Dizziness, Vertigo and the Vestibular System: Part 1

What is vertigo?

Have you ever experienced any one or more of these symptoms?

  • Dizziness: the feeling of light-headedness, giddiness and unsteadiness.
  • Disequilibrium: the feeling of being imbalanced and is a sensation of being disorientated within your surroundings.
  • Syncope: losing consciousness and fainting.
  • Vertigo: a sensation that you, or the room you are in, is in motion and is commonly felt like a spinning sensation.
  • Headache: is constant pain of aching anywhere within the head or upper neck
  • Tinnitus: is when an individual hears “ringing” in their ears

In this series of blogs, I will dive into the common causes of dizziness and the associated symptoms experienced by patient presenting to Fighting Fit Physio.

Our ability to remain balanced is determined by information received from our peripheral balance systems such as:

  • Our eyes (visual system),
  • Ears (vestibular system) and
  • The sensory nerves in our muscles, joints, tendons and ligaments (proprioception).

Our central nervous system, the brain, spinal cord and nerves receives this information and then must process it to maintain our balance in all kinds of positions.

Many people do not realise that Physiotherapists are well equipped to assist with diagnosing and treating common forms of dizziness. They mainly think to go to a physio for a torn muscle, a sore back or that niggling injurty that keeps flaring up.

So let’s look at what are causes of dizziness and the conditions we treat.

BPPV or Benign Paroxysmal Positional Vertigo

BPPV is a common disorder of the inner ear or what we call our vestibular system.

‘Benign’ Paroxysmal Positional Vertigo is just that: Benign, which means not life threatening or a progressive condition. Even though for some it can feel like it is not betteror worsening with time

BBPV is the result of a disturbance inside your inner ear.

There are 3 semicircular canals which contain fluid that moves when you move your head. This extremely sensitive area allows us to determine changes in head position relative to the rest of our body and environment.

BBPV develops when small calcium crystals (see above) within your inner ear break free and enter one of the semicircular canals, this results in your brain receiving mixed messages when tilting your head, lying down, rolling over or getting up.

This can occur idiopathically (randomly), with age or can occur following a trauma to the head.

What are the symptoms of Benign Paroxysmal Positional Vertigo?

The symptoms of vertigo include

  • Dizziness or spinning seconds after a head movement
  • Light headedness getting up from sitting or lying
  • Balance disturbances trying to get moving after changes in your position ie: getting out of bed, a chair or even just walking
  • Nausea and vomiting

How do you fix Benign Paroxysmal Positional Vertigo?

Let’s take a look at how physiotherapy helps BPPV.

“In terms of treatment for BPPV it is individualised depending on which of the semicircular canals has been identified by your clinician”

A thorough assessment including an in depth subjective assessment, or put simply a bunch of questions that well ask you to describe your symptoms ie

  • When it started?
  • How long do symptoms last for?
  • The positions that aggravate you most?
  • How this is affecting day to day activities and life?

We will then test you, performing a quick movement of the head and body called a Dix-Hallpike test.

If positive, this will reproduce your symptoms and give us information on perform a ‘repositioning’ technique such as the Epley Manouvre.

This seeks to dislodge the calcium crystals from where they shouldn’t be and return them to where they belong promoting a return to normal vestibular function.

This Repositioning technique for BPPV will result in casing those mixed signals sent from the inner ear to the brain and in most cases will have an immediate reduction in dizziness symptoms. 

Remember these techniques are individualised for the presentation and just attempting the first exercise could make you feel worse.

As a component of your assessment your therapist will identify the provocative movement patterns for your dizziness, treat it and then teach you some exercise to desensitise the vestibular system so to maintain our treatment effect long term.

Other things to consider with BPPV treatment

  1. Before the dizziness, began to occur did you have poor balance?
    If so: We need to implement strategies to reduce the risk of a balance related fall, exercise is a great tool to use help with this.
  2. The Eppley hangover”  is a phenomenon when the day after a successful treatment of BPPV you feel worse, your physiotherapist will warn you of this so you are prepared and it is very normal.
  3. It is important to resume normal activities, as you are able. This allows your body to resume exposure to the normal vestibular demands of day to day life and accelerate your recovery. Your physiotherapist can assist with a graded return to an activity program.

If you experience a sudden onset of dizziness please get in contact with us.

If your symptoms have been ongoing for many months ask your GP for a referral to us under a chronic disease management plan for vertigo.