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 experiencing.
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 head.
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 causes.
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 and tinnitus.
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 Sclerosis.
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
“Presyncope” is 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 tranquillisers.
When to seek medical advice
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
- Speech impairment
- 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
- Blurred vision
- Hearing loss
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 and vomiting.
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 Vestibular Therapy?
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 help?
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 the hospital.
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 serious injury.
- When you feel dizzy, sit or lie down immediately.
- Work closely with your Doctor and Physiotherapist to manage your symptoms effectively.
- If you experience frequent dizziness, avoid driving a car or operating heavy machinery.
- Turn the lights on, or use a torch when you get out of bed at night.