dizziness

Dizziness is a sensation of that is described in different ways by the person experiencing. The sensation ranges from being lightheaded, unsteady on feet, rocking like on a boat, or a whirling of self or the world.

The sensation may be contributed to by a range of causes including an ear problem, a neck problem, sensory problems in other parts of the body, damage to the brain or spinal cord, use of certain medications, fear and anxiety or a mixture of these events.

The description and pattern of the dizziness and accompanying symptoms will vary with every person, and this pattern is important in helping to work out the cause of dizziness and way to manage this.

Dizziness is associated with a range of medical conditions and it is important to talk with your GP as soon as possible. Dizziness associated with muscle weakness, loss of sensation, changes in speech patterns or changes in consciousness requires immediate medical attention.

The GP can refer you to a range of specialists for ongoing investigations, including a physiotherapist with training in management of dizziness. However you do not need a doctors referral to consult with a physiotherapist.

physiotherapy for dizziness

Differential diagnosis is very important to have the correct management. The earlier this is the determined, the more rapid can be the fixing of the problem. Full evaluation with physiotherapist considers a range of factors including the past medical history, examination of the neurological and musculoskeletal systems, activity performance for eye and head movements, walking and steadiness.

Further testing to make a definitive diagnosis maybe required, using expertise available with ear nose and throat surgeon (neuro-otologist) and/or audiologist.

Management will depend on the diagnosis and usually incorporates a range of strategies to improve the eye-head co-ordination, reduce the impact of concurrent orthopaedic conditions (eg muscle weakness and pain), and improve overall movements. Usually dizziness responds quickly to the correct management.

One of the most common conditions causing dizziness is benign paroxysmal positioning vertigo (BPPV). This will be managed with canal repositioning manoeuvre, as well as rather rehabilitation strategies. The manoeuvre should only need to be done once or twice to be effective on that occurrence. Note that Brandt-Daroff manoeuvre is not a canal repositioning manoeuvre. For a few people it may relieve the symptoms, but for many it stirs up the symptoms without relief and contributes to ongoing anxiety about the problems.

benign paroxysmal positioning vertigo (bppv) 

Benign paroxysmal positional vertigo (BPPV) is a condition of dizziness that is usually very sudden onset, and lasting up to about 30 seconds before settling back to nothing or lightheadedness. Usual triggers relate to head movement and may include rolling over in bed, getting out of bed, turning head to the side and lifting the head to look up. The symptoms may come intermittently, so they are not there every time the head is moved. The dizziness is a classical vertigo where suddenly feel like self is moving or the room. Very often this is associated with nausea and may lead to vomiting. There is a flicking of the eyes associated with head movement called nystagmus.

cause

The ear contains a special balance mechanism called the peripheral vestibular complex (system). Within this system are 2 types of sensory mechanisms. One is a tubular/fluid system (canals) that is triggered by movement/accelerations of the head or body in different directions, the second is a globular/fluid system (otoliths) responding to tilts and linear movements of the body and head. The otoliths have ‘rocks’, small calcium carbonate particles, that move with gravity changes, and this helps measure the head tilts. The two systems from each side of the head together act as miniature GPS units to tell the brain exactly how far, how fast and in what direction the head has moved.

BPPV is caused when some ‘rocks’ move into a canal and cause an error message about movement of the head to be sent to the central sensory integration area in the brain. This causes confusion about the real position of the head in space, and gives the illusion of movement and the response of dizziness. The ‘rocks’ are thought to get displaced by a range of causes including head or ear injury, ear infection, ear surgery, labyrinthitis, meniere’s disease, but often there is no apparent cause attributed to as degeneration.

Diagnosis is usually based on past medical history, and current presentation. Diagnosis is only confirmed completely with specific head positioning tests.

management

BPPV can resolve spontaneously however some people will require specific repositioning manoeuvres to move the ‘rocks’ back through the canals to the otoliths. This can be performed by a number of different health professionals who have been trained to do this.

self management

Dizziness caused by BPPV can be reduced by changing the way you move, however if these changes need to be maintained for a long time you will still remain fearful of movement and have reduced ability to cope and balance in more challenging situations.

Self help strategies to try:

• When watching TV sit upright
• Lift books and craft activities higher rather than bending over to them
• In bed, lie on the less affected side, sleep with your head higher than usual – eg. use two pillows instead of one.
• When getting out of bed move slowly. Rest on the edge of bed until dizziness stops.
• Move your head slowly, and in particular avoid up/down activities, eg hanging clothes, unpacking the dishwasher.

where to get help

• Your doctor
• Neurospace physiotherapy

You might also be interested in:

• Dizziness and vertigo
• Ears explained
• Meniere's disease