Lightheadedness affects thousands of people annually. It is not a disease itself but rather a physiological symptom of disequilibrium. In medical terminology, lightheadedness is also known as orthostatic hypotension. Orthostatic hypotension occurs when a person’s systolic blood pressure drops an average of 20 mmHg or 10 mmHg of diastolic blood pressure as a result of a change in postural position1,5.

The change of position that most commonly causes lightheadedness is going  from lying (supine) to sitting up on the edge of a bed or couch or standing up.  A quick transition between positions (i.e. 2-5 seconds) can affect almost anyone.  However, people with a cardiac condition such as heart failure, tachycardia (fast heart beat), anemia, a history of myocardial infarction and ischemic stroke are affected more profoundly.

Other symptoms such as nausea, vertigo(sensation of spinning), syncope (feelings of passing out), and headache can also accompany the lightheadedness2,5. Orthostatic hypotension is commonly seen in the geriatric population that often results from a sedentary lifestyle and low blood volume3.

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The cause from this drop of blood pressure is complex and has intersystem involvement. The systems involved are the cardiac, vascular, neurological, and muscular systems of the body. All of these systems are interdependent on each other to provide the proper perfusion (blood flow) to the body.  One area of the body that must have regular and continuous perfusion is the brain.

The brain must have 20ml of blood per minute in white matter and 70ml of blood per minute in grey matter6.  Cerebral blood pressure is under autonomous control and is controlled in the brain stem. Baroreceptors in the blood vessels (i.e. arteries) provide a baroreflex that are responsible to control normal blood pressure. Normal cerebral blood pressure is between 70mmHg-90mmHg6.

Cerebral blood pressure cannot drop below 70 mmHg for a sustained period of time. Even a loss of blood pressure for 30 seconds to the brain will cause ischemic changes in brain tissue which will cause cell death6. Prolonged ischemia to the brain is known as a stroke and can be fatal over a extended period of time.

People who experience lightheadedness temporarily experience an interruption of the cerebral perfusion. When a person changes their static position from supine to seated or standing, a temporary pooling of the blood to the lower portion of the body will occur.

The blood is stored in the veins until the muscles of the lower extremity (i.e. calves) can contract with the muscles of the heart to regulate and restore normal perfusion to the body and the brain.  Autoregulation of the body causes arteries to constrict and the sympathetic nervous system to release norepinephrine to aid in returning the body’s perfusion pressure back to normal during the change in position1,2,6.

Other than postural changes, there are other causes of lightheadedness. Medications, underlying pathologies (cardiac, neurological, diseases (Lyme, cancer, Parkinson’s, MS, diabetes)), and hemorrhage(loss of blood volume) could be the cause2.  These issues may not require a change in posture.

If a person experiences orthostatic hypotension from a change in position, the symptoms of lightheadedness should disappear after several minutes (5-6 minutes is typical)2,4.  If the symptoms persist beyond this time (>10 minutes), then an underlying disorder may be present.  The person should be referred to a medical professional for a full medical examination as soon as possible4.

causes of lightheadedness_2

Avoiding and treating lightheadedness

There are non- pharmacological ways to manage physiological orthostatic hypotension.  One simple way is to raise the head of the bed up to a 10-20 degree angle or 4 inches2.  This will help acclimate your head in an upright position at night during sleep.  Another simple way to prevent a decrease in blood volume is drink more fluids.

The healthy amount of fluid intake that everyone needs to consume is at least 64 ounces of water daily. That equates to 8  eight ounce glasses of water per day.  Knowing and having your blood pressure checked frequently will allow you to keep track of any loss of blood volume or rapid changes to your blood pressure2. Education into the signs of orthostatic hypotension is important.

When rising from  a supine position it is important to rise slowly and continue to breathe when you reach a seated position.  When feelings of lightheadedness, nausea, vertigo, headaches are felt; close your eyes and focus on breathing slowly.  Purse lipped breathing can aid with the decrease of the symptoms2.

To perform purse lipped breathing; close your eyes, slowly breathe into your nose.  Then make a “whistle like” orifice(opening) with your lips and slowly breathe through the whistle formed by your lips until all air is expelled from the lungs.  Diaphragmatic breathing is another technique to help reduce lightheadedness2,3,4.

This technique is also known as “belly breathing”. While lying supine, focus on breathing in air while pulling your belly button in towards your spine. Release the air and push the air out of the thorax by pushing your belly out.  Repeat technique until symptoms subside.

Exercises to reduce lightheadedness

Exercises can also prevent severity of orthostatic hypotension. Exercises such as ankle pumps, leg raises(from either a supine or seated position), marching in place, and seated adductor squeezes are excellent exercises to help maintain normal blood pressure.

Regular aerobic based exercises such as biking, swimming, rowing(i.e. crew), and walking can also aid in the decrease of episodes of lightheadedness2. These exercises will promote increased arterial pressure and ensure venous return so that a drop of blood pressure does not pool in the lower extremities.

The development of core muscles increases the stability and may increase intrathoracic pressure in the mediastinum. Increased stability within the mediastinum could help support arterial pressure throughout the body and brain and prevent a drop of blood pressure during changes in body position.

Plank

A plank is a good exercise to do to increase core and abdominal strength.  No special equipment is required. The plank is an isometric exercise that can increase endurance of deep core muscles without spinal flexion or change in postural position. The plank can be done in bed or the floor and can be done starting with elbows and knees position.

The modified plank

To start, assume a prone position( on your stomach with head facing the bed or floor).  Slide your elbows under your chest and have your hands facing each other.  Bend at the knees and have the feet facing up towards the ceiling.  From this position, raise your trunk off the ground or bed and hold this position.  Only the knees and forearms should be in contact with the ground.

Try holding the position for 10-15 seconds and breathe normally.  Avoid any rotation or bending of the trunk.  When completed 15 seconds of this isometric hold, slowly return the body down to the ground.  Repeat the exercise 3 times, holding each set for 10-15 seconds.

Progression into a standard plank (figure 1)

Assume the same position as the modified plank.  The difference in the standard plank position from the modified plank is the toes of the feet will be against the ground.  From this position, raise the full body off the ground about 5-6 inches.

The upper arms should be straight and perpendicular to the trunk.  The knees are straight and the legs except the toes should be off the ground.

pathological-perspective-management-lightheadedness

The body should be straight and the pelvis should be in neutral. There should not be a rounding of the back or increase of lordosis in the lower back( bending of the lower back). Breathe as normally as you can and hold position for 10-15 seconds.  Return the body slowly back to the ground and rest. Repeat exercise for 3 sets holding for 10-15 seconds in duration.

 

References:

1. Bradley JG, Davis KA.  Orthostatic hypotension – Problem-Oriented Diagnosis.  Family Physician. 2013; 1-6.

2. Figueroa JJ, Basford JR, Low PA.  Preventing and Treating Orthostatic Hypotension. As Easy as A,B,C.  Cleve CLin J. Med. 2010; 77(5); 298-306.

3. Gupta V, Lipsitz LA.  Orthostatic Hypotension in the Elderly: Diagnosis and Treatment. American Journal of Medicine. 2007; 120; 841-847.

4. Farquhar WB, Taylor JA, Darling SE, Chase KP, Freeman R.  Abnormal Baroreflex Responses in Patients with Idiopathic Orthostatic Intolerance.  Circulation. 2000; 102:3086-3091.

5. O’Sullivan SB, Schmitz TJ, Fulk GD. Physical Rehabilitation. (6th Ed). Philadelphia, PA. F.A. Davis Company.

6. Cerebral Perfusion. Wikipedia.com. https://en.wikipedia.org/wiki/Cerebral_perfusion_pressure. Accessed on 6/16/2015.

 

 

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