Vertigo can be a debilitating and frustrating experience for many around the world. Put simply, vertigo is a type of dizziness where the person experiences a sensation of spinning or movement of themselves or the environment around them. Vertigo can be caused by a range of conditions and the severity can range from hardly noticeable for a few seconds to constant, severe symptoms for hours.
The most common cause of vertigo stems from problems within the vestibular system of the inner ear, however causes can less commonly be a result of certain parts of the brain. The vestibular system is comprised of bone and cartilage within the inner ear which assists with balance, motion and spatial orientation. This complex system is comprised of semi-circular canals that are filled with fluid. As the body and head moves, so does the position of this fluid which is picked up by a sensor, signalled to the brain to assist in your sense of balance. Various conditions can disrupt this system, resulting in symptoms such as vertigo, ringing in the ears, nausea or headaches.
The most common cause is a condition called benign paroxysmal positional vertigo (BPPV), where small crystals form and sit in the canals, interrupting signalling from the vestibular complex to the brain. Other potential causes include, Meniere’s disease, vestibular neuritis, labyrinthisits, all of which impact the inner ear. If you have any symptoms of vertigo, dizziness, ringing in the ears, nausea or headaches please contact your GP who will be able to assist with diagnosis and further interventions. If it is suspected to be BPPV, your GP may refer you to a physiotherapist for management.
Physiotherapy and BPPV
As mentioned, BPPV is thought to be caused by displacement of small crystals into the semi-circular canals. This can disrupt signalling when the position of the head changes. Patients will commonly report that moving the head suddenly, looking up or down and rolling over in bed to be the main aggravating movements, that bring on symptoms. Symptoms may include vertigo (spinning sensation), visual disturbance or loss of balance and generally will last for less than a minute.
BPPV can be diagnosed through a thorough subjective and physical examination that includes diagnostic manoeuvres. The Dix-Hallpike is the most commonly used manoeuvre to diagnose BPPV. This test involves turning the patients head 45 degrees before quickly moving from a seated to supine (lying on back) position, with the head ending up extended. This manoeuvre is positive if vertigo and nystagmus (rapid eye movements) are provoked. If positive, your practitioner may suggest a further maneuverer, that attempts to move the position of the small crystals in the inner ear.
The Epley manoeuvre is an effective repositioning procedure for patients with BPPV, which can be performed by health professionals. This procedure involves a series of movements aiming at repositioning the small crystals in the inner ear, by doing this it may provoke symptoms temporarily. It may take multiple sessions to resolve symptoms or may be effective for patients with long-standing chronic vertigo to relieve symptoms. This technique may also be taught to complete at home if your practitioner believes it is safe and indicated.
Vestibular rehabilitation exercises
Vestibular rehabilitation can also be addressed through an exercise program which aims to utilise visual and proprioceptive inputs to manage difficulties that may arise in daily life. This program aims to address balance deficits, symptom management and education of how adjustments can be made for tasks such as driving, exercise, self-care and environment organisation.
Vertigo is a complex symptom that can have significant impact on an individuals quality of life. If you are experiencing symptoms or have any questions follow up with your GP or one of our physiotherapists who can help get the rehabilitation process started for you.