We have all at some point in our lives experienced dizziness in some shape or form. Whether this is from spinning like a child, rides at a fairground or perhaps drinking too much alcohol. It is disturbing, however, when the symptoms of dizziness occur for no apparent reason or with no obvious cause. Equally the symptoms associated with dizziness such as nausea and feelings of being unbalanced are also alarming and, at times, scary. The good news is physio for dizziness can help.
At this point, it is probably worth saying that we use some complicated and medicalised terms in this article but unfortunately dizziness is a very complex phenomenon and so we wanted to provide a full overview of some of the causes and also some of the treatments so please bear with us!
It is the Vestibular System that is responsible for detecting and controlling motion. It lives within the inner ear and combines information from our eyes and proprioception system (the system that gives us our awareness of the position and movement of our body). It maintains our balance and compensates for the effects of head motion.
Within the Vestibular Labyrinth, there are 3 semi-circular canals, anterior (front), lateral (side) and posterior (back) that are arranged in parallel planes. “Otoconia” are calcium carbonate crystals that bend hair cells when the head is moving producing an excitatory or inhibitory signal (a stop or go sign). When combined with our other senses (touch, taste, vision and hearing) and reflexes within the vestibular system we gain a sense of orientation and motion. Let’s find out which conditions physio for dizziness can help.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a condition that can occur when Otoconia (crystal) fragments from the wall of the Otolith (a calcium structure within the inner ear) are displaced into the semi-circular canals. 90% of these occur in the back posterior semi-circular canal, 10% in the lateral Canal and < 1% in the front anterior canal.
Following movements of our head, the debris of the affected side continues to move and stimulates the hair cells – giving false signals and, therefore, symptoms.
Diagnosis can be made of this condition using the Dix Hallpike test (for posterior canal problems) and side-lying test (for lateral canal problems). These are procedures in which the head is put into various combinations of movement in an attempt to bring the dizziness on and better understand the symptomatic side.
- Symptoms of BPPV can include:
- Sudden Onset Dizziness
- Severe spinning
- Positional dizziness, for example, turning in bed or hanging out clothes brings it on
- There is often a delay of between one and sixty seconds before the dizziness starts
- The dizziness is short-lived lasting between 5 and 30 seconds
Nystagmus can often be observed which involves an uncontrolled, repetitive movement of the eyes either beating upwards or down to the ground.
Vestibular Neuronitis is a condition that involves inflammation of the vestibular nerve and will usually at first come on gradually followed by a sudden severe attack of dizziness commonly accompanied by vomiting. It may well follow a viral infection or episode of flu, stress or a depressed immune system. Patients tend to improve after the onset of symptoms over a period of 1 to 6 months with an intervention from the GP of corticosteroids and / or antiviral treatment. The patient may also require vestibular rehabilitation to ‘retrain’ the balance system; this involves simple exercises that can be given when you visit your physio for dizziness. These exercises could involve the eyes, head and body.
This is a long term, progressive degenerative disease in which the patient may experience clusters of attacks and remissions affecting balance and hearing. There is no agreement on the definite cause and it is possible that it may be over-diagnosed for vestibular migraine. Severe vertigo can last for hours and patients may have fluctuating hearing loss, tinnitus (ringing in the ears) or feeling full in the ear. Patients can be treated by physio for dizziness with vestibular rehabilitation exercises between attacks but ultimately patients will undergo a progressive loss of hearing.
Physio for dizziness – The Epley manoeuvre
This procedure is used to treat BPPV and can be very effective in reducing symptoms of dizziness. It is a system of complex movements designed to work the loose Otoconia (crystal) fragments around the semi-circular canal and back into a position where it cannot give false signals that the head is still in motion.
Following the Epley procedure, the patient may experience nausea and generally feeling unwell the day of treatment. The day after treatment the patient can behave normally with regards sleep and head position. The patient may need a review in less than a week and the procedure may need repeating.
During an episode of dizziness, for whatever reason, the patient’s Vestibular system and its important relationship with the eyes may need to be rehabilitated, just as a runner may have to do exercise to rehabilitate a hip joint. This may involve simple gaze stability exercises such as following a moving target with the eyes, with and without head movements. Also rapid eye movement exercises and balance work. These can be done 4 times a day with a maximum of 4 or 5 exercises to work on.
Problems can occur with long-standing dizziness when patients (following an acute episode) fail to rehabilitate the vestibular system as doing so makes them slightly dizzy, therefore why would they bring on this unpleasant sensation again, unbeknown that the answer to improving the dizziness is to challenge it progressively.
Please do not try the Epley’s manoeuvre or any of the vestibular rehabilitation yourself at home without seeking proper medical guidance. Here at Roundwood Health Clinic our physiotherapist, Oliver Bassett, has completed training in the procedure and is competent at assessing your dizziness symptoms and discussing your treatment and rehabilitation. To learn more about dizziness and the Epley’s manoeuvre or to book in for an assessment please contact us on (01226) 282560 or book online.