Feeling Dizzy? Physio can help!
Over the past couple of months I have had quite a few clients come to me with feelings of dizziness or vertigo. Many of them were quite sceptical if physiotherapy would help their awful symptoms. In particular, there was a lady who came to see me and she was suffering vertigo for over 25 years and no one had ever suggested trying physio. I was shocked and felt horrible that she had been having these spells of dizziness for years and never knew there were techniques that could help her. There are several causes of vertigo or dizziness, but the most common and easily treated type is called Benign Paroxysmal Positional Vertigo (BPPV), which we will discuss below. Therefore, in a nutshell, physiotherapy can easily help manage your vertigo or dizziness.
In a nutshell, physiotherapy can easily help manage your vertigo or dizziness. #performbetter @pogophysio Click To TweetWhat is BPPV?
Benign paroxysmal positional vertigo is one of the most common causes of vertigo. It is a distinctive feeling of vertigo or dizziness with a sudden sensation that you or the room is spinning. This is what most people describe as the dizziness feeling associated with vertigo. The episodes of dizziness can vary from mild to very intense.
BPPV is a condition caused by unwanted and unnecessary debris floating around in one of the posterior semi-circular canals in your inner ear. It is essentially tiny calcium “crystals” called otoconia in our ears that have been dislodged from their normal location and affecting our vestibular system. Our vestibular system is the apparatus of the inner ear involved in balance. It is made up of a sequence of canals and fluid filled sacs that help us to detect movement and help us balance. Normally, when we move in different positions the crystals are embedded in a gelatin like substance and stay put while we change directions. If the otoconia become detached, they are free to flow in the fluid filled spaces of the inner ear, including the semicircular canals, which sense the rotation of the head. Due to the weight of the crystals they often migrate into the lower part of the inner ear (the posterior semicircular canal). Since the crystals are in the posterior semicircular canal, they can still move when the head changes positions and it is the movement of the crystals that cause the flow of fluid even if you are not moving your head. Therefore, this can cause the misleading feeling that the head and body are spinning or your surrounds are revolving.
Approximately 50-70% of BPPV cases are idiopathic. Secondary causes may include mild to moderate or severe head trauma, head resting in the same position for long periods of time (eg. in a dentist chair, hair salons or strict bed rest), bike riding on rough trails, viral or vascular Labryrinthitus (inner ear inflammation), Ménières disease, Vestibular Migranes and inner ear surgery.
Although the true cause of BPPV remains unknown, is often triggered due to changes in the position of your head, for example looking up or down, lying down, turning over or getting in or out of bed. It can also be caused by certain medications or post virus/sickness.
Signs and Symptoms of BPPV
People who suffer from BPPV may experience signs and symptoms including:
- Dizziness (woozy feeling)
- Vertigo- a sense that you or your surroundings are spinning or moving
- A loss of balance or unsteadiness
- Nausea
- Vomiting
- Light-headedness
- Nystagmus (abnormal eye movements)
These symptoms can come and go, usually lasting for less than one minute. Symptoms may sometimes completely disappear and then reoccur again.
Vertigo can be quite debilitating and a very annoying condition, but it is rarely serious unless it is increasing the risk of falls or causing other bodily dysfunctions.
Vertigo can be quite debilitating and a very annoying condition. #performbetter @pogophysio Click To TweetAlthough it is uncommon for dizziness to indicate serious illnesses, please see your doctor or call the ambulance if you experience dizziness or vertigo along with any of the following symptoms as it may indicate a more serious condition:
- Double vision or loss of vision
- Dysphasia (difficulty swallowing)
- Dysarthria (slurred or slow speech)
- Loss of consciousness
- A new, different or severe headache
- Leg or arm weakness
- Falling or difficulty walking
- Numbness or tingling
How can Physiotherapy help?
Physiotherapists will perform a test called the Dix-Hallpike Manoeuvre. This test usually elicits symptoms such as dizziness and abnormal eye movements called nystagmus. This will help confirm BPPV and help determine which ear is being affected. Once confirmed, your physio will perform treatment techniques such as the Epley Manoeuvre to help drain the debris out of the inner ear/ reposition the crystals. The technique can be repeated until the client’s symptoms ease and fully cease.
BPPV is definitely a very distressing condition due to the associated symptoms. So the take home message should be that BPPV is a condition that can easily be diagnosed and treated with a few simple diagnostic tests and treatment manoeuvres. It is also important to note that BPPV usually resolves by itself within 6 months time, which should be reassuring for anyone suffering with this condition.
If it sounds like you may have BBPV, please speak to your local GP or seek the help of a physiotherapist to get started on relieving your symptoms as it can be easily treated.
If you have any questions please feel free to leave a comment or email me.
Natasha Chan (APAM)
Physiotherapist
Musculoskeletal Injuries, APAM
References
Herdman, S. J., Tusa, R. J., & Herdman, S. J. (2000). Benign paroxysmal positional vertigo. ed Herdman SJ. Vestibular rehabilitation second edition, 451-475.
Hopkins, J. Neurology and Neurosurgery. Benign paroxysmal positional vertigo. Retrieved February 27, 2017, from https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/vestibular/conditions/benign_paroxysmal_positional_vertigo.html
Parnes, L. S., Agrawal, S. K., & Atlas, J. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Canadian Medical Association Journal, 169(7), 681-693.
Rahko, T. (2002). The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV‐SC). Clinical Otolaryngology & Allied Sciences, 27(5), 392-395.
Staff, M. C. (2015). Benign paroxysmal positional vertigo (BPPV) definition. Mayoclinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/vertigo/basics/definition/con-20028216
