You know that there's no such thing as a one-size-fits-all training program for clients. Every client is going to require different needs and special attention. You simply have to be prepared to handle any client that walks through your door.
And sometimes that client may throw a real curve ball by suffering from vertigo, which can suddenly cause spontaneous dizzy spells. Your client still wants to be trained, but he also needs to avoid any sudden movements of the head, bending over, or even lying down. Huh, challenge accepted.
With just a few careful and considerate programming changes, your client can stay on track with their fitness goals and healthy in the process.
What is vertigo?
Vertigo is a sensation of losing balance, as if the world were spinning. One moment a person with vertigo could be fine so he reaches down to simply tie his shoes; in the next moment, he comes back up, and the entire room is going in circles.
That's what vertigo is like. The result isn't pretty: extreme dizziness, nausea, and vomiting are the usual symptoms. It happens when those tiny crystals inside your inner ear which regulate your balance become dislodged.
Worst of all, a bout of vertigo can last for hours and can quickly turn a pleasant day into an absolute nightmare.
Fortunately, physical therapists can treat vertigo through a series of exercises known as vestibular rehabilitation therapy (VRT), which helps get the crystals and brain back to working properly. The thing is, treatment for vertigo can last a month or longer, during which patients are asked to avoid any sudden movements of the head. Patients are also told to avoid bending over or lying down in certain ways as well.
At this point, your client going through therapy will assume that he can no longer work out with you until he's finished vertigo therapy. At the same time, if he's been killing it in the gym for a goal that's almost touchable, he will be anxious about keeping up with progress.
The good news is your client doesn't have to stop: a client with vertigo can still get in a decent strength training session, even in the midst of a therapy program.
However, it will be challenging. The workout you perform one week could be useless the next week. It's possible, but there are certain rules to follow.
Three things to consider for a client with vertigo
For the reasons I talked about earlier, you must abide by the following:
- Avoid tilting the head.
- Avoid lying down.
- Avoid sudden head movements.
If you can't tilt the head, then deadlifting, inverted rows, planks, bent-over rows, triceps kickbacks, back extensions, and wall push-ups are not an option.
If you can't lie down, then bench pressing, dead bugs, hip bridges, and most mat exercises are gone.
Finally, if you can't do sudden movements, then kettlebell swings, snatches, slam balls, and plyometrics are a no-go.
So, what can you do?
Working around your client's vertigo
Aim to keep the head as vertical as possible throughout the workout. Also avoid exercises where your client's head is going through a change in elevation, which can aggravate symptoms as well. That means avoiding step-ups, squats, and lunges.
When I train a client with vertigo, the meat of my programs is formed from exercises that involve sitting or standing upright. (I've included a list below that will give you somewhat of a foundation for ideas to start off with.) It's in no way all-inclusive, but it will give you a rough outline of exercises that you can work with.
- Chest: Chest press, machine/cable pec fly
- Back: Lat pull-downs, seated cable rows, machine rows, face pulls, straight-arm pull-downs, rear delt fly
- Quads: Knee raises, some leg press machines
- Glutes/Hams: Hip abduction machine, donkey kick machine, cable hamstring curl, cable hip abduction, cable hip extension, leg press machines (sometimes)
- Shoulders: Military press, dumbbell lateral raises, upright rows, cable internal/external rotation
- Biceps: Seated/standing bicep curls, high pulley curls
- Triceps: Cable push-downs, seated overhead triceps press
- Core: Cable anti-rotation, hanging leg raise, Pallof press
When it comes to intensity, it's really on a case-by-case basis. Prior to being cleared by the physical therapist, the only caveat with intensity is obviously avoiding things that make a client dizzy.
If the client is feeling a little dizzy and nauseated that day, you may want to ease up a bit and just focus on traditional strength training with non-exacerbating exercises. On the other hand, if the client feels fine and wants to do a good, hard workout, that's fine. Just don't do any of the non-cleared exercises. What I usually do is have my client use a recumbent bicycle for sprints, avoid exercises that tilt/move the head, and also move slowly from exercise to exercise.
It's better to be cautious in this case, and there is absolutely nothing wrong with telling your client you want to wait another week or so before you build back up to interval training, or harder workouts.
Additionally, your client can still go pretty heavy. I still have my vertigo clients do the same weights that they're used to (on cleared exercises, of course). You don't really have to worry about the internal pressure from weightlifting, unless that client's vertigo isn't posture related (i.e. cardiac-related). If the vertigo is from anything other than posture, then you'll need a doctor's clearance to continue training and know more about the condition.
For my vertigo clients, a typical workout may look something like the below example.
- 5-10 minute warmup on the stationary bike
- 3 sets of 10 chest press machine
- 2 sets of 15 lat pull-down
- 2 sets of 10 leg press
- 3 sets of 10 leg extension
- 3 sets of 10 seated leg curl machine
- 3 sets of 15 tricep push-downs
- 3 sets of 10 bicep curls
- 3 sets of 10 seated row
- 3 sets of 15 pec fly machine
Notice that I'm still training my clients somewhat normally and that I've taken out any exercises that involve any movement or tilting of the head.
Avoid making a client's vertigo worse
We certainly don't want to make a client feel worse. I've found that a lot of clients with vertigo can't handle rapid movement, especially in their peripheral vision. Plus, the motion of their arms moving back and forth really fast can trigger vertigo unexpectedly. Some people can ride while keeping their head pretty still, while others can't at all.
As a result, I try to avoid elliptical-like machines when a client is being treated or has a history of vertigo. Likewise, I wouldn't recommend the row machine either, unless the client has proven he can do it without feeling dizzy (and really wants to use it). It's the same principle for leg press machines. I don't like using them unless the only moving part is the foot plate, not the chair in which the client is sitting.
If your client isn't feeling well during or after training with you, the first thing I would do is take a solid look at the workout and ask these questions:
- Is there anything in the workout that could possibly be moving the head?
- Are they near anything that's moving really fast?
These could easily be the reasons that the client is experiencing vertigo symptoms. Remove what you think could be aggravating vertigo and see how he feels next time.
If that still doesn't work, then just resting until he's been cleared by his physical therapist is probably best. It'd probably take a couple of weeks, but the alternative scenario might be your client throwing up and crawling across the floor in the middle of a gym. When in doubt, apply a little caution and common sense.
In short, this is all on a case-by-case basis. Even vertigo clients will be different, so exercise caution. At the same time, don't be afraid to let clients experiment a little bit if they are the ones who recommend doing something.
Post therapy: Help your clients get over their "fear"
Typically, somebody with vertigo will also be seeing a physical therapist regularly, along with training with you. That's fine.
After a certain number of appointments with the physical therapist, the client will be "cleared" of vertigo. This means that the physical therapist has given him permission to really do whatever the heck he wants.
However, there's a very good chance that even after your client has been cleared, he is going to be a little leery of resuming normal activities again.
This is where you're going to have to teach your client to trust his body once more.
I'd recommend slowly adding back the exercises that he was doing before. The first week you may add something back like the bench press. The second week you may add back planks. And so on.
Basically, you want to let these clients to adjust back to normal workouts over a series of workouts. Let them learn to trust themselves.
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