When you were young, spinning around and
getting dizzy was a lot of fun. But now,
as an adult waking up and finding the room
is spinning is not a nice experience at all.
Being "dizzy" is usually the word
describing feeling faint or light-headed,
weak or unsteady. When you are dizzy and
you feel that your surroundings are spinning
or moving, is called vertigo. There are a
few different problems that can cause these
symptoms; your Physiotherapist will be able
to help you deal with these.
Being able to keep your sense of balance
depends on your brain processing information
from your eyes, nervous system and inner
ears. If your brain can't process signals
from these, the messages are contradictory,
or if your sensory system is not working
correctly, this could be why you are experiencing
dizziness or loss of balance.
Did you know that
Dizziness is one of the most common reasons
older adults visit their Doctor.
Aging increases your risk of developing
several conditions that can cause dizziness.
Although it can be restrictive, dizziness
does not usually signal a life-threatening
condition. Your dizziness will be treated
depending on the cause and symptoms you are
Signs and symptoms
- Difficulty concentrating
- Blurred vision after quick head movements
- A loss of balance
- A feeling that you or your surroundings
are spinning or moving
Usually, your sense of balance is controlled
by signals that your brain receives from
several different locations. Your eyes determine
where your body is and how it is moving;
your sensory nerves send messages to your
brain about your movements and position and
lastly your inner ear. The organ that controls
your balance is called the Vestibular Labyrinth.
It is located in your inner ear, it has many
canals including; semicircular canals, the
utricle and the saccule. These are filled
with fluid and fine, hair-like structures
that sense and monitor all movements of your
Your balance depends on at least two of
the three sensory systems working well. For
instance, if you close your eyes in the shower
while washing your hair you won’t lose
your balance. The signals from your inner
ear and sensory nerves help to keep you upright.
If your central nervous system can't process
signals from all of the areas, if the messages
are contradictory, or if the sensory systems
aren't functioning properly, you may experience
loss of balance.
Vertigo is a feeling of motion or spinning
when you are not moving - this is the most
common symptom of dizziness. Sitting up,
moving around or looking up can make it worse.
Sometimes vertigo can cause nausea and vomiting.
Vertigo is usually cased by a problem with
the nerves and the structures of the balance
mechanism in your inner ear (Vestibular system),
this senses movement. Abnormal eye movements
(Nystagmus) almost always accompany vertigo.
Dizziness may have a number of potential
These may include:
Benign paroxysmal positional vertigo (BPPV). BPPV
involves intense, brief episodes of vertigo.
These are associated with a change in the
position of your head, some examples of when
theis can occur include; rolling over in
bed, sitting up in the morning or looking
up to the ceiling. It occurs when the normal
calcium carbonate crystals (otoconia) break
loose and fall into the wrong part of the
canals in your inner ear. When these particles
move when your head moves, they stimulate
sensors in your ear, this causes the sensations
related to vertigo. No one is exactly aware
of what causes BPPV, but it is thought that
it is a natural result of aging. It can also
be caused by trauma to the head.
Inflammation of the inner ear. An
infection in the inner ear, either the Vestibular
Nerve or the Labyrinth can cause inflammation
that results in a sudden, intense feeling
of vertigo that can last for several days,
along with nausea and vomiting. This can
also cause hearing loss in one ear. It can
be debilitating and require bed rest for
1-2 days to minimize the symptoms. However,
as soon as you are able to move around without
vomiting, then movement is very beneficial.
Fortunately, Vestibular Neuronitis generally
subsides and clears up on its own. Recovery
time may be shorter with rehabilitation exercises
that your Physiotherapist show you. Although
the cause of this condition is unknown, it
is thought that it may be a viral infection.
Meniere's disease. This involves the excessive build-up of
fluid in the inner ear. It is characterised by sudden episodes of vertigo lasting
anywhere from 30 minutes to over an hour. Other symptoms include the feeling
of fullness in your ear, buzzing or ringing in your ear (tinnitus), and fluctuating
hearing loss. The cause of Meniere's disease is unknown.
Vestibular migraine. People
who experience vestibular migraines are very
sensitive to motion. Dizziness and vertigo
associated with a vestibular migraine may
be triggered by turning your head quickly,
being in a crowded or confusing place, driving
or riding in a vehicle, or even watching
TV. A vestibular migraine can cause you to
feel imbalanced or unsteady, hearing loss, "muffled" hearing,
or ringing in your ears. These symptoms can
last from a few minutes to several days.
Chronic Neck Pain. People
who have had very limited movement of their
neck over an extended period of time can
develop vertigo when their neck movement
is increased after treatment of their neck.
Symptoms generally are experienced when new
movement of the neck and head is gained through
therapy. This may be due to the adaptability
of the vestibular system. The vestibular
system adapts over time to the limited movement
of the head when there is neck pain. So,
when the neck movement is improved, the vestibular
system occasionally needs to adapt. Your
Physiotherapist can show you a range of exercises
that can help the system adapt faster and
therefore reducing symptoms.
Acoustic neuroma. An Acoustic
Neuroma (Schwannoma) is a non-cancerous growth
on the acoustic nerve. The acoustic nerve
connects the inner ear to your brain. Signs
and symptoms of an Acoustic Neuroma can include
dizziness, loss of balance, hearing loss
Rapid changes in motion.
Riding on a roller coaster, boats, cars or
even airplanes may make you dizzy.
Other causes. Rarely, vertigo
can be a symptom of a more serious problem
such as a Stroke, brain hemorrhage or Multiple
If you experience
any of these symptoms, visit your health
care professional for an in-depth assessment
of your problem to ensure that you get
the correct treatment for you condition.
Feeling of faintness
the medical term for feeling faint and light-headed
without losing consciousness. Sometimes you
may also experience nausea, pale skin and
a sense of dizziness accompanying a feeling
of faintness. Causes of Presyncope include:
Drop in blood pressure (Orthostatic
Hypotension). A dramatic drop in your systolic
blood pressure reading may result in light-headedness
or a feeling of faintness. It can occur after
sitting up or standing too quickly.
Inadequate output of blood from
the heart. Conditions such as
partially blocked arteries, dissected arteries,
disease of the heart muscle, abnormal heart
rhythm or a decrease in blood volume may
cause inadequate blood flow from your heart.
Loss of balance
Disequilibrium is the loss of balance or
the feeling of unsteadiness when you walk.
Causes may include:
Inner ear problems. An
abnormality with your inner ear can cause
you to feel like you are floating, have a
heavy head or are unsteady in the dark.
Sensory disorders. Failing
vision and nerve damage in your legs are
common in older adults and can result in
difficulty maintaining your balance.
Joint and muscle problems. Muscle
weakness and Osteoarthritis can contribute
to loss of balance when it involves weight-bearing
joints. This is increased when pain is involved
as this causes the muscles around the painful
joints to weaken and therefore add to the
feeling of loss of balance.
Medications. Loss of balance
can be a side effect of some medications,
such as anti-seizure drugs, sedatives and
When to seek medical
Be sure to see your doctor if you experience
any unexplained, recurrent or severe dizziness.
Although it is uncommon for dizziness to
signal a serious illness, see your doctor
immediately if you experience dizziness or
vertigo along with any of the following:
Loss of consciousness
Numbness or tingling
Falling or difficulty walking
Leg or arm weakness
Chest pain or rapid or slow heart rate
A new, different or severe headache
Doctors can usually determine the cause
of dizziness. Once the problem is determined
you may require a consultation with an ear,
nose and throat (ENT) specialist or a neurologist.
Even if no specific cause is found or if
your dizziness persists, prescription drugs
and Physiotherapy treatment may help to make
your symptoms more manageable.
Dizziness can increase your risk of falling
and hurting yourself. If you experience dizziness
while driving a car or operating heavy machinery
it greatly increases the risk of an accident.
You may also experience long-term consequences
if an existing health condition that may
be causing your dizziness goes untreated.
When being treated by a Health Professional,
we base your treatment the cause as well
as your symptoms.
BPPV. Treatment for BPPV
usually done by using Canalith Repositioning.
This is a simple procedure that involves
your Doctor or a Physiotherapist manoeuvring
the position of your head. The aim is to
shift the loosened particles in your ear
to a place where they won't cause dizziness
and will be reabsorbed into your body. This
procedure has a very high success rate at
90 percent. Although, you may need to have
the procedure repeated.
Inner ear conditions. Balance
retraining exercises are used to treat acute
Vestibular Neuronitis or Labyrinthitis. These
are exercises that you learn from a Physiotherapist,
then do them regularly at home. This rehabilitation
involves movements of your head and body
to correct any loss of balance.
Meniere's disease. Treatment
of Meniere's disease involves reducing your
body's fluid retention through Diuretics
and/or dietary changes, such as a low-salt
diet. Sometimes surgery is also an option.
Vestibular Migraine. To
combat vertigo that is associated with Vestibular
Migraines, your Doctor will firstly try to
help you determine and avoid the triggers
for your attacks. Your Doctor may suggest
that you avoid certain types of foods, reduce
stress, improve your sleep patterns and exercise
regularly. Specific rehabilitation exercises
can be taught by your Physiotherapist to
adjust your balance system and make it less
sensitive to motion. Some medications may
help to prevent attacks of Migrainous Vertigo
or make them less severe by relieving nausea
Anxiety disorders. Your
Doctor may suggest counselling. This can
help you to deal with your anxiety issues
and manage your dizziness.
Other contributing health conditions. Your
Doctor will recommend and review any treatment
of an existing disease. Some health conditions
that could contribute to your dizziness include
an ear infection, Stroke, heart problems
or Multiple Sclerosis.
Why is therapy needed?
Your ability to maintain posture and co-ordinate
your balance is reliant upon the information
your brain receives from the vestibular system,
if there is a problem you can become overly
dependent on vision or on the information
received from the muscles and joints (Proprioception).
This can lead to new patterns of movement
to compensate for the change and to avoid
head movements create symptoms of dizziness
and nausea. For example, you may swivel your
whole body instead of just your head when
turning to look at something, or always look
down at the floor to avoid looking at what
appears as a confusing swirl of activity.
Unfortunately, these types of adaptation
can result in neck pain, headaches, fatigue,
muscle stiffness and a decrease in the ability
to retrain the brain to adjust to the vestibular
problem; this can make the symptoms much
worse. Vestibular physiotherapy is designed
to retrain the brain to recognize and process
signals from the vestibular system in coordination
with information from vision and Proprioception.
What happens during
Your Physiotherapist will first perform
a thorough evaluation of your posture, balance,
movement, and compensatory strategies. Once
the evaluation is completed an individualized
treatment plan will be developed that will
include exercises to be done both in the
therapy department and at home. The exercises
will combine head, body and eye movements.
Treatment may also include increasing activities
and exercise in order to strengthen muscles
and increase tolerance. Sometimes the exercises
and activities can at first cause an increase
in symptoms, as the body and brain adjust
to the new pattern of movements. But, with
time and practice, the coordination signals
from the eyes, Proprioception, and vestibular
system will all improve.
How does therapy
In most cases, balance improves if the exercises
are correctly and regularly performed. Symptoms
such as headaches, muscle tension, fatigue,
dizziness, vertigo, and nausea will decrease
or disappear. Usually Physiotherapy alone
is so successful, that no other treatment
is required. If surgery is required to correct
an inner ear problem, therapy will also be
a vital part of treatment. A Physiotherapist
may perform a vestibular evaluation before
surgery, visit during the hospital stay to
help with the temporary increase in balance
problems and may provide some simple exercises
to do at home once you are discharged from
If you experience
dizziness, consider these tips:
- Excessive caffeine, alcohol and tobacco
can restrict your blood vessels and worsen
your signs and symptoms.
- Walk with a cane for stability.
- Be aware of the possibility of losing
your balance, this can lead to a fall and
- When you feel dizzy, sit or lie down
- Work closely with your Doctor and Physiotherapist
to manage your symptoms effectively.
- If you experience frequent dizziness,
avoid driving a car or operating heavy
- Turn the lights on, or use a torch when
you get out of bed at night.