Dizziness is an unpleasant and potentially disabling condition that may respond to physiotherapy treatment. To maintain balance your brain must interpret nerve signals coming from the neck, inner ears, eyes, joints and muscles. A problem in any of these areas can cause dizziness.
Inside your inner ear there is a set of sensory organs called your vestibular system. This system senses motion of your head and sends signals to the brain.
Labyrinthitis or Vestibular neuritis are the most common causes of vestibular dizziness. It is caused by an infection, usually viral. It can be very severe and disabling but luckily it most commonly gets better in a few days. Your doctor can help with the symptoms. If these symptoms persist, a physiotherapist can give exercises that may help.
Meniere’s Disease causes dizziness that comes and goes. It is due to a build-up of pressure in your inner ear. A physiotherapist can advise a management plan and give exercises to reduce symptoms.
Central Vestibular Dizziness is more complex and involves disturbance to the processing of vestibular signals. Common causes are migraine, stroke, head injury, intoxication.
Benign Positional Paroxysmal Vertigo (BPPV)
A very common cause of vestibular dizziness is Benign Positional Paroxysmal Vertigo (BPPV).
Benign – Not dangerous to your health
Positional – Is brought on by particular positions or change in position
Paroxysmal – Comes and goes in bursts
Vertigo – A spinning sensation
It is characterised by often powerful dizzy events, lasting 15-30 seconds, that typically occur after rolling over or lying down/sitting up. It occurs in people of any age but is more common in older people. BPPV is related to the movement of tiny naturally occurring crystals or particles within the fluid in the inner ear canals. Sometimes, for various reasons, these crystals end up in the wrong place.
A physiotherapist with knowledge in this area can direct you through a series of movements that can help reposition the crystals and settle these symptoms. Often only one treatment is required, but occasionally up to 3 sessions may be needed. Our physiotherapists trained in this can also provide some home exercises for you to do if the condition recurs.
Dizziness related to the neck
Cervicogenic dizziness is dizziness related to the neck. This is often related to conditions such as whiplash, concussion, and head injuries. It is also present in some people with chronic neck pain. If the source of dizziness is attributed to the neck, the majority of patients can improve with treatment targeted to the neck (e.g. changing habitual neck posture, strengthening and stretching exercises). Other people with dizziness might require additional vestibular rehabilitation to optimise their recovery (e.g. eye/head coordination exercises, balance exercises, and graded exposure to dizzy environments).
Dizziness related to blood pressure
If you have low blood pressure and stand up quickly, you may experience a feeling of dizziness or feel faint. This is called ‘Orthostatic Hypotension’.
Orthostatic – Related to moving into an upright position
Hypotension – low blood pressure
If you have ever fainted when changing position, you should visit your doctor to have your blood pressure checked and examine you for any other causes.
Dizziness related to Hypermobility
Those with conditions associated with hypermobility (being extra flexible) such as Ehlers Danlos Syndrome, can also often experience dizziness or faintness, particularly on rising to standing. Hypermobile people may have blood vessels that are more stretchy than normal. This can allow blood to pool in your legs, lowering your blood pressure. Many people with hypermobility have lower blood pressure and may experience ‘orthostatic hypotension’.
Postural Orthostatic Tachycardia Syndrome (POTS)
Postural - referring to your body position
Orthostatic - Related to moving into an upright position
Tachycardia - an increase in heart rate
Syndrome - just referring to a combination of symptoms
POTS is a frequent cause of low blood pressure that is associated with numerous conditions, including Hypermobility. When you move to an upright position, it is normal for your heart rate to increase a little. In POTS, the increase in heart rate is higher than normal. This may be associated with a drop in blood pressure, but not always. Your heart rate, and other things that are controlled automatically without you needing to think about them, are controlled by a special part of the nervous system, called the Autonomic Nervous System. POTS develops due to an irregularity in the functioning of this system.
POTS can lead to symptoms of dizziness on changing positions quickly but also with periods of sitting/standing still. POTS has been associated with a variety of other symptoms including fatigue, brain fog, headaches, racing heart/palpitations, anxiety and digestive issues. There are many other conditions that can cause POTS and it can also be caused by medication, so check with your doctor. Our physiotherapists can assist in helping you better manage the symptoms of POTS and other difficulties related to Hypermobility.
If you are suffering with dizziness, a physiotherapy assessment with one of our physiotherapists skilled in these areas can identify if we can help you.