Vestibular Physiotherapy
Did you know that physiotherapists can treat certain causes of dizziness? In our Vestibular Rehabilitation Physiotherapy Appointments, your physio can assess whether your dizziness is coming from your inner ear and how we can help!
What is dizziness and how common is it?
IT’S MORE COMMON THAN YOU MIGHT THINK!
Dizziness is much more common that you might have initially thought. Various studies looking at large populations predict that around 20% of the population may be experiencing some type of dizziness or imbalance at any one time. No two people are the same when it comes to symptoms of dizziness, there may be common themes, but everyone will experience their own unique set of symptoms.
These episodes of dizziness may last for varying periods of time and some of them may not need treatment at all!
However, if you’ve ever experienced dizziness before you’ll know how incredibly debilitating it can be. As a result, a larger percentage of those experiencing dizziness will seek some assistance from a medical practitioner.
Common symptoms we often discuss with our clients include:
Vertigo (head spinning or a sense/ illusion of movement, tilting/ rotating/ ‘I’m on a boat’ feeling)
Difficulty managing balance or dizziness if you’ve moved too quickly
Lightheaded feelings/ faintness/ fullness of the head
Spatial confusion- difficulty determining distance or registering speed of movement
General imbalance- feeling less steady on your feet
Hearing disorder- changes in your hearing can be associated with some causes of dizziness
What causes dizziness?
The cause of dizziness you are experiencing will determine who is best placed to help you get over the symptoms. It’s a complex topic with a huge number of factors affecting why or how someone is feeling their symptoms of dizziness.
Not all of the causes stem from the same system. Multiple systems in our bodies are involved in maintaining our balance and keeping us level-headed. A slight problem in one system may lead to us feeling dizzy. These include:
Vestibular system - our balance centre in our ears
Neurological system - the system extending from our brains and spines to the very small nerves in our hands and feet.
Other medical causes - think low blood pressure for example!
Psychological causes - anxiety and other mental health issues may also have an effect on dizziness
What is the Vestibular System?
Physiotherapy treatment for dizziness will focus largely on assessing and treating the vestibular system. Although this system is not exclusively what we may discuss with you in an appointment, our physical and non-physical assessment will centre around this system heavily.
The vestibular system is our balance centre within our inner ear. We have one on either side of our head and they connect into the brain via different nerve connections.
Images of the ‘inner ear’ often show a variety of components however those relevant to our discussion today are:
Semi-circular canals
3 different canals all positioned in different planes. These allow fluid to flow through as we move our head, giving us feedback to the movement we are completing. They are especially good at registering our heads rolling and rotating.
Otolith Organs
These register linear head movements both forward - back/ left and right and up and down.
Sensory hair cells
These are found in both of the above components helping to convert the physical movement into a neural signal that is sent to the brain
Types of Vestibular Dizziness
There are 3 very common types of vestibular dizziness: Benign Proximal Positional Vertigo (BBPV), Labyrinthitis or Vestibular Neuritis and Meniere’s Disease. Although there are other types, other vestibular conditions are significantly less common and may need more investigation from a consultant to uncover.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a type of vestibular dizziness. It is generally thought to relate to the presence of ‘debris’ (calcium carbonate crystals) within the semi-circular canals of the vestibular system. These crystals originate in a near by structure called the Utricle (an organ that measures horizontal movement of the head).
Usually, the utricle doesn’t allow these crystals to leave and eventually enter the canals, however over time we can see some degenerative changes in this organ which may allow the some of the crystals to escape. This is likely to be the reason we see BPPV most commonly in people over 55 years of age.
Age is not the only factor effecting the likelihood of developing BPPV, however. If you’re under 55 and develop BPPV, this may be due to a head trauma, infection or some other deficit in the Utricle.
Symptoms of BPPV:
Very short (30-60sec commonly) of intense room spinning dizziness.
Dizziness is sometimes associated with a feeling of nausea.
Episodes are often aggravated with head movement, worse if less controlled often.
Most people suffering with this will describe real problems with sitting up in bed or rolling over.
Treatment of BPPV
Typically physiotherapists can diagnose BPPV using a test called the Hall-Pike Dix test. This mimics the positions of aggravation we see in BPPV and will cause your symptoms to start. This may also cause something we call nystagmus (jumping eye movements) which is completely normal within BPPV.
Following a positive test, we can move directly to the treatment of BPPV. The most common, although not only treatment, is a manoeuvre called the Epley’s Manoeuvre.
Epley Manoeuvre
Your physiotherapist will help you to move through 4 positions while lying down.
The aim of this manoeuvre is to move the crystals within your inner ear from a more sensitive location to a less sensitive location, and improve your symptoms.
Once completed, symptoms should start to improve over 1-2 weeks, but often more than one treatment is needed.
Your physiotherapist will aim to be able to complete the Hall-Pike Dix test without bringing on your dizziness symptoms. Then, they may need to talk through some exercises you need to complete to ensure that vestibular system is working as effectively as possible again! These will be completely tailored to you and your symptoms.
Meniere’s Disease
Not as well understood as BPPV by the medical community, Meniere’s was first discovered in the 1800’s and since has been classified as a vestibular condition. It is characterised by episodes of dizziness lasting between 2-4 hours (much longer than BPPV) and associated with a fullness in the ears and head. It can even cause hearing loss in some people!
The current consensus is that the condition is caused by varying pressure of the fluid within the vestibular system, but this hasn’t been well researched.
Usually this is something that starts within one ear but can extend to both in some people.
Labyrinthitis or Vestibular Neuritis
Vestibular neuritis stems from a viral infection on one of the two vestibular nerves carrying movement information from the vestibular system to the brain. When this presents it effects how well the vestibular system can communicate with the brain and this causes dizziness.
When these symptoms of vestibular neuritis are combined with hearing loss, we call the combination of the symptoms labyrinthitis.
This is absolutely not written to substitute medical advice and it is always important to see a qualified health care professional for a formal diagnosis. Do not attempt any of the manoeuvres yourself at home before consulting a physiotherapist.
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