Vestibular

Vertigo Treatment/Vestibular Rehabilitation

There are many reasons why you can get dizzy or vertigo. Some dizziness can be caused by low blood sugar, stroke or blood pressure fluctuation, while some dizziness can be caused by inner ear dysfunction or neck issues.

What is the function of the inner ear?

The inner ear has two main functions: hearing and helping to maintain balance. There are sensory organs in the inner ear that can sense changes in head position, acceleration and deceleration. If there is a dysfunction in the inner ear, the sensory organs can send wrong signals to the brain. The conflicting information from the inner ear, eyes and joints can cause imbalance or lightheadedness.

What conditions can a physiotherapist help with dizziness or vertigo?

Some specific conditions can be improved or treated by a vestibular-trained physiotherapist. These conditions include:

• BPPV (Benign Paroxysmal Positional Vertigo)
• Cervicogenic dizziness
• Vestibular hypofunction (can be caused by aging or toxicity from medication or alcohol)
• Post-concussion or whiplash dizziness
• Post-operative rehabilitation of the vestibular system (e.g. removal of vestibular schwannoma)
• Labyrinthitis/Vestibular Neuritis (inflammation of the inner ear)
• Perilymphatic Fistula (tear of a hole that separates the middle and inner ear, commonly caused by head trauma)
• Meniere’s Disease (abnormally large amounts of a fluid called endolymph collecting in the inner ear)
• Vestibular Migraine

The most common cause of vertigo is BPPV (Benign Paroxysmal Positional Vertigo), especially in people above 60 years old. BPPV is a mechanical disorder in the inner ear. Patients usually feel like they are spinning or dizzy for a few seconds to half a minute when changing head position, such as getting out of bed, looking up and turning. Physiotherapy treatments with positioning therapy (e.g. Epley’s manoeuvre) can effectively treat BPPV.

How can a physiotherapist help with dizziness or vertigo?

A thorough assessment is necessary to identify the cause of dizziness or lightheadedness. Physiotherapists can provide a tailored treatment and exercise plan to help with patients’ condition, reduce their symptoms and improve functional levels by prescribing vestibular training exercises, joint position training, balance training and manual therapy to the neck.