Dizziness is a common issue in the general population. It is estimated that at least five percent of the Australian population (over one million people) will experience dizziness issues at some point in their lifetime. There are a number of causes for dizziness, and treatment options include medical management (eg, medications), physiotherapy and psychology intervention. Your GP can help determine the appropriate clinician for your specific needs.
--What is the difference between dizziness and vertigo?
Dizziness and vertigo are similar symptoms but with some specific differences. Dizziness is a general term used to describe sensations such as light headedness, giddiness, disorientation and unsteadiness. Vertigo is easier to describe and involves a sensation that the room or the environment is spinning. Vertigo is highly characteristic of an inner ear (vestibular) complaint whereas there are a number different causes for sensations of dizziness. These include inner ear (vestibular) disorders, reduced blood flow to the brain (vascular), neck (cervicogenic) issues, psychological problems and mild traumatic brain injury (concussion).
Research has determined that inner ear (vestibular) disorders are the cause for dizziness and vertigo in at least 50 per cent of cases but remain poorly diagnosed. For this reason, dizziness and vertigo are often associated with significant feelings of frustration, anxiety and depression and can markedly affect a range of everyday activities. If your symptoms of dizziness and vertigo are triggered or made worse by moving quickly, then it is highly likely that they are caused by a problem in the inner ear (vestibular) system and require further investigation.
--How do I know if what I’m experiencing is dizziness or vertigo?
Many people find it quite difficult to accurately describe their sensation of dizziness. Vertigo, however, is easier to describe and involves a sensation that the room or the environment is spinning. Sometimes symptoms of vertigo come on out of the blue and sometimes they are triggered by something that you do, such as lying down or rolling over in bed.
Although there are a number different causes for dizziness, a medical specialist such as a neurologist, is commonly used to help establish the diagnosis. They are able to organise the tests required to determine the cause. These include a hearing test, a brain (MRI) scan, blood tests and specific balance function tests. Ways of treating the dizziness are dependent on the results of these tests.
--Should I be worried?
In most instances, dizziness and vertigo are caused by conditions that are not serious. The symptoms themselves, however, can be very disabling and can affect all aspects of everyday life. Most people with dizziness are unable to function normally and avoid certain activities, such as driving, attending exercise classes, walking outside of the home and using public transport. Work can also be affected with many people feeling dizzy when using the computer or when exposed to bright lighting and increased noise. Financial pressures associated with reduced work hours can put stress on relationships with family and friends and many people report feelings of frustration, loss of confidence, anxiety and depression.
--How can physiotherapy help with dizziness and vertigo?
Vestibular physiotherapy can be a very good option for treating symptoms of dizziness and vertigo, especially if these symptoms are triggered or aggravated by movement. In many cases dizziness that is worse with movement is caused by a disorder involving the inner ear (vestibular) system. Research has shown that vestibular physiotherapy is highly effective in treating vestibular disorders, such as benign paroxysmal positional vertigo (BPPV), viral infection of the inner ear (vestibular neuritis) and vestibular migraine (a form of migraine that causes vertigo and dizziness with or without symptoms of headache).
Your physiotherapist with specific skills in vestibular rehabilitation would conduct a comprehensive assessment of your dizziness and vertigo, and, in many cases, would be able to establish the cause for your symptoms. If unable to establish a cause for your symptoms, your physiotherapist would refer you to a medical specialist who would be able to order more extensive testing.
Vestibular physiotherapy involves:
- Habituation exercises: These exercises involve specific movements that are designed to gently stimulate the symptoms of dizziness in order to desensitize the vestibular system to those movements. These are designed to reduce symptoms of dizziness.
- Eye-head coordination exercises: These exercises are designed to improve focus and reduce symptoms of dizziness.
- Balance and gait exercises: These exercises involve challenging the vestibular balance system in order to strengthen it. They are designed to improve balance and confidence when walking.
- Re-positioning techniques: These techniques are used for a specific inner ear (vestibular) condition known as benign paroxysmal positional vertigo (BPPV). This condition results in significant symptoms of vertigo when changing position, such as when lying down or rolling over in bed. Techniques such as the Epley manoeuvre can successfully treat BPPV but should be performed by your physiotherapist with specific skills in vestibular rehabilitation.
--How effective is physiotherapy for dizziness and vertigo?
Many studies have been performed in the past 25 years which provide evidence regarding the effectiveness of vestibular physiotherapy in successfully treating people with dizziness and vertigo. These studies have demonstrated reductions in dizziness and vertigo, improved function, increased balance and reduced risk of falling following vestibular physiotherapy. In particular, research has found greater improvements if the exercises are customised to the specific needs of each person,
Vestibular physiotherapy can be delivered as a home exercise program which is performed three times every day, or with supervised classes. Both approaches have been found to result in significant changes in dizziness and balance measures. It is unknown how long a vestibular physiotherapy program will take, but changes should be expected within 4–6 weeks.
There are a number of factors that affect how long a vestibular physiotherapy program will take and these include: how long you have been dizzy, how regularly you do the vestibular exercises, how significant the symptoms of nausea are, how many other medical problems you have and the presence of any emotional or psychological issues.
BPPV is a specific inner ear (vestibular) condition that occurs when small calcium carbonate particles break loose within the inner ear. This can occur without reason or associated with an isolated incident. The particles can move into the wrong part of the inner ear and cause significant symptoms of positional vertigo when lying flat or rolling over in bed. Techniques such as the Epley manoeuvre can successfully treat BPPV and can be performed by physiotherapists with specific skills in this area. These techniques are highly successful in treating BPPV.
--What can I do at home?
Vestibular physiotherapy consists of a customised set of exercises which need to be performed three times every day. Because the exercises are tailored to each individual, it is important that you see a qualified physiotherapist with specific skills in vestibular rehabilitation before you start your home exercise program.
However, we encourage people with vestibular complaints to try and keep as active as possible. This might be as simple as a gentle walk around the block with a friend or a visit to the gym as tolerated. It is the recovery that is important. If an activity makes you dizzy, then the dizziness should settle within 30 minutes of finishing that activity. If the dizziness takes more than 30 minutes to settle, then the activity was too challenging and should be modified to shorten the recovery time.
There are a number of home treatments for BPPV that can be found on the internet: we do not recommend that people try these treatments at home without adequate supervision. Your physiotherapist with expertise in treating BPPV can advise you as to the correct treatment technique for your particular condition.
--How long until I improve?
Vestibular physiotherapy for the treatment of dizziness and vertigo can be highly successful but time frames can be difficult to determine. Most people need to be doing the vestibular exercises in a safe environment for 3–4 weeks before they feel any significant improvement. Reductions in dizziness and improvements in balance generally occur within 4–6 weeks.
Treatments for conditions such as BPPV are also highly effective, and generally only 1–3 treatments are required if the techniques are performed by physiotherapists with specific skills in vestibular physiotherapy.
