Up to 10% of the population will experience vestibular vertigo at some point in their lives, yet many sufferers don’t realize that effective, non-pharmaceutical treatments exist. Vestibular physiotherapy has emerged as a leading solution for those battling vertigo, with success rates exceeding 80% for certain types of balance disorders. Here’s what you need to know about how these specialized techniques work and how they might help you find your footing again.
What Is Vertigo, and Why Does It Happen?
Vertigo is not a disease itself, but rather a symptom that is most often described as a false sensation of movement within the body, commonly characterized as “spinning.” Unlike general dizziness, vertigo specifically involves the sensation that you or your surroundings are rotating, tilting, or swaying when no actual movement is occurring.
Many patients report intense spinning or whirling sensations, feeling pulled toward one direction, nausea and vomiting, abnormal eye movements (nystagmus), sweating, hearing changes, difficulty maintaining balance, and feeling dizzy when moving their head.
These symptoms can range from mild to severe, lasting from minutes to days, and can be triggered by certain head positions or movements.
The Role of the Inner Ear and Vestibular System
The vestibular system, located in the inner ear, plays a critical role in maintaining balance and spatial orientation. This intricate system comprises three semicircular canals, two otolith organs, and a vestibular nerve, which transmit signals about gravity and the head’s position from the inner ear to the brain. The result is the ability to instinctively maintain our balance, stabilize our gaze, and navigate through our environment.
When the vestibular system doesn’t function properly or its neural connections are disrupted, the brain receives conflicting signals about your body’s position in space, resulting in vertigo.
Common Causes of Vertigo
Several conditions can trigger vertigo, with benign paroxysmal positional vertigo (BPPV) being the most common. BPPV occurs when tiny calcium crystals (otoconia) in the inner ear become dislodged and migrate into the semicircular canals, causing the brain to receive false signals about head movement.
Other common causes include vestibular neuritis (inflammation of the vestibular nerve), labyrinthitis (infection or inflammation of the inner ear labyrinth), Ménière’s disease (an inner ear disorder causing vertigo, hearing loss, and tinnitus), and central nervous system issues such as stroke or brain tumors. Certain medications can also lead to vertigo as a side effect.
How a Physiotherapist Diagnoses Vertigo
Accurate diagnosis is essential for effective treatment of vertigo. Vestibular physiotherapists use specialized assessment techniques to determine the exact cause of your symptoms, allowing them to recommend the most effective course of action.
Comprehensive Assessment
During an initial assessment at Leaside Sports Medicine, one of our vestibular physiotherapists will take a detailed medical history, including the onset of symptoms, triggers, duration, and intensity. They will assess your balance, coordination, and gait, evaluate eye movements and visual stability, test your positional awareness, perform specific maneuvers to reproduce symptoms where appropriate, and evaluate neck mobility and function.
This comprehensive assessment helps us differentiate between various types of vertigo and determine whether the issue originates from the vestibular system or another source.
Inner Ear Disorders vs Central Nervous System Issues
A crucial aspect of the diagnostic process is determining whether vertigo originates from an inner ear disorder (peripheral vertigo) or a central nervous system issue (central vertigo). These distinctions are crucial as they require different treatment approaches.
Signs that suggest peripheral vertigo can include intense dizziness or spinning sensations triggered by head movements, strong accompanying nausea or vomiting, hearing issues, horizontal nystagmus (eye movement), and a lack of neurological symptoms.
On the other hand, signs suggesting central vertigo include more persistent symptoms or long-lasting spells, the presence of neurological symptoms such as double vision or difficulty swallowing, vertical or direction-changing nystagmus, and an inability to stand or walk even with open eyes.
If central nervous system issues are suspected, your physiotherapist will refer you to appropriate medical specialists for further evaluation.
Vestibular Physiotherapy – What Is It?
Vestibular physiotherapy, also known as vestibular rehabilitation therapy, is a specialized form of physical therapy designed to address issues with the vestibular system and improve balance and dizziness.
It operates on the principle of neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections. Through repeated, specific exercises, the brain can compensate for vestibular dysfunction by adapting to inconsistent or incorrect information from the damaged vestibular system.
Research has shown that vestibular rehabilitation therapy can significantly reduce symptoms and improve the quality of life for patients with various forms of vertigo.
What Vestibular Physiotherapists Do?
Vestibular physiotherapists are specially trained to assess the vestibular system through specialized testing, identify the specific type of vertigo or balance disorder a patient has, and develop individualized treatment plans tailored to each patient.
This may involve performing repositioning maneuvers, designing and monitoring exercise programs that promote vestibular adaptation, educating patients on managing symptoms and preventing future episodes, and coordinating with other healthcare providers as necessary.
These specialists combine their extensive knowledge of the vestibular system with their skills in physical therapy to provide comprehensive treatment and care.
Treating Vertigo with Physiotherapy
Our approach to treating vertigo depends on the underlying cause of the condition. Here’s how vestibular physiotherapy addresses common conditions related to vertigo.
Techniques for BPPV and Vestibular Neuritis
For BPPV, treatment typically focuses on relocating the displaced calcium crystals in the inner ear through specific repositioning maneuvers. For vestibular neuritis, the emphasis is on compensatory exercises that help the brain adapt to the imbalanced input from the affected side.
Specific techniques include progressive habituation exercises that gradually expose patients to triggering movements, substitution exercises that train alternative sensory systems to compensate for deficits, and balance retraining to improve stability during daily activities.
Repositioning Manoeuvres
The Epley maneuver is one of the most effective treatments for BPPV. This series of head and body movements helps to relocate the displaced calcium crystals out of the semicircular canals and back to their proper location, where they can no longer cause symptoms.
Other repositioning maneuvers include the Semont maneuver, the Half-somersault maneuver, and the Lempert roll. These maneuvers have success rates of 80-90% for resolving BPPV symptoms, often within just one or two treatment sessions.
Gaze Stability, Balance Training, and Exercises
Vestibular rehab also often includes gaze stability exercises, such as having a patient focus on a stationary target while moving their head, tracking moving objects while keeping their head still, and coordinating head and eye movements in various directions.
Balance training usually involves standing on different surfaces, maintaining balance with eyes both open and closed, performing tasks while maintaining balance, and practicing dynamic movements with controlled stability.
Specific exercises that might be taught to patients include habituation exercises for motion sensitivity, coordination exercises for vestibular-visual integration, and activities that gradually expose patients to symptom-provoking movements.
Benefits of Physiotherapy for Vertigo
Vestibular physiotherapy offers numerous benefits for patients with vertigo, many of which extend beyond symptom relief:
- Improved Balance and Postural Stability – Through targeted exercises, vestibular physiotherapy helps strengthen the core muscles essential for balance, improves postural control, enhances proprioception (awareness of body position), and reduces the risk of falls.
- Reduction in Dizziness, Nausea, and Spinning Sensations – One of the most significant benefits is the reduction in the frequency and intensity of vertigo episodes, as well as reduced dizziness during position changes, nausea, and decreased sensitivity to movement.
- Enhancing Daily Living and Quality of Life – Beyond the physical benefits, vestibular physiotherapy can help restore confidence in a patient’s movement and daily activities, reduce anxiety related to vertigo episodes, improve social participation and work performance, and enhance their overall quality of life.
By addressing the root cause of vertigo rather than just masking symptoms, physiotherapy offers long-term solutions that empower patients to return to their normal activities.
Why Early Diagnosis Matters
Seeking treatment early for vertigo can prevent symptoms from becoming chronic, reduce the risk of falls and related injuries, and improve the effectiveness of treatment.
Many people unnecessarily suffer from vertigo for months or years before discovering the benefits of vestibular physiotherapy, and can even develop secondary problems like anxiety or deconditioning along the way, so it’s important to address your symptoms as soon as possible if they are interfering with your daily life.
Book Your Comprehensive Assessment with a Vestibular Physiotherapist Today
Take the first step toward regaining your balance and confidence. Contact our Toronto clinic to book a comprehensive assessment with physiotherapists Matthew and Valerie, specializing in vestibular care.
Our team is dedicated to providing evidence-based treatment that addresses the root cause of your vertigo and helps you regain control of your life. Book your vestibular therapy consultation at Leaside Sports Medicine today!
