Instability, Falling, & Oscillopsia – Quality Physical Therapy Can Help!

According to the Wisconsin Department of Health Services, falling injuries are the number one cause of injury-related death in Wisconsin. Drug overdosing came in a close second (7/2015 report).

An interesting additional research finding was opioid pain reliever medications (i.e. oxycodone, hydrocodone, methadone and other morphine-like drugs) contributed to 45% of the state’s overdose injury deaths.

Falls are the Greatest Cause of Injury-related Death

Medication, addiction, and falls obviously are huge issues in both our state and the country at large. The bottom line is both instability and medications can be deadly! Since falls are the largest cause of injury-related death in Wisconsin, it’s imperative to identify and discuss causes, and treatment options.

When evaluating and treating individuals who have a history of falling or instability, it’s important to understand and appreciate any relevant underlying mechanical, neurological and environmental conditions.

Poor vision and lighting, throw rugs and clutter, problems with medication (i.e. psychotropic drugs such as benzodiazepines), weakness and neuropathy (i.e. from back pain), and low blood pressure can be contributing factors.

Vestibular Oscillopsia

A disorder which too often is overlooked and not well addressed is vestibular oscillopsia.

Oscillopsia is a condition involving malfunctioning of the inner ear resulting in gaze visual disturbances in which objects in the visual field appear to oscillate and are unclear.

Our inner ear vestibular receptors are crucial contributors to our spatial orientation, postural control and effective gaze head-eye coordination. This is achieved through ongoing corrective neurological feedback the receptors share with the brain.

When the inner ear is not working, it’s very difficult for an individual to accurately perceive and interpret their environment; it can lead to instability and falls as well as reduced ability to perform other functional activities such as driving safety.

Severity can range from mild blurring to rapid and periodic jumping of eyes. The bouncing condition is worse when trying to focus while the head is moving, especially with fast moving targets of interest (i.e. a moving car or a busy supermarket).

Individuals often experience double vision and frequently avoid head movements as even minor ones can cause things to blur. Some tend to close their eyes to avoid resulting nausea and vomiting from movement around them.

A way to better understand this condition is to consider photography. Normally the neurological vestibular ocular reflex keeps the camera (your eyes) steady with head movements; this is achieved through effective vestibular head-eye coordination. In order to get a good picture, the camera (the eyes) must be held steady by the photographer.

With the malfunctioning vestibular oscillopsia, the problem is not the camera (the eyes) but that a skilled photographer has turned into one who no longer is keeping the camera stable. Lousy images result ( as well as instability. The impact on balance can be devastating!

Increasing Risk

With the resulting fear of movement, this further leads to cycles of inactivity, deconditioning, weakness, tightness, and even more fall risk.

In terms of medication, it’s important to consider drugs which depress the vestibular system (i.e. vestibular suppressants such as antivert, meclizine, valium) are typically most effective only during acute episodes and actually can delay or prevent central nervous system compensation if used long-term.

Some medications also can damage the inner ear. Patients should always discuss the ongoing risks versus the benefits of any drugs with their medical physician.

In terms of treatment, physical therapy vestibular exercise-based adaption and substitution interventions often are very effective! Doctors of physical therapy are highly trained and uniquely qualified health care providers who specialize in treating complex movement disorders, including oscillopsia.


Finally, many consumers are now seeing the tremendous value and cost savings benefits of direct access physical therapy as well as procedure-bundled cash-based clinics.

Quality physical therapy often can save significant time and expense, reducing or eliminating the need for medication, expensive diagnostics, & invasive procedures.

Many find it clearly is a great investment!


Dr. L. Voigt Smith, PT DPT CredMDT

About Dr. L. Voigt Smith, PT DPT CredMDT

Dr. Smith is a state licensed Doctor of Physical Therapy, owner of the Backsmith Advanced Physical Therapy clinic in Weston, Wisconsin, and inventor of the Backsmith Selective Stabilization Support. Dr. Smith prides himself on advanced and high value physical therapy care. He has been exceptionally effective with many outlier chronic pain patients. Dr. Smith is often able to save patients significant time and money, while restoring mobility and reducing chronic pain. Dr. Smith can be reached at the Backsmith Advanced Physical Therapy Clinic in Weston, WI (by appointment) or at (715) 298-5888.

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