Choose Physiotherapy for Dizziness and Vertigo

Sarah Cowgill (Physiotherapist – Burnie)

Dizziness and vertigo are very common complaints that people have and often they don’t know where to go to get help for their condition. Some people can be suffering in silence for years.

There are many different causes of dizziness, from blood pressure complications to problems with your neck or inner ear. It can be hard to find the right treatment for your problem.

Did you know that Physiotherapists can help treat many different causes of vertigo and dizziness? If you are suffering from vertigo it is a good idea to see one of our Physiotherapists here at Coastal Physiotherapy.

Below are a few common causes of dizziness. Remember dizziness is a confusing ailment so avoid trying to diagnose yourself and instead see one of our trained Physiotherapists to help you.

Dizziness can be caused by a problem with the peripheral vestibular system (inner ear and connecting nerves), central vestibular system (brain and brain stem), cervical spine or by a range of other body systems.

Benign Peripheral Paroxysmal Vertigo (BPPV)

BPPV is the most common cause of vertigo and often the most well-known. It can affect anyone but is more common in females and those aged between 60-70 years.

Symptoms are often 30-60 seconds of vertigo (feels like room is spinning) after a rapid change in head position. This can occur without warning the first time and can be scary. You can also feel a little off balance between moments of vertigo.

The body has little crystals that sit in your semi-circular canals (see picture) that when you turn your head to the side will float along inside the canal with the effect of gravity. This movement is picked up by your vestibulocochlear nerve which send a message to the brain telling it that your head is now on its side. Your eyes will also be picking up a sideways image of the world and relaying that to your brain as well as the nerves in your neck muscles notice the neck is tilted and send this message to your brain.

Crystals = head is on its side

Eyes = head is on its side

Neck muscles = head is on its side

Brain = tick, tick, tick and is therefore happy.

Sometimes though the crystals can get stuck. When you turn your head to the side the crystals don’t move so the nerve sends a message to your brain saying your body is still upright while your neck and eyes are saying the head is on the side.

Crystals = head is upright

Eyes = head is on its side

Neck muscles = head is on its side

The brain is therefore getting a mismatch of information and then vertigo commences due to the confusion.

As Physiotherapists we are well trained in assessing for BPPV and treating it. If BPPV is thought to be the cause of your dizziness we will do a small technique that involves lying you back on the bed and moving your head into some positions. This technique can help to dislodge the crystals. It is often a very effective treatment.

Vestibular Neuritis

Vestibular neuritis can give you similar symptoms to BPPV. When you turn your head you will suffer from severe vertigo.

Vestibular neuritis is caused by an infection to the vestibulocochlear nerve. Some people may have felt unwell in the days to weeks before their first vertigo attack. It can affect anybody but is more common in those aged 30-60. Due to the nerve being injured the message sent from the semicircular canals is not being sent effectively to the brain.

The condition is often diagnosed by a Ear Nose and Throat specialist.

Treatment can involve some medications as well as special ‘dizziness’ exercises prescribed by a Physiotherapist. These exercises are called Vestibular Rehabilitation Therapy (VRT) and often involve challenging someone’s dizziness to improve it.

Meniere Disease

Meniere Disease is another common form of dizziness. Meniere will cause one or a mixture of symptoms including dizziness, a fullness of the ear, decreased hearing, tinnitus (ringing in the ears), rotational vertigo, balance problems, nystagmus (eye movements), nausea and vomiting. The vertigo symptoms are not triggered by a change in body position.

Meniere Disease is believed to be caused by an excess amount of fluid in the inner ear.

Vertigo symptoms can come on at random and can last anywhere from 30mins to 24 hours. It is more common in females and those aged between 20-60. Often dizziness attacks can be weeks or months apart.

It is often diagnosed with audiology and ENG.

Treatment for Meniere’s Disease is controversial and therefore people often suffer from Meniere’s for many years or sometimes it can be a lifelong problem.

Some treatment options can be avoiding low temperatures, changes to diet, surgery, psychiatric support for the chronic condition and VRT exercises prescribed by a Physiotherapist.

Tired frowning girl suffering from headache Free Photo

Bilateral Conditions

The above conditions often affect one inner ear (vestibular organ). There are some conditions that can affect both ears though. This can be as a result from meningitis (brain fluid infection), laryrinthine infection, otosclerosis, diabetes, chronic alcohol abuse, pagets disease, polyneuropathy, bilateral tumours or ototoxic drugs.

Problems with the vestibular system that is bilateral can cause gait ataxia (abnormal walking pattern) and postural disturbances. Management of these conditions is related to what caused them. Physiotherapy can help with some of these conditions.

Central Vestibular Disorders

Central vestibular disorders are caused by damage or illness to the vestibular cortex, thalamus, brain stem, medulla and vestibular cerebellum – these are all parts that make up our brain.

People with a central disorder will often have trouble with their balance, posture, eye movements and head movements.

It can be tricky to determine if a person’s vertigo is caused by a central or peripheral vestibular problem. A Physiotherapist can be very helpful by pointing you in the right direction for diagnosis and treatment.

Cervicogenic Dizziness

Cervicogenic dizziness is caused by damage to the upper cervical spine. This can be due to an accident such as whiplash from a car accident or from chronic structural pathologies such as osteoarthritis. This injury causes disruption to the nerves in the area which advise the brain where the head is in space. This can lead to dizziness symptoms. People with cervicogenic dizziness often will complain of vertigo when they move their head, light-headedness and a feeling of imbalance.

Cervicogenic dizziness is often easy to diagnose and differentiate from other forms of dizziness. Physiotherapists are well training in detecting cervicogenic dizziness and treating it. Treatment often involves some sessions with hands on therapy to release pressure on the irritated nerves along with some exercises to work on neck stability, strength and flexibility.

If you believe you may have cervicogenic dizziness, seeing one of our physiotherapists at Coastal Physiotherapy can help.

Other

Other types of dizziness/vertigo are listed below. This is not a conclusive list. Physiotherapy can help with some of these conditions:

  • Migraine associated vertigo – diagnosed by doctor/specialist
  • Psychological – diagnosed and treated by psychologist
  • Mal de debarquement syndrome – Physiotherapy can help manage
  • Postural hypotension – dizziness after standing – diagnosed by doctor.
  • Hormonal changes – can often be related to menopause
  • Acoustic neuroma – similar to other unilateral vestibular conditions. Is caused by a benign tumour growing on the vestibulocochlear nerve.
  • Auto-immune disease of the inner ear

It is important to get immediate assistance if you feel any of the following along with your dizziness/vertigo:

  • Numbness, tingling
  • Weakness in the limbs
  • Slurred speech
  • Progressive hearing loss
  • Tremors
  • Incoordination
  • Loss of consciousness
  • Rigidity
  • Loss of visual field
  • Onset

Physiotherapy does not help all causes of vertigo, however we are very skilled in recognising what we can treat and if we cannot, we will send you in the right direction for the appropriate treatment. If you are worried about your vertigo or dizziness, then ring us on 64314586 and make an appointment with one of our friendly Physiotherapists.

References

https://vestibular.org/central-vestibular-disorders

https://www.asha.org/Articles/Signs-and-Symptoms-of-Central-Vestibular-Disorders/

https://vestibular.org/cervicogenic-dizziness