Dizziness + Balance
Dizziness + Balance
Dizziness + Balance
Dizziness + Balance
Dizziness + Balance
We can help with dizziness, unsteadiness or trouble focusing when you’re moving.
Do you sometimes feel dizzy or unbalanced? Whether it just affects you once in a while or it’s a bigger problem that makes it hard to enjoy day-to-day life, we can help.
Vestibular rehabilitation is a proven treatment for dizziness and balance problems, no matter what your age or how long you’ve been struggling with the problem.
Did you know?
- In Canada, about 1.5 million people suffer from chronic vestibular damage.
- BPPV (Benign Paroxysmal Positional Vertigo) is thought to be responsible for 50% of all dizziness in seniors.
The vestibular apparatus in your inner ear senses your head position and movement, and is the pathway that carries that information to your brain for processing. It helps control balance and orientation, so problems in any part of this complex system can create dizziness, vertigo, unsteadiness or visual issues.
What causes vestibular problems?
They can result from anything from hitting your head to having a reaction to medication. And sometimes they can begin “out of the blue” with no diagnosable cause. Common causes include:
- Trauma (motor vehicle accidents, falls, contact sports, blows to the head)
- Inner ear infections
- Brain-related problems (tumours, stroke, decreased blood flow, migraines)
What is BPPV? (Benign Paroxysmal Positional Vertigo)
BPPV is the most common cause of vertigo (the sensation that the world is spinning). It’s usually set off by specific head movements such as:
- Rolling over in bed, often with one side being worse
- Getting into/out of bed
- Bending over
- Tipping your head back to look up
- Quick head movements
BPPV occurs when the calcium carbonate crystals (otoconia) located in the utricle in your inner ear become dislodged from the gel that normally holds them in place. If they move into a different part of the inner ear, they send mixed messages about your movements to your brain. For example, if you’ve changed positions and gravity makes the crystals move, one ear will tell your brain you’re rotating while the other says you’re not. This is what causes the spinning sensation (which typically lasts less than a minute).
What are some types of vestibular problems?
- Unilateral vestibular hypofunction/unilateral vestibular loss happens when only one ear is affected. Because the ears are no longer in sync, your brain receives two different messages about your head position or movement.
- Bilateral vestibular hypofunction (loss) occurs when both ears are affected. The information your brain needs for orientation is reduced or missing, meaning you have to rely on other systems like vision and touch.
- Central vestibular disorders result when the brain is having trouble processing the information sent from the ears. They can be caused by structural damage from a stroke or head injury, a tumour, abnormal blood flow, disease or degeneration in the brain, or the effects of some medications.
Vestibular issues can vary from a mild irritation to symptoms that make it difficult to perform everyday activities. Common symptoms include:
- Dizziness or vertigo (a spinning sensation) with certain head positions or movements
- Sensitivity to motion (your own or that around you)
- A sense of “after-motion” when you move
- Nausea or vomiting
- Unsteadiness or falls, especially in darkened environments or soft/uneven surfaces
- Blurry or “jumpy” vision when you’re moving
- A rocking sensation
- Sensitivity to busy environments like crowds, stores or traffic
- Visually provoked dizziness when you’re reading or watching TV, using a computer or looking at busy patterns
We’ll help you learn about your condition and explain the rationale behind your prescribed treatment, which may include:
- Manoeuvres to correct BPPV
- Habituation techniques to help your brain reduce or eliminate symptoms provoked by movement
- Gaze stabilization techniques to improve your ability to focus while your head is moving
- Balance training to address unsteadiness
- Hands-on treatment of the neck or other muscles/joints
- Addressing other factors such as medical conditions, diet and lifestyle
- At-home exercises
When can I expect to see results?
Most patients notice improvement quickly, especially when they’re diligent with their at-home practice. Vestibular rehabilitation is like learning to play a song on the piano; we teach you the basics and you practice on your own to get better. Each time you have an appointment (typically once a week over several weeks), we’ll see how you’re progressing and teach you more and more of the “song” until you’ve got it mastered.
Your initial assessment will be a one-to-one with your vestibular therapist and should take about an hour. Please arrive a little early to fill out some paperwork.
Your therapist will want to know specifics about your problem, so you may want to think about these details before your appointment:
- When did your symptoms start?
- Did they come on “out of the blue” or were they related to an incident or illness?
- Were there any symptoms other than dizziness (nausea/vomiting, hearing changes, vision changes, headache, numbness/pins and needles, unsteadiness)?
- What is the nature of your dizziness (light-headedness, disorientation, room spinning, feeling “off”)?
- How long do your symptoms last?
- What increases or decreases them?
- Are you dealing with other medical conditions or taking medication?
- Have you had previous experiences with dizziness?
- Has anyone in your family had similar issues?
Once we understand what you’re experiencing, we’ll move onto testing, which starts with neck and neurological screening. We may also:
- Evaluate your stationary and moving balance
- Test eye-movement reflexes relating to the inner ear
- Measure motion/positional sensitivity
- Analyze your eye movements
- Check if your neck is a factor
- Test blood pressure
- Check for problems in your feet/legs
Assessment may be spread out over a few sessions, with reassessments throughout your course of care.
What should I wear?
Please wear loose, comfortable clothing. You may be asked to do a number of movements like getting on and off a bed, bending over and walking around.
Can I bring someone along for my assessment?
You are welcome to have someone accompany you during assessment, in fact we encourage it. That way someone can drive you home if you’re affected by the testing.
Does your patient have trouble with dizziness or balance? We can help you with differential diagnosis and treatment.
We know that dizziness can be a flag for serious pathology and physiotherapy may not be appropriate for everyone. We are careful to take a thorough history and perform screening for signs of serious problems before even considering vestibular rehabilitation.
Our assessment includes:
- A cranial nerve scan
- Screening for signs/symptoms of vertebrobasilar insufficiency
- Cerebellar tests
- Scans for upper motor neuron lesions
- Ligamentous stability testing of the upper cervical spine if there has been injury or RA
- If indicated, blood pressure testing
Although we don’t require a referral to see a patient, communication with you is paramount in forming an efficient recovery team. If we have concerns or you request communication, we will report to you right away. Otherwise, we will send you an assessment, treatment and outcome report at the end of our course of care.
Why are vestibular disorders so hard to identify?
If you break your leg, it’s pretty easy for a doctor to diagnose. But vestibular disorders aren’t quite so obvious, especially if your condition is mild. Symptoms are generally something your doctor can’t see, so they have to look for underlying signs by investigating your balance and eye movements.
To make things trickier, symptoms of vestibular issues often fit the profile of other disorders. In some cases, doctors may be unable to arrive at a definitive diagnosis due to lack of technology or access to testing.
What happens if my vestibular disorder is left untreated?
Without treatment, your symptoms could escalate and lead to secondary problems like:
- Increased fear of falling
- Memory and concentration issues
- Muscle guarding / restriction of movement
- Decreased activity levels / deconditioning
- Social isolation
- Anxiety and depression
I have ringing or buzzing in my ears. Is that related to a vestibular disorder?
Ringing or buzzing in the ears, known as tinnitus, typically comes from a problem with nerves in the ear and brain that interpret auditory information. Tinnitus is not a vestibular disorder, but there are certain disorders affecting the vestibular system that also cause tinnitus.
Vestibular rehabilitation does not address hearing-related issues. If you have dizziness, unsteadiness and sensitivity to motion in addition to your hearing problem, then vestibular rehabilitation can be helpful with those symptoms, but you should not expect your tinnitus or hearing problem to change.
So you can’t treat any kind of tinnitus?
Research has found that some types of tinnitus can have a relationship with the jaw joint (TMJ) or neck. This is referred to as somatic tinnitus. If you seem to be able to alter your tinnitus with certain head, neck or jaw movements, posture, or trigger points, then physiotherapy may be helpful in reducing or eliminating symptoms. Make an appointment today to find out if we can help you.
Can you avoid getting BPPV?
The vast majority of cases occur for no apparent reason, with many people describing that they simply went to get out of bed one morning and the room started to spin. However associations have been made with:
- Inner ear infection or disease
- Intubation (presumably due to prolonged time in a lying position)
- Reduced blood flow
- Your preferred sleep side
Do I need a doctor’s referral?
Most people come to us on the recommendation of their doctor, but you don’t need one. If you have extended health benefits, check if your plan requires a completed referral note.
Our vestibular therapists have strong backgrounds in orthopedic and/or neurological care, with extensive training in vestibular rehabilitation through ongoing education, mentorship and support.
In addition, LifeMark is one of the few facilities in Canada to use Goggle Infrared Technology to analyze eye movements; it can pick up subtle movements that aren’t visible in regular light. Because the eyes are highly integrated with the vestibular system, it gives us valuable information to help determine the underlying cause of your dizziness.