Vestibular

Physiotherapy For Dizziness, Vertigo & Imbalance

There are many possible causes of dizziness and impaired balance including disorders of the inner ear and neurological problems. Finding the right help can be difficult but vestibular disorders are more common thatn you migt think and often respond well to Physiotherapy.

Conditions Treated

Labyrinthitis describes inflammation of the labyrinth. The term is often used interchangeably with vestibular neuritis, though this infection affects both branches of the vestibulo-cochlear nerve, resulting in hearing changes as well as dizziness or vertigo. Labyrinthitis usually resolves within a couple of weeks.

Vestibular physiotherapy following labyrinthitis is usually directed to improve the symptoms of vertigo and imbalance. Your Physio will complete a full assessment and design a vestibular rehabilitation programme to help resolve your symptoms. 

BPPV is a common cause of dizziness and vertigo, resulting in short periods of intense vertigo associated with head movements. Our Vestibular Physiotherapists regularly help people with this condition. It is caused by movement of small crystals (otoconia) from one part of the inner ear that detects linear acceleration (travelling in a lift or a car) into the semi-circular canals that detect rotation.

You have a set of three canals on each side which are paired for directional movement. When you turn your head fluid rushes around inside and gives information to your eyes brain about the speed and direction of movement. Because one of the paired canals now has debris inside it, the fluid in this canal moves at a different speed and the information provided is not the same from each side. This is what causes the symptoms of vertigo, dizziness and imbalance.

It’s most common for people suffering with BPPV who attend a vestibular physio consultation to complain of short, intense vertigo when they are rolling in bed, shopping or bending down. This can be very debilitating and affect your ability to complete simple daily tasks. Fortunately the treatment for BPPV is actually fairly straightforward for most people and usually highly effective. It involves a mechanical movement to relocate the otoconia debris out of the semicircular canals. A Vestibular Physiotherapist will likely also prescribe some specific exercises to improve the speed of your recovery and help to sharpen you balance.

If you think that you may be suffering with BPPV please contact us using the form below.

Motion sensitivity (sometimes called visual vertigo) describes symptoms of dizziness, vertigo and imbalance which are provoked by moving visual environments or patterns. It is not a diagnosis in itself, but describes symptoms which can be caused by a variety of factors including inner ear disorders, migraine, whiplash, concussion and brain injury.

 A Vestibular Physiotherapist helps to reduce these symptoms by prescribing exercises based on the movements that provoke the motion sensitivity. These ‘vestibular rehabilitation’ exercises help to reduce the intensity of the symptoms and assist the person in developing different strategies to maintain their balance and orientation.

Mal de Debarquement Syndrome (MdDS) is a sensation of rocking, swaying and imbalance which is commonly experienced after travel on water, though now also recognised to occur after other forms of travel too. These symptoms commonly don’t require any treatment and resolve of their own accord after 24 hours. In some cases however they can persist for much longer and treatment may be required.

There is no specific test to confirm MdDS and the history of the onset is very important. It is common for people to notice that there symptoms actually improve with movement but are noticably worse when they are still. A Vestibular Physio helps to improve these symptoms by prescribing exercises to help the person to re-adapt to the lack of motion.

 

 

 

Dizziness, imbalance and disequilibrium can also be caused by neurological conditions including head injury, strike, Parkinson’s disease and Multiple Sclerosis. Neurological dizziness is usually accompanied by other signs and symptoms which require further investigation by a doctor.

If you have already been diagnosed with a neurological disorder and suffer with a loss of balance, vertigo, dizziness or motion sensitivity a Vestibular Physio may be able to help .

Vestibular neuritis is commonly caused by an infection in the inner which affects the nerve and consequently the transmission of information between vestibular system within the ear and the brain. This results in difficulties with balance and orientation, but no change in hearing.

The person may experience vertigo, nausea, visual disturbances, imbalance and vomiting which starts suddenly and is constant in the early stages. Once this early stage has resolved, a vestibular rehabilitation programme can be useful to help the brain adjust and improve balance and dizziness. On occasion BPPV may develop following vestibular neuritis, which can be treated with positional manoeuvres.

 

Meniere’s Disease is a chronic, incurable inner ear disorder resulting from large amounts of fluid (endolymph) collecting in the inner ear. This results in characteristic ‘attacks’ of vertigo, ringing in the ear (tinnitus), imbalance and hearing loss. Between the attacks some people continue to experience symptoms whilst others do not.

Vestibular rehabilitation can be helpful between attacks to improve balance and postural stability or to help the person to develop confidence with their balance with a progressive exposure to different situations. 

Migraines are a common affliction, affecting millions of people in the UK. Migraine sufferers describe a variety of symptoms including vestibular symptoms such as vertigo, sickness, dizziness and motion sensitivity.

Vestibular migraines are usually treated by a combination of medical management and vestibular therapy. Exercises are carefully prescribed to target the particular problems experienced, whilst not aggravating a new migraine onset. A vestibular rehab programme may include exercises to improve gaze stability, postural control and balance.

Some Common Symptoms of Vestibular Disorders

The type and severity of symptoms associated with a vestibular disorder can vary significantly and be quite frightening. They can make performing even the most simple tasks incredibly difficult and often has a huge impact on day to day life

Vertigo & Dizziness
Spinning, whirling, floating and rocking which might be provoked by movement, the environment or when still.
Imbalance
Staggered walking, difficulty turning or balancing when still. Sometimes people look at the ground more often to compensate.
Visual Changes
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Nausea
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Light-headedness
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Spatial Disorientation
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Cognitive & Psychological Changes
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Don't Suffer in Silence

We see people who have suffered with dizziness and vertigo for extended periods of time. Vestibular disorders respond well to targeted Physiotherapy, there's no need to suffer.

How Does a Physio Assess and Treat Vestibular Disorders?

What to expect from your dizziness assessment

Possible treatments for your dizziness

Your Physiotherapist will take a thorough history so that they can understand the type, pattern, severity and nature of your symptoms. Some inner ear disorders have characteristic symptoms and the history of your problem is vital in establishing what the cause of your dizziness is.

Your vestibular system, eyes and brain work together and have close connections. Because of this your Physio will want to examine your eye movements, complete positional testing and assess your balance.

  • Canalith Repositioning Manouvers (e.g. Epley)
  • Habituation Exercises
  • Gaze Stabilisation Exercises
  • Balance Retraining
  • Functional Restoration