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The Irish Society of Chartered Physiotherapists

Vertigo & Vestibular Rehabilitation


Vertigo is a sense that you or your surroundings are spinning or moving. The most common cause is Benign Paroxysmal Positional Vertigo (BPPV), which is a debilitating condition. It is an inner ear disorder in which changes in the position of the head, such as lying down, rolling in bed, bending forwards or tipping the head backwards can lead to the sensation of vertigo. This sensation can range from mild to severe, lasting for up to a few minutes at a time. As well as the spinning vertigo
sensation, other symptoms include:
● Dizziness
● Loss of balance or unsteadiness
● Nausea
● Vomiting

inner ear anatomy graphic only

What’s happening?
In the inner ear there are 3 semi – circular canals. Which are roughly situated at 90 degrees to one and other. These canals are lined with hair cells and fluid called endolymph which flows through the canals. As the head moves and fluid stimulates the hair cells. This allows us to detect head movement e.g. nodding of the head, turning etc.

Slightly further down from the semi – circular canals are the utricle and saccule. In these structures there a calcium carbonate structures called an otolith/otoconia, commonly referred to as “crystals” of the inner ear. Together these make up the otolith organ. The otolith organs sense gravity and linear acceleration.

The problem occurs when the crystals/otoconia get displaced from the utricle and saccule and move into one of the semi–circular canals. The otoconia are now moving freely in the canals stimulating the hair cells. The makes the brain think that you are moving even when you’re not. This is what causes the symptoms of vertigo, dizziness, loss of balance or unsteadiness, nausea and vomiting.

What can Physiotherapy do?
The good news is that this type of vertigo (BPPV) is very treatable and is straight forward to diagnose. Vestibular physiotherapy is a specialised area of physio which allows us to safely diagnose and treat this condition. We use some very simple positional test to provoke your symptoms this allows us to identify BPPV and from there we go straight into treatment. The treatment involves several different positional changes of the head which allows us to work the crystals/otoconia back out of the semi-circular canal. This is generally a very effective treatment method with symptoms often being resolved or extremely diminished depending on the severity.

If the vertigo has been longstanding for months or years, you may develop additional balance, coordination or motor control deficits, as well as persistent dizziness, for which we can prescribe a tailored vestibular rehabilitation program to suit your specific needs.

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