Causes of vertigo and the role of physiotherapy

Vertigo is a sensation of spinning or dizziness, often described as feeling like the room is moving around you. It can be a debilitating condition that significantly impacts a person's quality of life. Understanding the causes of vertigo and the role of physiotherapy in its management is crucial for effective treatment.

Causes of Vertigo:

Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of vertigo. BPPV occurs when small calcium crystals (otoconia) in the inner ear become dislodged and move into the semicircular canals. This causes a false sense of movement when the head position changes.

Vestibular Neuritis or Labyrinthitis: These conditions involve inflammation of the vestibular nerve or labyrinth in the inner ear, often due to viral infections. They can cause sudden, severe vertigo that may last for several days.

Meniere's disease: This inner ear disorder is characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. The exact cause is unknown, but it's thought to be related to fluid buildup in the inner ear.

Vestibular Migraine: Some people experience vertigo as a symptom of migraine headaches, even without the typical headache pain.

Acoustic Neuroma: This is a benign tumor that grows on the vestibular nerve, which connects the inner ear to the brain. It can cause gradual hearing loss, tinnitus, and balance problems.

Cervicogenic Dizziness: This type of dizziness is related to neck problems, such as cervical spondylosis or whiplash injuries.

Central Causes: Conditions affecting the brain, such as stroke, multiple sclerosis, or brain tumors, can cause vertigo.

Perilymph Fistula: This occurs when there's an abnormal connection between the middle and inner ear, allowing fluid to leak from the inner ear.

Mal de Debarquement Syndrome: This rare condition causes a persistent sensation of rocking or swaying, typically after sea travel.

Medication Side Effects: Some medications can cause dizziness or vertigo as a side effect.

Anxiety Disorders: Severe anxiety can sometimes manifest as a sensation of dizziness or vertigo.

The Role of Physiotherapy in Managing Vertigo:

Physiotherapy plays a crucial role in the assessment and treatment of many types of vertigo, particularly those of vestibular origin. The primary goals of physiotherapy for vertigo are to reduce symptoms, improve balance and stability, and enhance overall function. Here's how physiotherapists approach vertigo management:

Comprehensive Assessment:

·         Detailed history taking to understand the nature and triggers of vertigo

·         Physical examination including balance and gait assessment

·         Specific vestibular tests such as the Dix-Hallpike test for BPPV

·         Oculomotor examination to assess eye movements

Vestibular Rehabilitation Therapy (VRT): This is a specialized form of therapy aimed at reducing vertigo and dizziness. It includes:

·         Gaze stabilization exercises to improve visual focus during head movements

·         Habituation exercises to reduce sensitivity to certain movements

·         Balance training to improve stability and reduce fall risk

·         Adaptation exercises to help the brain compensate for vestibular deficits

Canalith Repositioning Procedures: For BPPV, physiotherapists use specific maneuvers (e.g., Epley maneuver, Semont maneuver) to guide the displaced crystals back to their proper location in the inner ear.

Balance Retraining:

·         Static and dynamic balance exercises

·         Use of balance boards or other equipment to challenge balance systems

·         Functional balance activities that mimic daily tasks

Gait Training: Improving walking patterns and confidence during mobility.

Manual Therapy: For cervicogenic dizziness, manual techniques to the neck like decompression therapy and spinal manipulation can help alleviate symptoms.

Education:

·         Explaining the cause of vertigo and the rehabilitation process

·         Teaching self-management strategies

·         Providing information on fall prevention