"Can deconditioning cause orthostatic issues? I'm in severe deconditioning."
A way to think about this:
Which Came First?
Did you have the orthostatic issues first, and then that created the lack of movement, which then created the deconditioning? Or did you just stop moving — got hooked on Breaking Bad or something — and then stopped moving, and then all of a sudden you started to get orthostatic problems?
You can see where one is more of a catalyst than the other.
If you're noticing that you were having orthostatic problems and then you could do less things — it probably wasn't the "doing less things" that caused the problem, right? And then we kind of work backwards and think about what could have been more causal, and can we solve that underlying problem.
But if the deconditioning in and of itself is the thing that led to it, then we work on the conditioning as a way to build back up that tolerance.
Here's what matters in both cases: In both cases, you will still have to do some conditioning to build the strength back up. Whether the deconditioning was the cause or not, once we're at a point where the underlying issue is solved, we still have to build up the tolerance and build up the strength.
Quality Over Quantity
This is something we talk about all the time. We are a quality over quantity type of a field. Meaning it's way better to do two good ones than ten bad ones, because all those ten bad ones do is keep the circuit going of the faulty response. We want to break that faulty response with perfect ones.
Think of it like doing less weight on the bar if you're doing a bench press, right? You pull the dosage down. You go really slow and controlled. You're trying to make it easier for the system to actually succeed at the task.
What we see very frequently is people saying "yeah, I do the exercises" and then when we ask what it looks like, they're doing it and their head is moving all crazy and their eyes are moving crazy and they're dizzy — and it's like, well, that's not a good idea.
So in these instances, we say: we're not going to do that. We're going to do something that's more targeted toward making it smooth.
When the neck complicates things: One thing we know is if there are injuries in the neck, that neck injury — if it causes an aberrant movement when you move your eyes and head, or even just in the way you position your head — it's going to create a pull in your eyes where the reflexes won't work as cleanly. And it can go the other direction too: if your eyes are jerking around, your body will try to become more still, and your neck will get tighter automatically through something called a cervical collic reflex. So sometimes we have to address eye stability on its own without involving the neck, let that reflex relax, and then start to incorporate neck movement.
Figuring Out Which Mechanism Is Driving the System
So here's how we think about it. Number one: which faulty mechanism is actually driving the system?
Number two: am I at a dose where I'm able to do the required task perfectly? If the answer is no, we need to pull back further than you'd think.
And number three: is there an interaction between systems that we have to break apart? Sometimes gaze stabilization work, for example, involves moving the head on the neck, right? But in some cases when that neck is really problematic, we may have to actually do it in a whole-body format — still stimulating the vestibular-ocular system but taking the neck out of the game. That might even be something we have to do laying down, or with someone else supporting your head, or with some sort of sensory trick that helps you do that.
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