Did you know that physiotherapy can help to treat symptoms of vertigo?

December 6, 2021 | By More

By Edel Wiliams

Chartered Physiotherapist


“I’m so dizzy, my head is spinning, like a whirlpool, it never ends…” – recognise these lyrics? Well, hopefully after reading this blog, you will agree with me that it does not have to be never-ending!


Why do we get dizzy?

In order to answer this, we need to first talk about balance!

How do we balance? In order to stay upright and balanced, we need information from our body about where we are in space – this comes from 3 main senses and these all play an important role in our balance control. The brain is the boss of this and acts as a processing centre – it receives valuable information or signals from the inner ear, the eyes and from the deep postural muscles in our neck and also our feet. It then processes it all together to establish where we are in space and maintains our balance. For example, if we turn quickly, the fluid in the ear tubes senses this and sends information to the brain to stop us falling over! This is also the case with acceleration and deceleration. In fact, the nerve cells in our inner ear provide the exact same information for a head movement backwards as it would for an acceleration – this explains the need for added information from the eyes and neck to corroborate. Cats have very high functioning balance systems, which is why they ‘always land on their feet’! They have an amazing ability to quickly adapt to which way is up.


So where does dizziness come into this?

If there is a conflict in the signals from these three senses or similarly between the left and right ears, this leads to an asymmetry or imbalance and the brain gets confused with the mixed messages. We experience this as dizziness or a spinning sensation. This in turn can confuse the messages coming back from the brain to the eyes and muscles and can result in a feeling of unsteadiness and a higher risk of falling over. This is highlighted by that feeling you experience after getting off a merry go round at a children’s playground – repetitive spinning in one direction really confuses the brain and that results in dizziness and feeling totally off balance. Luckily our brain has the ability to adapt and recover relatively quickly once the event passes. Problems only arise when something causes a persistent internal mismatch of signals.


Similarly, have you ever sat on a train at a station, and noticed a strange feeling when you watch a fast train whizz by past you? This is another really good example of a mismatch of signals to our balance centre. The eyes see movement but the ear and neck do not feel the perceived motion. Therefore, we can experience a brief feeling of dizziness until our system recovers. This is a completely normal reaction and, again, quick thinking from the boss upstairs rebalances everything and the feeling passes!


How common is dizziness and what are the causes?

Dizziness is incredibly common, affecting up to 30% of us of working age at some stage in our life and is even more common over the age of 65. Dizziness can be caused by various things but the most common by far is vestibular vertigo, which affects our inner ear function. Other causes include neck pain and whiplash, migraine, neurological problems, blood pressure problems, medication side effects, poor diet and certain medical conditions that affect our senses needed for balance, for example Heart Disease and Diabetes.

What is Vertigo? Is it not the same as dizziness?

Vertigo is defined as “a perception of movement in the environment, or of the self within the environment” or simply put, it is a symptom of a problem within our balance system! People usually describe it like a spinning feeling and so it is often used interchangeably with “dizziness”. Either they feel like they themselves are spinning or else they feel like the world is spinning around them!


What does vestibular vertigo mean??

The vestibular system is in our inner ear and essentially acts as a motion sensor. In our inner ear, we have two different organs – a hearing organ (cochlea) and a balance organ (otolith), which are both innervated by the vestibular nerve. Because these two organs are actually separate, this explains why we can often experience dizziness without associated hearing loss! However, because they have the same nerve supply, there are cases where hearing can also be impaired for example with vestibular neuritis. Within the inner ear, there are tiny tubes that are filled with fluid attached to a small chamber full of tiny nerve cells, these work together to sense when we move. We have a balance organ on each side of our body and the brain depends on the right and left side being in balance with each other. Anything that affects this symmetry will cause an issue. As well as dizziness, because our vestibular system has strong links to the areas in our brain that cause vomiting and anxiety, some people also complain of these symptoms. The most common cause of vestibular dizziness is called BPPV.


What is BPPV?

Approximately 90% of people with dizzy symptoms suffer from this type of dizziness and it stands for Benign Paroxysmal Positional Vertigo. The clue is in the name – it is positional (dependant on head position) and paroxysmal (sudden, recurrent, short-lived episodes)! It is also benign, meaning it is not harmful!  Basically, it is a fancy term for vertigo type symptoms relating to a certain type of inner ear imbalance. This particular type of imbalance happens when tiny crystals from the inner ear chamber fall into the fluid-filled tubes and start moving around in response to gravity or head movement. This disrupts the ability of the tubes to sense movement correctly and usually affects one side only, therefore creating further imbalance in the system.

A simple way to visualise this is the snow globe effect! When we shake the globe, the ‘snow’ moves around in a flurry until it very slowly settles back down to the bottom. When the crystals are loose in the tubes, as with BPPV, they can move like this with head movement and create a dizzy feeling until they settle back down. This can help to explain the positional and paroxysmal parts of BPPV, as the crystals (or snow!) move and relocate in relation to the aggravating movement. These symptoms can be extremely debilitating for people as they get a severe spinning sensation when they move position.


What causes BPPV?

It can often be spontaneous, with no obvious cause but also it can happen following an ear infection, virus or head and neck trauma.


Physiotherapy can often help!

Great news though! The evidence in this area is really strong and very supportive of physiotherapy intervention, the earlier the better, being really effective in this group of people. Whatever the cause, once the initial trigger has passed, for example an ear infection or migraine, the residual symptoms are very treatable and our balance system has brilliant potential to adapt. Physiotherapy exercises can help to retrain the balance system and reduce sensitivity to head movements.


So to referring back to the song lyrics at the beginning .. it CAN end!


Take home messages

The main take home message should be that vertigo is common and can be very disabling – BUT there is hope! In fact, the majority of people never need any specific medication or surgery to control their symptoms. A systematic and thorough assessment by a specialist physiotherapist can help identify the cause of your dizziness and whether physiotherapy can help you. Where appropriate, this can provide significant relief. Specific physiotherapy intervention enables people to take back control and tap into their body’s ability to heal and regenerate – the most powerful human superpower in my opinion!


More on what to expect from physiotherapy in the next part of this blog series.


Booking an appointment

If you would like to book an appointment for physiotherapy assessment of dizziness or vertigo with Edel Williams, please call the clinic on 091 727777 or get in touch via the contact page.


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