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Physiotherapy for dizziness – I didn’t know physio could help

Dizziness is an unpleasant experience when there is a mismatch in our sense of balance. Around 15-20% of adults experience a from of dizziness each year. Dizziness can include sensations of spinning, light headedness, feeling weak or unsteadiness. The great news that there is usually a reason for dizziness (although a definitive diagnosis is sometimes not possible) and is rarely a sign of something concerning. Physiotherapy for dizziness provides diagnosis, effective management and specific treatment to relieve the symptoms.

Your balance is a highly complex communication and coordination system between your eyes and inner ears. Your brain then has to make sense of all of that information. A mismatch in the information the eyes and ears produce or indeed a problem with how the brain processes that information can cause dizziness. Vestibular (inner ear) issues account for a quarter of all dizziness making assessment of the ear an essential component. As physiotherapists we are also aware of importance of examining the upper neck (cervical spine) due to its proximity to the ear. attachment of the deep neck muscles and how the nerves of the upper neck can influence the nerves in the face and head.


Benign Paroxysmal Positional Vertigo (BPPV)

Vertigo is often described as room spinning dizziness. More accurately vertigo a perception that you are moving despite being still. Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo.

BPPV occurs when calcium-carbonate crystals (technically called canalits) spill into the inner ear canals. The inner ear canals are filled with fluid. This fluid flows as you move your head and stops when you are still. In the case of BPPV this fluid in the ear canals continues to behave normally (i.e. the fluid moves when you move your head and stops when you stop). However when you stop moving your head, the crystals continue to travel along the ear canal. There is then a mismatch in the sensory information the brain is receiving. Your eyes are saying that you have stopped moving but the ear thinks differently. This results in a feeling of the room spinning. Often the eyes flick around (nystagmus) due to the false sensation of movement.

With BPPV (thankfully) there is some consistency to its presentation. In 93% of cases the posterior canal is effected and it is often (85%) on one side only. This is what produces that classic room spinning sensation and often patients will experience this getting out of bed in the morning, which is consistently on one side. You can have this problems in both ears and the two other canals (horizontal and anterior) can be effected but this is rare.

Canalith (crystals) repositioning procedures, for example Epleys manoeuvre, can be extremely effective and treating BPPV.


Headaches and dizziness

Headaches can be anotherĀ frequent cause of dizziness. Specifically labelled ‘vestibular migraine’, this is a variant of the migraine classification of headaches (of which there is 28!) so again accurate diagnosis is important. Vestibular migraine can produce feelings of unsteadiness, balance problems and vertigo. With vestibular migraine the vertigo type symptoms are often in combination with headaches and episodes can be spontaneous as opposed to when moving the head (as per BPPV).

In our headaches blog we discuss headaches in more detail and more importantly how physiotherapy can help.


Neck pain and dizziness

Whilst not as common, cervicogenic dizziness can be an issue from some people. Cervicogenic dizziness is not as prevalent as BPPV or vestibular migraine. This condition, which is referred from your neck, can produce a feeling of disorientation. There are usually some subtle signs that your dizziness may be arising from your neck, such as, associated stiffness in your neck or feeling dizzy following moving your neck.

Physiotherapy for dizziness referred from the neck can be very effective. Mobilisation/manipulation of the joints of the neck, massage of the surrounding soft tissues and conditioning exercises help to restore the normal movement and equilibrium (proprioception) of your neck and reduce the referred symptoms of dizziness.


Physiotherapy for dizziness

We detail some of the common treatments we use for dizziness in our second blog in this series. The most important factor in treatment for dizziness is comprehensive assessment and accurate diagnosis. From this point we can commence the best treatments for your condition, for example:

– management of stiffness and tension in the upper neck

– scientifically proven treatments such as the Epley’s manoeuvre

– evidenced based exercises and rehabilitation protocols


Clinical Director Johnny Cassidy is a keen manual/manipulative therapist. He has a specialist interest in the treatment of headaches, dizziness and disorders of the neck and spine.