Make sure that you stay up to date on the latest medical trends and treatments in the Physical Therapy realm! This medical blog is here to inform and educate our patients in their rehabilitation journey for a brighter future.

Let’s Clear the Fog Surrounding Vertigo

One in three adults experiences dizziness and balance issues that in most cases, can be treatable with Physical Therapy. Many body systems including your muscles, bones, joints, eyes, the balance organ in the inner ear, nerves, heart and blood vessels must work normally for you to have normal balance. When these systems aren’t functioning well, you can experience balance problems. Many medical conditions can cause these issues. However, most balance problems result from issues in your balance organ in the inner ear, also known as your vestibular system.

The Vestibular System

Have you ever had an ear infection and noticed that you had difficulty with balance or dizziness? That’s because your ears aren’t just for hearing. They also serve as your centers for balance and spatial equilibrium, without which your brain wouldn’t have the necessary information to understand your body’s relationship with your external environment.

The vestibular system is a collection of structures in your inner ear that provides you with your sense of balance and an awareness of your spatial orientation, meaning a sense of whether you are right-side-up or upside-down. Your brain then integrates that information with other sensory information from your body to coordinate smooth and well-timed body movements.

It’s a pretty complex series of actions and not something we’re born innately knowing to do. We all learned to walk as toddlers by honing and refining these interacting systems, and every time you learn something new that requires balance (like riding a bike, snowboarding, surfing, or paddleboarding) your brain further modifies and refines these integration processes.

Causes of vertigo or balance issues

Balance problems can be caused by several different conditions. The cause of balance problems is usually related to the specific sign or symptom. Here is a list of some common causes.

  • Benign paroxysmal positional vertigo (BPPV). BPPV occurs when calcium crystals in your inner ear — which help control your balance — are dislodged from their normal positions and move elsewhere in the inner ear. BPPV is the most common cause of vertigo in adults. You might experience a spinning sensation when turning in bed or tilting your head back to look up.
  • Vestibular neuritis. This inflammatory disorder, probably caused by a virus, can affect the nerves in the balance portion of your inner ear. Symptoms are often severe and persistent, and include nausea and difficulty walking. Symptoms can last several days and gradually improve without treatment. This is a common disorder second to BPPV in adults.
  • Persistent postural-perceptual dizziness. This disorder occurs frequently with other types of vertigo. Symptoms include unsteadiness or a sensation of motion in your head. Symptoms often worsen when you watch objects move, when you read or when you are in a visually complex environment such as a shopping mall. This is the third most common disorder in adults.
  • Meniere’s disease. In addition to sudden and severe vertigo, Meniere’s disease can cause fluctuating hearing loss and buzzing, ringing or a feeling of fullness in your ear. The cause of Meniere’s disease isn’t fully known. Meniere’s disease is rare and typically develops in people who are between the ages of 20 and 40.
  • Migraine. Dizziness and sensitivity to motion (vestibular migraine) can occur due to migraine. Migraine is a common cause of dizziness.
  • Acoustic neuroma. This noncancerous (benign), slow-growing tumor develops on a nerve that affects your hearing and balance. You might experience dizziness or loss of balance, but the most common symptoms are hearing loss and ringing in your ear. Acoustic neuroma is a rare condition.
  • Ramsay Hunt syndrome. Also known as herpes zoster oticus, this condition occurs when a shingles-like infection affects the facial, auditory and vestibular nerves near one of your ears. You might experience vertigo, ear pain, facial weakness and hearing loss.
  • Head injury. You might experience vertigo due to a concussion or other head injury.
  • Motion sickness. You might experience dizziness in boats, cars and airplanes, or on amusement park rides. Motion sickness is common in people with migraines.

Please enjoy this video this great video made University of San Francisco Otolaryngology explaining BPPV.

Symptoms of Vertigo or Balance issues

Signs and symptoms of balance problems include:

  • Sense of motion or spinning (vertigo)
  • Feeling of faintness or lightheadedness (presyncope)
  • Loss of balance or unsteadiness
  • Falling or feeling like you might fall
  • Feeling a floating sensation or dizziness
  • Vision changes, such as blurriness
  • Confusion

What now?

If you feel off balance or dizzy, one of these systems may not be working correctly, or the information from these systems may not be being “put together” or “integrated” correctly. A physical therapist can help to determine how you are using these systems (or not) to keep your balance and can instruct you in exercises that can improve how your body uses all these systems together.

Vertigo affects people of all ages. Although it is very rare among children, it is common in adults over the age of 20. Vertigo and balance problems are more dangerous for people ages 65 and over. Older adults are at greater risk for fractures and major injuries from a fall caused by imbalance.

How Can Physical Therapy Help?


A physical therapist can help people manage vertigo and dizziness symptoms so they can get moving again. Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. 

No prescription is needed for you to be evaluated for BPPV so if you feel you are having symptoms please reach out to your closest WESTARM Physical Therapy facility. 


Therm-X: Next Generation of Hot/Cold Treatment For Athletes & Patients

For athletic trainers and sports therapists who want the latest technology for their athletes and patients, the use of cold and heat has a new high-tech option. WESTARM Physical Therapy, a trusted leader in physical therapy for nearly 40 years, has partnered with Zenith Technical Innovations to provide Therm-X, an all-in-one portable device that provides heat, cold, compression, and contrast therapy.


Therm-X features an intuitive touch screen with pre-programmed or customized protocols. With its digital control, the Therm-X circulates a coolant that can maintain a specific temperature for the entire treatment cycle. This provides a distinct advantage to heat packs or ice packs that can lose temperature once they’re applied.

The easy-fill tank uses distilled water and isopropyl alcohol as a coolant solution that does not require constant refilling and cleaning. The fluid passes through a garment with a tailored treatment area to concentrate the cold or heat where it is needed most.

Therm-X can be used to support a variety of injuries and recovery plans for patients. By using rapid cold, heat, and compression, the Therm-X can help reduce edema, swelling, and discomfort.  The system is equipped with a variety of preset treatment options to choose from—or control the treatment on your own with the easy-to-use digital temperature modules. 

Six separate garment compression options ensure full contact for optimal thermal transfer.  Designed specifically for the knee, back, elbow, ankle, shoulder and hip, these Therm-X garments are bilateral so “left” and “right” purchases don’t need to be made. They’re also one-size-fits-all for additional flexibility.

Therm-X at WESTARM Physical Therapy

Free Hip and Knee Lecture Set To Take Place In Leechburg

Experienced orthopeadic surgeon Dr. Eric Evans from Greater Pittsburgh Orthopeadic Group (GPOA) is teaming up with WESTARM Physical Therapy to give a free lecture to local residents of the Alle-Kiski Valley and it’s surrounding communities who are considering hip or knee replacement. The lecture is scheduled to take place at 6 p.m Tuesday, November 16th at WESTARM’s Leechburg facility. Facility Director Luke Ladouceur, MSPT, will join Dr. Evans in conducting the lecture.

RSVP for your spot at the lecture here or by calling us at 724-337-6522.

WESTARM hosts a series of lectures in order to help educate the communities in which we serve. The aim of these lectures is to help attendees ease their minds and ask any questions or voice any concerns they have about their potential upcoming surgery. Please check out some common myths about joint surgery provided by Temple Health.


Myth: Artificial Joints Are Only for People with Arthritis

Arthritis is one of the many conditions treated by replacing a damaged joint with an artificial implant. But pain, stiffness and swelling can also be caused by diseases, injuries and years of wear and tear.

If your quality of life is not the same as it used to be, and you’re having trouble doing everyday tasks like walking, climbing stairs or lifting your grocery bags, you may also benefit from joint replacement. And keep in mind that joint procedures range from total joint replacement to repairing the damaged parts of your joint.

Myth: Hip and Knee Replacements Don’t Last – I’ll Need Another Operation Eventually

While there is always a chance that your artificial joint implant will wear down over time, studies show that statistically, knee and hip replacements can last for 15 to 20 years, or even longer. Depending on your age and other factors when you have your joint procedure, you may never need another procedure again.

Myth: I’m Too Young/Old for Joint Replacement Surgery

Joint overuse and injury can occur at any age – most often in your hips and knees. That’s because you use your hip and knee joints for everything, from carrying groceries, to lifting your kids onto your shoulders, to playing weekend sports. Wear and tear on these joints breaks down the protective cartilage between your bones, causing pain and inflammation.

The goal of joint replacement is to help patients of all ages move freely and live with minimal or no pain. Your provider will consider many factors – including your overall health – before recommending joint replacement as an option for you.

Myth: An Orthopaedic Surgeon Will Just Try to Talk Me Into a Procedure

An orthopaedic surgeon is a bone doctor with years of training and experience in working with patients who have acute joint injury or chronic joint pain from various conditions.

To find out if you’re a candidate for joint replacement, an orthopaedic surgeon will talk to you about your medical history, conduct a physical exam and may run some tests such as an X-ray or arthroscopy to view the extent of the damage. At that point, it may be that rest, medications (NSAIDs) and/or physical therapy are all you need.

If extensive damage has already occurred, you can discuss all your options with the surgeon, and even get a second opinion before you decide the best treatment for you.

Myth: I Don’t Have Time for a Long Recovery Following Joint Replacement

Even with total knee or hip replacement, you should expect to stand or begin walking with assistance the day of surgery. You will have initial pain as your surgical area heals, but as you work with your physical therapy team, you’ll learn how to strengthen the muscles around your joint.

Within a few weeks to months, you should be back to your daily activities once again.

Leader Times’ Report on Shoulder Lecture at Kittanning Facility

Nathan Formaini, DO - ACMH Hospital
Kelsey Cushey, DPT - Kittanning Facility Director

Experienced shoulder surgeon Dr. Nathan Formaini from ACMH Hospital is teaming up with WESTARM Physical Therapy to give a free lecture to residents of Kittanning, and surrounding Armstrong County communities who are considering shoulder surgery. The lecture is scheduled to take place at 6 p.m Sept. 21st at WESTARM’s Kittanning facility. WESTARM Kittanning Facility Director Kelsey Cushey, DPT, will join Dr. Formaini in conducting the lecture. She recently won second place in the Leader Times’ Best of the Best in 2021.

RSVP for your spot at the lecture here or by calling 724-337-6522.

Free lecture planned locally for those considering shoulder surgery

By A.J. PANIAN- Managing Editor of The Leader Times

Having grown up in Armstrong County, Dr. Nathan Formaini knows a good many people living in the area earn their respective livings through various kinds of work that can be hard on their bodies.

“The area is full of hard-working people that regardless of their orthopedic issue, ultimately just want to get better. They make excellent patients. You’re in a population that basically uses their body to earn a living,” said Formaini, a Ford City High School graduate and well-known orthopedic shoulder and elbow orthopedic surgeon since 2015 at Armstrong Orthopedic Associates.

From disorders including arthritis, rotator cuff tears and tendonitis, to sports-related injuries and fractures, Dr. Formaini treats numerous patients in the locale and also cares for many additional orthopedic issues and fractures throughout the body.

One thing he has learned is that some jobs take a heavy toll on many parts of the body, but not nearly as heavy a price as extended time off can impact a breadwinner in a household.

“When you’ve got people that are doing laborious jobs, they need their bodies to make a living and earn their money, so when they feel they need to or have to seek medical treatment, it can be a very different scenario for them — they gotta get back to work,” he said. “They tend to be more compliant, make sure they go through treatment once, and have a great outcome so they can get back to earning a living.”

Providing perspective and peace of mind to such individuals, in particular, represents one of Dr. Formaini’s prime motivations to join forces with WESTARM Physical Therapy to give a free lecture to residents of Kittanning and surrounding Armstrong County communities who are considering shoulder surgery, he said.

The lecture, which is scheduled to take place Sept. 21 at WESTARM’s Kittanning Facility11931 State Route 85, Kittanning, Pa 16201 — which is at the intersection of Route 28 and Route 85 in Indian Hills Professional Center.

It will offer those in attendance an opportunity to learn about up-to-the-minute advancements in the field of orthopedic surgery — possibly toward the end of returning them back to work sooner than they originally thought was possible, according to Dr. Formaini.

“People normally come in for evaluation in an office setting where it’s too abbreviated,” he said. “Having events like this, you can take more time to educate them and take questions while in a more relaxed setting. You can really make them feel a lot more comfortable about a lot of the unknowns — people don’t know what surgery is like — or about the issues they have or even what treatment options are available.”

Noting that some individuals put off the prospect of surgery because they simply can’t afford to take the time off work, Dr. Formaini said information that comes out of the upcoming lecture can inform attendees of updated approaches to treatment and procedural advancements that perhaps can dispel certain enduring myths.

“I think that educational events like this — I do them a lot — people that come in and they’re concerned and will say, ‘I was told I’m not going to be able to work for months.’ And you can kind of put some of those myths to bed, because there can be other options where we can get people back to work in just a few weeks.”

The rapid advances in orthopedic care changes the game every few years when it comes to what prospective patients can expect, he added.

Event to offer attendees face time with professionals

Dr. Formaini will serve as the guest speaker along with WESTARM Kittanning Facility Director Kelsey Cushey, Doctorate of Phyiscal Therapy.

“They will be discussing options for treatment of shoulder pain and other related conditions such as surgery and physical therapy,” said Patrick McClernon, marketing and communications manager, WESTARM Physical Therapy/WESTARM Home Health.

The lecture will be beneficial for anyone with shoulder/rotator cuff issues, anyone considering shoulder surgery, or even those who’ve recently had shoulder surgery, McClernon confirmed.

“Those attending can expect to learn what to expect if they’re getting shoulder surgery, how to prepare for an upcoming surgery, and also have the opportunity to ask questions or share concerns about an upcoming procedure,” he added.

The lecture will also provide a good opportunity for the community members to have face time with Dr. Formaini and Dr. Cushey and be able to ask personalized questions about their issues.

“There can be a lot of anxiety, and uncertainty that comes along with needing shoulder surgery and preparing for the therapy thereafter,” McClernon said.

WESTARM hosts the lecture series every year to help local residents through some of those concerns and help them be better prepared. View more info on the full lecture series here.

Its officials will be providing free refreshments to all in attendance.

Those planning to attend are asked to RSVP by calling 724-337-6522 or by sending an email to: administration@westarmtherapy.com.

Dr. Formaini’s additional background

As per Dr. Formaini’s website — pittsburghshoulderdoc.com — he joined Armstrong Orthopedic Associates in August of 2015.

Born and raised in the Kittanning area, he graduated from Ford City High School and received his undergraduate degree from the University of Pittsburgh, graduating with honors.

Dr. Formaini attended the Lake Erie College of Osteopathic Medicine before completing a five-year orthopedic residency through Ohio University at Doctors’ Hospital and Grant Medical Center in Columbus, Ohio.

He concluded his surgical training with a one-year shoulder and elbow fellowship under the direction of Dr. Jonathan Levy at Holy Cross Hospital in Fort Lauderdale, Florida.

Dr. Formaini has a special interest in shoulder and elbow surgery, having completed a surgical fellowship focusing solely on complex shoulder and elbow problems.

His diagnostic skills and surgical expertise in this particular area include reverse shoulder replacement, total shoulder replacement, total elbow replacement, arthroscopic shoulder and elbow procedures, and upper extremity fracture management.

He also brings a superior level of care in the fields of general orthopedics and advanced fracture care surgery to Armstrong County and the surrounding region.

Dr. Formaini has been very active in orthopedic research and authored multiple journal publications as well as textbook chapters on various orthopedic topics.

He lectures at state, regional, and national meetings and also serves as a reviewer for research-based orthopedic journals.

Original article written by A.J. Panian, managing editor of the Leader Times.

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