Vertigo: How Can Physio Help?

What is vertigo?

Verti- what? A very strange term for a very strange symptom. It’s basically the sensation that you or your environment is spinning or moving. Imagine you’ve spun around in a chair 10 times then tried to stand up, and everything in vision is still moving – that’s vertigo.
It differs to dizziness, which encompasses sensations like light-headedness, feeling off balance or “woozy”. In the chair scenario, the spinning sensation is the vertigo, and the associated “wooziness” is the dizziness.
Vertigo can be caused by many different conditions, some of which can be either treated or managed with physio. Older populations are usually at higher risk of experiencing vertigo and dizziness.

What causes vertigo?

Most cases of vertigo are caused by a disruption to the vestibular system, a very small complex of canals that sit in the inner ear. These canals contain fluid, which move when our head moves, stimulating the attached nerve and letting our brains become conscious that our head is moving. This also signals our eyes to adjust so they can either follow the movement of our head or stay looking at an object while we move. Cool huh!
These canals connect to a sack of tiny calcium crystals (called otoconia), which move in relation to gravity. It’s our brains way of detecting whether we are lying down, bending over, or hanging upside on the monkey bars like when we were kids!

The most common condition that causes vertigo is benign paroxysmal positional vertigo (BPPV). In this condition, a crystal has come loose and gone swimming in one of the canals! So, when we move our heads, the crystal moves in the fluid and interrupts the signal to our brain. Our eyes struggle to keep up, resulting in a spinning sensation. Remember that chair spinning analogy? You feel dizzy because the particles in your ear are still moving in the fluid for a period after you stop spinning in the chair.
If you experience vertigo that is triggered by specific head movements and only lasts a few seconds (usually no more than a minute), you might have BPPV. Symptoms that often accompany BPPV include vertigo described as spinning, rocking, or swaying (any false illusion of movement), unsteadiness and nausea.

What else causes vertigo?

Other conditions that may cause vertigo and respond well to physio rehab include:
• Vestibular neuritis or labyrinthitis (inflammation of the vestibular system or nerve)
• Vestibular migraine
• Post-concussion
• Multiple sclerosis
If you have any of the following symptoms associated with your vertigo, it would be best to see your doctor prior any physio intervention:
o Severe loss of balance or coordination
o Acute hearing loss in one ear
o Fluctuating hearing loss, ringing in one ear, or feeling of fullness in the ear
o Change in blood pressure
o Episodes of vertigo unrelated to change of position
o Neurological signs (loss of muscle strength or sensation, acute bladder/bowel dysfunction)
o Difficulty with speaking or swallowing
o Double vision
o New and severe onset of headache associated with dizziness
o History of head trauma or stroke

How can a physio help?

Most physiotherapists have been trained to assess and treat vertigo. They will go through a series of tests to determine the cause of your symptoms and rule in or out certain conditions. If you are diagnosed with BPPV, the physio can perform manoeuvres to shift the loose crystals back to where they’re supposed to be. Some cases only need 1-2 sessions to resolve, and some may need home exercises to assist the process.

When to see a physio if you have vertigo

• If you experience the symptoms of BPPV listed above (sensation of spinning, rocking, or swaying, unsteadiness and nausea)
• If you’re having regular episodes of dizziness with specific head movements
• If you’ve had vertigo in the past and are experiencing ongoing symptoms (e.g., light-headedness, nausea, light or sound sensitivity)
• If you have vertigo associated with your migraines
• If your doctor has ruled out any other pathology as the cause of your vertigo