Vertigo Checkup

Vertigo Physiotherapy Treatment in Kingston

Experienced professional assessment and treatment of dizziness and vertigo

What is vertigo?

Vertigo is the sensation that either you or your surroundings are moving without any actual movement occurring. It is a common complaint and frequently due to a vestibular (inner ear) problem. As many as 35% of adults 40 years and older – over 6 million Canadians – will have a vestibular issue at some point in their lives. The most commonly diagnosed type of vertigo (~20% of all vertigos) is Benign Paroxysmal Positional Vertigo (BPP Vertigo). BPP Vertigo can affect all ages but is most common in people over the age of 60.  It can happen repeatedly, with a one-year recurrence rate of 20% and a 5-year recurrence rate of 50%.

A key feature of BPP Vertigo is a spinning sensation associated with changes in head position. Frequently BPP Vertigo strikes abruptly in the middle of the night or early morning when rolling over in bed or sitting up from lying down. This can be an extremely uncomfortable and frightening experience and, often triggers anxiety and fear that a serious illness is causing the vertigo.

inner-ear diagram
Women dizzy holding head

BPP Vertigo symptoms can include:

  • A mild sense of constant unsteadiness and “fogginess” punctuated by recurrent attacks of more acute spinning.
  • Sudden sensation that the world is spinning when bending over, looking up, or turning to look over a shoulder.
  • Other unpleasant symptoms such as nausea, vomiting, difficulty changing position, difficulty walking, hot flashes and anxiety.

Many episodes of BPP Vertigo occur without any specific cause. Risk factors that can increase the incidence of BPP Vertigo are:

  • gender (female>male),
  • advanced age,
  • osteoporosis,
  • vitamin D deficiency,
  • head trauma.

Sometimes BPP Vertigo can occur in conjunction to other vestibular disorders such as Meniere’s Disease or vestibular neuritis. BPP Vertigo symptoms may develop within a few days following some kind of head trauma. Even seemingly mild bumps to the head, falls, whiplash injuries and sports injuries can trigger BPP Vertigo. Additionally, BPP Vertigo can be triggered by keeping the head in the same position for a prolonged time, such as in the dentist’s chair, at the hairdresser or after doing some home renovation projects. However, you do not need any trauma to experience BPP Vertigo. You may develop BPP Vertigo after a cold, infection or flu, or sometimes there may not be any obvious trigger.

Walking Dizzy

On either side of our head, in our inner ear, we have tiny vestibular sensory organs (Membranous Labyrinths) that detect head motion, by sensing angular and linear movement. These little sensory organs send precise information to our brain about the position of our head in space. These two vestibular sensory organs are mirror images of one another and each has three fluid filled semicircular canals. The canals are oriented at 90 degrees to one another (like an x/y/z coordinate axis) and are able to sense movement in three dimensions. Within this organ there are clumps of calcium carbonate crystals (otoconia) that are normally embedded in gel just near the openings of the semicircular canals. Movement of these crystals triggers sensory nerve endings. The brain interprets this sensory information as linear acceleration and tilt of the head relative to gravity.

BPP Vertigo occurs when these crystals have become dislodged and moved into one or more of the semicircular canals. If enough of the crystals shift into a semicircular canal, they will accumulate in the lowest part of the canal. This interferes with the normal fluid movement in the canals that gives information about head motion, thus causing that inner ear to send false signals to the brain.

Our brain also receives information from our eyes, and from the position sense (proprioceptive) nerves in our joints about the position of our head relative to gravity, and about which direction we are moving. Normally all of these sources of information will match one another. Any mismatched information coming from the inner ear can be perceived by the brain as a spinning sensation in direct response to a specific movement, and as a general sense of imbalance throughout the day.

Happily, BPP Vertigo is a condition that is usually easily diagnosed and in most cases is readily treatable. Diagnosis is based on physical evaluation to rule out more serious neurologic and cervical spine (neck) causes for vertigo. It is critical to take a detailed health and symptom history and to look for nystagmus (involuntary jerking motion of the eyes) caused by the abnormal position signals from the semi-circular canals when head position is changed. Nystagmus will have different characteristics depending on which ear the displaced crystals are in, and which semicircular canal(s) they have moved into. There is no medical imaging such X-rays/MRI that will show rogue crystals in the semicircular canals.

If your vertigo symptoms are due to BPP Vertigo, physio treatment is often the best approach. A Physiotherapist with specialized training in assessing and treating BPP Vertigo can evaluate whether your particular symptoms are indicating BPP Vertigo. They will take a detailed history and perform a physical assessment to evaluate the central nervous system, neck and inner ear function. Through this assessment, the physiotherapist can determine whether your symptoms are caused by BPP Vertigo and which semi-circular canal is triggering the vertigo.

Depending on results of the assessment, the Physiotherapist may perform a very specific series of guided head movements to move the crystals back into place. There is no evidence to support the use of vestibular suppressing medications such as Betahistine in the treatment of BPP Vertigo, but if extreme nausea is present anti-nausea medications can be used.

Professional treatment of BPP Vertigo is usually the optimal choice. There are resources available on the internet that often lead people to self-diagnose and self-treat. Caution should be used with self-treatment or with being treated by someone who is not fully trained in vestibular rehabilitation and identifying the different variants of BPP Vertigo and treatment manoeuvres. Incorrect repositioning manoeuvres may not improve symptoms, and potentially more serious causes of the symptoms may be missed. Additionally, self-treatment can be challenging as the manoeuvres frequently provoke unpleasant symptoms. Consulting with a specially trained and experienced Physiotherapist at Best Health Physiotherapy will provide you with an accurate assessment of your condition, and confidence in the appropriate treatment approach, plus provide you with education and understanding of your specific situation.

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