‘Vertigo’ is not a diagnosis. Just like back pain may have many causes, there may be many reasons that someone experiences vertigo. Some of these include Inner ear problems, blood vessel disorders or cervicogenic (neck related) issues.
Vertigo is often described as the ‘illusion of movement’ and we find that inner ear problems are the most common cause. The inner ear’s ‘vestibular apparatus’ works much like a spirit level – it provides you with information on where you are in space. The hair cells in the vestibular apparatus move like seaweed in the ocean, detecting subtle changes in the position of your head relative to gravity.
Receptors throughout our body also provide constant feedback about our balance, and are matched with information from our inner ear. All of this data is integrated in our spinal cord and brain to provide a perception of where our bodies are in space.
Our eyes are also closely connected to the vestibular apparatus – you may have heard of the vestibulo-ocular reflex. The vestibular nerve coordinates eye movement enabling stable vision when your head is moving. For example, when focussing on a target with your eyes and the head is moved right, the eyes will be moved exactly the same amount to the left. You can test your vestibulo-ocular reflex by focusing on the text on this page and turning your head from side to side.
So it’s a pretty complex system, and problems can arise when there is a mismatch of sensory inputs or when the integration system isn’t working properly. A ‘vestibular’ physio can help work out what the problem is by examining many areas – the eyes, spine, your reflexes and movement patterns, sensation, proprioception… you get the picture! Sometimes physios can treat you and cure the vertigo at the first appointment! Benign Paroxysmal Positional Vertigo (BPPV for short) is a common condition where physiotherapy treatment is extremely effective and almost immediate. Vertigo or dizziness caused by whiplash injuries (such as after a car accident) can also be successfully treatment by your physiotherapist.
So where should you start? Obviously with an assessment with a suitably trained physiotherapist.
by Daniel English, Physiotherapist
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