Find Balance with a Vestibular Physiotherapist at Pollinate Health
Battling with dizziness or vertigo can be daunting. It can feel like you are spinning or off balance and can impact you for days, weeks or even months. Pollinate Health’s vestibular physio service may hold the key to regaining your equilibrium by providing a thorough assessment, accurate diagnosis and treatment designed to provide relief and a sense of control.
Meet Danny, our vestibular physiotherapist
Danny Nguyen is our resident vestibular or dizziness physiotherapist. He has strong vestibular experience in the hospital system both in Emergency and Outpatients and has completed independent training in the field.
Danny treated dizzy patients at the Northern Hospital where he saw a steady case load of patients for some time, received specialised training in vestibular disorders and ongoing mentoring from colleagues.
Danny says that patients experiencing a dizzy episode can find it quite traumatic and it’s often something they never forget.
He enjoys being able to reassure patients of their vestibular symptoms once they’ve ruled out significant pathology and for some patients who have dizziness symptoms that just linger, he has a toolkit of techniques, manoeuvres and exercises that can help these patients settle those nagging symptoms.
Book with Danny today:
Understanding vestibular physiotherapy
Hidden deep within your ear is the complex vestibular system, often overlooked until it starts causing problems. This intricate network is responsible for maintaining balance and spatial orientation. When it’s thrown off course, the result can be nothing short of disorienting.
Vertigo can arrive suddenly or be triggered by specific head movements.
Vertigo symptoms can include:
- Feeling as if you are spinning or not well balanced.
- Feeling like you are going to fall over.
- Experiencing nausea.
- Experiencing ringing in the ears.
Will my vertigo ever go away?
The duration of vertigo can vary widely depending on the underlying cause and individual factors.
In many cases, vertigo can settle on its own within a few days. If treatment is required and exercises are done regularly, the symptoms should settle over the next 10 days.
Most people return to work or normal activities within a week.
Some people (about 1 in 3) will have vertigo again within a year. This can cause anxiety and discomfort, but again they can be treated with the help of a health professional and are not likely to have long-term effects.
While there are some serious causes of vertigo, in most cases, it is not a serious condition and usually gets better with time and treatment.
Can stress cause vertigo?
Stress can certainly cause vertigo, messing with the balance system in our ears.
When we’re stressed, our body releases hormones that can affect our inner ear, making us feel dizzy or off-balance. Stress can also cause muscle tension, which might make the symptoms of vertigo worse.
So, if you’re feeling stressed out and experiencing vertigo, it’s important to take steps to manage your stress, like deep breathing, exercise, or talking to someone you trust.
Common vestibular disorders where physiotherapy can assist
Vestibular physiotherapists treat various vestibular conditions, either independently or in collaboration with other healthcare specialists. They assess and determine the best treatment course, using physiotherapy alone or in combination with medical intervention.
Benign paroxysmal positional vertigo (BPPV)
BPPV occurs when calcium carbonate crystals in the inner ear become dislodged, causing vertigo with certain head movements. Physiotherapists diagnose BPPV using tests like the Dix-Hallpike manoeuvre and treat it with the Canalith Repositioning Manoeuvre (e.g., Epley manoeuvre) to relocate the crystals. Follow-up care includes additional balance and habituation exercises if needed, ensuring effective symptom management and improved quality of life. More information
The role of physiotherapy in rehabilitation of BPPV
- Diagnosis and assessment: The physiotherapist will first confirm the diagnosis of BPPV using specific tests, such as the Dix-Hallpike manoeuvre, to identify which ear and which canal are affected.
- Canalith repositioning manoeuvre: The primary treatment involves performing specific manoeuvres, such as the Epley manoeuvre, to move the dislodged calcium crystals out of the semicircular canals where they cause vertigo and back to their proper location in the inner ear.
- Brandt-Daroff exercises: You may be advised to perform Brandt-Daroff exercises. These may cause dizziness initially, which can cause anxiety and discomfort, so it is recommended to seek advice from a health care professional before performing them. Your physio will ask you to:
- a. Sit upright on the edge of the bed.
- b. Turn your head slightly (45 degrees) to the left.
- c. Keep your head in the same position as you lie down quickly on the right side.
- d. Ensure the back of the head rests on the bed. Wait 20–30 seconds or until the dizziness stops.
- e. Sit upright. Wait 20–30 seconds for any dizziness to settle.
- f. Repeat on the other side.
- g. Turn the head slightly to the right before lying down quickly on the left side.
- h. Do this five times on each side (takes about 10 minutes). Repeat three times a day.
- Follow-up and monitoring: The physiotherapist will monitor the patient’s progress, ensuring that the manoeuvres are effective and addressing any residual symptoms or balance issues. They may also perform additional manoeuvres if needed.
- Balance and Habituation Exercises: If necessary, the physiotherapist may introduce balance training and habituation exercises to help the patient adapt to any remaining dizziness and improve overall stability and confidence in movement.Overall, the physiotherapist helps patients manage BPPV effectively, reducing symptoms and improving their quality of life through targeted, evidence-based interventions.
Vestibular neuritis or labyrinthitis
Vestibular neuritis and labyrinthitis, often caused by viral infections, lead to inflammation of the vestibular nerve or labyrinth, causing vertigo, dizziness, and sometimes hearing loss. Physiotherapists manage these conditions through Vestibular Rehabilitation Therapy (VRT), including gaze stabilization, balance training, and habituation exercises. Education on self-management and a personalized home exercise program support ongoing improvement and stability. More information
The role of physiotherapy in neuritis or labyrinthitis
- Assessment: The physiotherapist will perform a thorough assessment to understand the extent of the vestibular dysfunction. This involves evaluating the patient’s balance, gait, and symptoms of dizziness or vertigo.
- Vestibular rehabilitation therapy (VRT): The core treatment involves VRT, which includes a set of exercises designed to promote central nervous system compensation for vestibular deficits. VRT aims to reduce dizziness, improve balance, and enhance the patient’s ability to stabilise their gaze.
- Gaze stabilisation exercises: These exercises help improve the patient’s ability to maintain a steady vision during head movements. Examples include focusing on a stationary object while moving the head back and forth or up and down.
- Balance training: Balance exercises aim to improve the patient’s stability and coordination. This can involve activities like standing on one leg, walking on uneven surfaces, or using balance boards.
- Habituation exercises: These exercises involve repeated exposure to specific movements or positions that provoke dizziness, helping the brain gradually become less sensitive to these triggers.
- Education and self-management strategies: The physiotherapist educates the patient about their condition, providing information on how to manage symptoms and avoid triggers. They also teach techniques to prevent falls and injuries due to dizziness.
- Home exercise program: The physiotherapist designs a personalised home exercise program for the patient to practice regularly. This program reinforces the exercises done in therapy sessions and promotes continuous improvement.
- Follow-up and monitoring: Regular follow-up appointments allow the physiotherapist to monitor the patient’s progress, adjust the exercise program as needed, and address any ongoing or new symptoms.
Vestibular migraine
Vestibular migraine involves vertigo and imbalance, often without a headache. Physiotherapists manage symptoms through Vestibular Rehabilitation Therapy (VRT), balance, and gaze stabilisation exercises. They educate patients on avoiding triggers, use relaxation techniques, and collaborate with neurologists for comprehensive care.
The role of physiotherapy in vestibular migraine
In treating vestibular migraine, physiotherapists focus on managing symptoms like dizziness and balance issues through Vestibular Rehabilitation Therapy (VRT). This involves exercises to improve balance, gaze stabilisation, and habituation, which help the brain adapt to vestibular changes. They also educate patients on vestibular migraine, identifying and avoiding triggers, and provide strategies for coping with symptoms, such as relaxation techniques and stress management.
Additionally, physiotherapists offer guidance on posture and ergonomics to reduce symptom frequency and severity, recommend appropriate physical activities that won’t exacerbate symptoms, and design personalised home exercise programs. They often collaborate with other healthcare providers, like neurologists, to ensure comprehensive care and adjust treatment plans based on patient progress and needs.
Vestibular disorders treated primarily by a medical doctor or specialist
Ménière's disease
Ménière’s disease features episodes of vertigo, fluctuating hearing loss, tinnitus, and ear fullness. While physiotherapy helps manage vertigo and balance issues, medical management by an ENT specialist or audiologist is often necessary, including medications, dietary changes, and sometimes surgical procedures.
Perilymphatic fistula
This condition involves a tear in the membranes separating the middle ear from the inner ear, leading to fluid leakage and symptoms such as vertigo, dizziness, and hearing loss. Medical management is essential for diagnosis and treatment, with physiotherapy aiding recovery post-surgery or intervention.
Central vestibular disorders
These disorders result from issues in the central nervous system, like strokes, multiple sclerosis, or brain tumors, affecting vestibular function. Management by neurologists or neurosurgeons is crucial, with treatments including medications, rehabilitation therapies, and possibly surgery. Physiotherapy supports recovery by addressing balance and mobility issues related to these central disorders.
Central nervous system disorders
These are caused by problems in the central nervous system and include strokes, multiple sclerosis, or brain tumors and typically require management by neurologists, neurosurgeons, or other medical specialists. Treatment may involve medications to manage symptoms, rehabilitation therapies, and in some cases, surgical interventions.
When should I seek urgent medical help?
If you have more serious symptoms — speech difficulty, double vision, unsteady walking, difficulty swallowing, altered strength or feeling in your legs or arms, ringing in your ears or deafness — you should seek medical help urgently.
Where to next?
Pollinate Health offers a vertigo and dizziness physiotherapy service. Book with us today.