levels but also enhances your mood and motivation.
  • Turn your park into your playground: Public parks offer tons of fitness opportunities. Utilize the equipment for bodyweight exercises, join a pick-up game of basketball, play a round of disc golf, or find an outdoor fitness class.

Incorporate Seasonal Activities:

  • Get active with seasonal sports: Participating in spring sports leagues like volleyball, softball, pickleball or tennis is a fun and social way to get moving. You’ll meet new people while engaging in friendly competition and getting some exercise.
  • Cultivate your green thumb: Gardening is a surprisingly active hobby. Digging, planting, and tending to your garden provides a full-body workout while connecting you with nature.

Navigating The Changes

  • Spring clean your activity plan: Just like your home, your exercise routine might need a spring cleaning. Evaluate your current program, identify areas for improvement, and think about what new exercises or activities you’d like to add. 
  • Don’t spring forward too fast: Spring is an exciting time with longer days, better weather and new opportunities. Don’t take on too much too fast. Injuries from overuse and overtraining start to get more common in our clinics when people ramp activity up too fast.
  • Celebrate your progress: Track your progress and acknowledge your achievements, no matter how small. This will keep you motivated and focused on your goals.

Spring is a season of growth. Let it be the catalyst for your own personal transformation. By embracing the outdoors, incorporating seasonal activities, and refreshing your routine, you can spring into action and experience the joy of a healthier and happier you.

If you’d like someone to evaluate your current plan or develop a new one for you, we’d be happy to help! And of course, we’re always here for aches and pains from too much too soon, or weekend warrior injuries from those spring sports.


  1. Sex- and age-specific seasonal variations in physical activity among adults. Journal of Epidemiology & Community Health 2010;64:1010-1016. https://jech.bmj.com/content/64/11/1010.short
  2. Impact of Seasonality on Physical Activity: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(1):2. https://www.mdpi.com/1660-4601/19/1/2
  3. The Effect of Season and Weather on Physical Activity: Systemic Review https://www.sciencedirect.com/science/article/abs/pii/S0033350607001400
  4. Seasonal Rhythms and Exercise https://www.sportsmed.theclinics.com/article/S0278-5919(04)00120-6/fulltext
  5. Exercise Assessment and Prescription in Older Adults Webinar https://learningcenter.apta.org/products/exercise-assessment-and-prescription-in-older-adults-and-individuals-at-risk-for-functional-decline?_gl=1*2t7olk*_ga*MTEwNjIzMzg2MS4xNjgxODQyODcw*_ga_ZZJK74HXNR*MTY5NzIwMjg2OC4xMi4xLjE2OTcyMDI4ODEuNDcuMC4w&_ga=2.227565085.1495021570.1697197738-1106233861.1681842870
  6. Exercise Attitudes https://www.apta.org/article/2023/03/31/exercise-attitudes

Stick To Your Exercise Program

Don’t fall off the treadmill (or bike, or rower, or…)

New year’s resolutions around fitness and exercise are incredibly popular. The excitement and hope generated by the start of the year makes starting an exercise program easy.
Now that it’s February, staying with it gets hard. Life gets busy, motivation drops, and suddenly you’re back on the couch, wondering how you’re 6 episodes into The Golden Bachelor instead of at the gym.

You know the benefits of exercise – they’re probably what motivated you to start exercising in the first place. If you need a reminder here are just a few:

• 3 hours of exercise a week reduced pain and disability by 47% in people with knee arthritis
• Exercise reduced the progression of dementia by 50%
• Exercise reduced the risk of hip fracture in post-menopausal women by 47%
• A meta analysis showed exercise decreased anxiety by 48%
• A low dose of exercise relieves depression in 30% of people, a higher dose woks for 47% of people
• A 12 year study of 10,000 Harvard alumni showed that people who exercised were 23% less likely to die
• Exercise is the #1 treatment for fatigue

Knowing that you should exercise or why you should exercise isn’t the problem. Actually getting up and doing it is. Here are our top tips for making sure you stick to your exercise plan:

Set realistic goals. Don’t try to go from zero to hero overnight. Start with small, achievable goals and increase them gradually. Make it easy to win – that helps you build motivation and an exercise habit. For some people that might mean starting with a daily 10 minute walk. For some people, that bar is too high.

When we say make it easy to win, we mean easy. Your goal could be to scan your card at the gym 3 times a week. It might be putting on your walking shoes and going out the door. It might be one pushup. Start tiny.

Do activities you enjoy. Exercise isn’t punishment. Choose activities that are fun. It could be running, walking the dog, dancing, swimming, kickboxing, or playing a sport.

Schedule it. Schedule your workouts like you would any other important appointment. When people ask you to do something else during that time, say “sorry, I’ve got an appointment.” The more you make exercise a routine, the less likely you are to skip it.

Don’t go it alone. Having someone waiting for you at the gym really motivates you to get there. Having support helps push you to work harder, and motivates you when you’re feeling down. Your support could be a friend, the other people in a group fitness class, or a trainer.

Mix it up. Try a new class. If you usually run at the same pace, try intervals. Walk a different route. Doing the same thing over and over again gets boring and leads to burnout. Keep things interesting to stay interested.

Track your progress. Bonus points if you find a way to make it visual somehow. Our brains love to see tasks checked off, a chart or numbers going up, and rings closing. Seeing how far you’ve come is a great motivator. Keep track of your workouts in a journal, make a spreadsheet, use an app or fitness tracker.

Bribes work. Celebrate your successes, no matter how small. Set a goal to work out 3 times this week and treat yourself to your favorite coffee when you do. Buy yourself a new workout outfit, get a massage, or anything else that will help you stay motivated when you reach milestones.

Adjust. Don’t push yourself too hard, especially when you’re starting out. If you’re feeling tired and sore, take the intensity down. Plan rest days into your routine. Don’t make your goal and plan so rigid that it’s impossible to complete in the real world.

Forgive yourself! Everyone has setbacks. You’re going to get sick. You’re going to miss a workout. That’s ok. Pick yourself up and get back on track. With the right mindset and a little perseverance, you can reach your fitness goals.


1. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. Medicine & Science in Sports & Exercise 47(11):p 2473-2479, November 2015. https://journals.lww.com/acsm-msse/fulltext/2015/11000/updating_acsm_s_recommendations_for_exercise.28.aspx
2. Benefits of exercise for older adults: a review of existing evidence and current recommendations for the general population. Clinics in geriatric medicine 8.1 (1992): 35-50. https://www.sciencedirect.com/science/article/abs/pii/S0749069018304968
3. Exercise Acts as a Drug https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2012.01970.x
4. Perceived Exercise Barriers https://doi.org/10.1002/art.22098
5. The Benefits of Exercise on Brain Health https://www.choosept.com/podcast/benefits-of-exercise-on-brain-health
6. Exercise Assessment and Prescription in the older adults and individuals at risk for functional decline https://learningcenter.apta.org/products/exercise-assessment-and-prescription-in-older-adults-and-individuals-at-risk-for-functional-decline?_gl=1*1c4v900*_ga*MTEwNjIzMzg2MS4xNjgxODQyODcw*_ga_ZZJK74HXNR*MTY5NzE5NzczNy4xMS4xLjE2OTcyMDAzODMuNTguMC4w&_ga=2.223614619.1495021570.1697197738-1106233861.1681842870
7. 23 and ½ hours: What is the single best thing we can do for our healtt. https://www.youtube.com/watch?v=aUaInS6HIGo
8. Time Magazine: How To Keep New Year’s Resolutions: https://time.com/6243642/how-to-keep-new-years-resolutions-2/

Swearing in PT

Did you know that “Swearing can create tighter human bonds and enhance the therapeutic alliance between a patient and a physical therapist”?!

The article by Washmuth and Stephens from the Archives of Physiotherapy, suggests that swearing can help with pain and improve tolerance and force.

Here’s a link to the paper: Frankly, we do give a damn: improving patient outcomes with swearing | Archives of Physiotherapy | Full Text (biomedcentral.com)

If you must resort to swearing while in physical therapy, just make sure that there isn’t anyone nearby that may offended  or worse yet, a younger patient that colorful language is not appropriate for!

Move More

Want to Stay Healthy? Move More.

COVID has certainly made the importance of health very clear and we have all seen how quickly things can change with an illness. While COVID is currently front and center in most people’s thoughts, it isn’t the only thing out there that can change your life. Heart disease, diabetes, strokes and cancer can all be devastating too.

Movement offers a defense

If you’re looking to be more resilient and defend against these things, physical activity can do it. The dangers of being sedentary are well known and documented in the research. Excessive sitting and sedentary time have even been called the new smoking. For many of us, sitting and being inactive is part of our jobs. However, research has shown that getting in enough movement can counteract the negative effects of being sedentary.

A large study done in the U.K. found no association between the amount of time people spent sedentary and their chances of illness. But the authors didn’t conclude that being sedentary is OK. Instead, they felt their findings were likely “attributable to a protective effect of the high volumes of daily walking.” The study was conducted in London, where people tend to spend much more time walking or standing than average. The people in the study had daily walking times that were over double the average amount reported in the U.K.

Physical Therapists Are Unequaled Experts in Human Movement

While walking was the activity in this particular study, other research has shown that all kinds of movement can help protect your health. If you’re looking to get those protective benefits for yourself you could choose to walk, bike, lift weights, dance or garden. If you’re not moving as much or as well as you’d like, see your physical therapist. PTs are the most qualified professionals on the planet to help you move better and allow you to stay healthy and enjoy life. From designing a program to get you started or moving more to helping you recover from an injury, your PT is the right person to look to for help.

Sitting-Rising Test

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s called the sitting-rising test. Here’s how it works:

You start standing, and without support you sit down on the floor, then stand back up. You start with a score of 10. Every time you put a hand, knee, forearm or the side of your leg on the floor you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in the next 6 years when compared to people who scored higher. Score 3 or less and you’re 5 times more likely to die in the same period. Overall, each point in the test is worth a 21% decrease in mortality from all causes.

Death in the sitting-rising studies was death from anything. So while we know that exercise and healthy lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that being able to move may provide much more wide ranging protection than we previously thought.

Insurers Are Moving From “Sick-care” to “Well-care”

Insurers Are Moving From “Sick-care” to “Well-care”

TRICARE has decided to waive the cost-sharing requirement of up to three visits to a physical therapist for low back pain. They’ve said that the goal is to encourage more use of “high-value” treatments for low back pain. Understanding what they mean by “high-value” vs “low-value” treatment can help us see the direction healthcare payers are moving and how physical therapy is a part of that.


TRICARE tells us in their summary of this demonstration what they mean by high and low-value care: “Increasing the value of health care refers to improving patients’ quality of care and outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast, low-value care refers to interventions that: are not proven to benefit patients; may harm patients; result in unnecessary costs; or waste health care resources.”

High-value care

High-value care leads to better outcomes, is easy to access and is cheaper for both patients and insurers. We already know that physical therapy fits into this category, but if we look at other things that fall into this category, a larger theme starts to emerge. In 2017 the American College of Physicians released guidelines for treating low back pain that have been widely endorsed. Initial treatment recommendations include exercise, stretching, tai chi, yoga, progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise. These are all active treatments, where the practitioner and the patient are working together to improve. This is “well care” or “let me help you get better.”

Low-value care

In contrast, low-value care tends to be “sick care” where the patient is a passive participant and the practitioner is saying “let me make you better.” TRICARE puts imaging before six weeks without red flag symptoms, surgery for non-specific low back pain, opioids as the first or second-line treatment, and bedrest in the low-value category. We would also place spinal injections in this category for most people. They’re expensive, only offer temporary relief, usually have a long wait before they’re available and include the risk of serious infection and damage to surrounding soft tissues like skin, cartilage, and ligaments.


This isn’t to say that imaging, surgery, or injections are always bad. For a small percentage of people with low back pain, they’re the right thing. But, most people should start with treatments that have the best outcomes for the lowest cost. If those treatments tend to focus on empowering the person in pain to actively participate in their care rather than making them dependent on someone to “heal” them, that’s even better. Physical therapists have known this and have been providing care that fits this model for years. TRICARE’s demonstration that waives cost-sharing clearly shows that insurers are recognizing the value of this type of care and that they are actively moving in this direction.

Why Physical Therapy?

About Physical Therapy

Physical therapists evaluate and record a patient’s progress. Physical therapists help injured or ill people improve movement and manage pain. They are often an important part of preventive care, rehabilitation, and treatment for patients with chronic conditions, illnesses, or injuries.

Physical therapy will help you strengthen the muscles associated with your injury as well as surrounding muscles. Often, strength imbalances lead to injury. Improve outcomes: Physical therapy helps improve post-surgical outcomes, by addressing pain, scar tissue, strength, range of motion, and more.


Welcome to Park Avenue Physical Therapy

Voted Best of the Best for Physical Therapy
by the Medina Journal Register and Hometown Extra multiple times!

The husband-and-wife physical therapy team of Drs. Anthony J. Diaz and Nadia A. Nava-Diaz offers more than just effective physical therapy techniques. Their personalized, involved approach to patient care gives you the support you need to heal, in a friendly, supportive and comforting environment. This level of care achieves the results doctors’ trust and patients rely on.

Park Avenue Physical TherapyWith their doctorate degrees in physical therapy and commitment to ongoing education courses, Anthony and Nadia are qualified to address the wide-ranging conditions that cause physical impairment or pain.

Anthony and Nadia are both manually trained therapists that use a variety of hand on techniques to accelerate your rehabilitation. These techniques include joint and soft tissue mobilization, myofascial release and cross friction massage along with therapeutic exercises and modalities. They are well known for their successful treatment methods and friendly, customized, one-on-one care.

For your convenience Park Avenue Physical Therapy offers same-day, early morning and lunchtime appointments. Evening hours are also available by appointment. Most insurance coverage is accepted and they will file your insurance paperwork for you. You will find free, convenient parking, including spaces that are handicapped-accessible.