The human balance system is made up of various complex systems working together to let our bodies function and perform complex tasks in an upright and steady position. The body automatically makes judgements of the environment around us and after processing the information, allows us to function in a smooth and regular way.
Vision – the eyes take cues from everything we see to make sense of whether we are balanced or not
Proprioception – signals from muscles and joints help us know where our body is positioned in space
Vestibular systems – the systems in our inner ears have two major functions, detecting gravity and linear motion (utricle and saccule) and any rotational movement (3 semi-circular canals)
The information from the eyes, muscles and joints and vestibular systems is sent to the brain stem and brain. It is processed and signals are sent to the eyes and muscles to allow them to move accordingly to keep us balanced. This process happens extremely quickly, especially with eye reflexes – which bypass the brain.
The complexity of the balance system means that all the components need to be working in sync and if one component is impaired then dizziness, vertigo, disequilibrium and being unbalanced can occur.
Vertigo is when the world is moving in front of your eyes, generally rotating, even though you are still.
Dizziness can be light-headedness, faintness, unsteadiness or many other symptoms, but generally does not include the sensation of the world moving in front of your eyes like vertigo.
However, it is common for people to suffer from dizziness and vertigo at the same time.
Symptoms can be very difficult to explain and make sense of, so don’t worry about trying to classify your symptoms.
There are numerous causes of dizziness and vertigo; some are extremely serious, such as stroke, and others are more benign.
An overview of various vestibular conditions are listed here:
However, there are many other causes which is why a thorough and comprehensive history and assessment is needed and at times, there is more than one issue at play. The assessment also serves to try and rule out any potential serious or urgent conditions.
If stroke is suspected, the acronym F.A.S.T is useful:
Face – the face/ eye may have dropped on one side, smiling may not be possible on one side
Arms – the arms can be affected in stroke, so an inability to lift the arms or hold them in one position due to weakness or numbness
Speech – slurred or garbled speech, or the inability to speak are all potential signs
Time – dial 999 or get immediate medical attention if any signs are present
Further details and other signs or stroke can be found here:
If you suspect a stroke or have any of these symptoms you should seek medical help immediately!
Please bring along a completed medical questionnaire and we’ll initially have a long chat (subjective assessment) to rule out serious pathologies and discuss the problems you’re experiencing, the factors which bring on your issues, their duration, intensity and coping mechanisms, if any.
The subjective assessment will be followed with some objective testing, where a screen of your neck, visual and vestibular systems will take place – these may invoke dizziness, which is the first step in identifying your main issues and being able to manage them effectively. If your symptoms have a long duration, you may want to ensure you have someone with you to help you get home.
A full explanation of the findings from the assessment will be given and throughout the assessment feel free to ask questions and let me know if there are tests you are unsure about or do not want to perform.
The assessment and treatment can only take place with your full consent, which you can withdraw at any time and for any reason.
The key to a successful assessment and treatment is to work together to find the affected areas and devise a tailored treatment programme which is realistic and effective.
Can dizziness, balance issues and vertigo be treated?
Yes, in some cases, such as an uncomplicated Benign Paroxysmal Position Vertigo (BPPV), a total cure is possible.
In other cases where the dizziness is coming from dysfunction in the vestibular system, neck or how the brain is interpreting the information, the key is to find the correct source and then treating accordingly.
The vestibular system as a whole can be trained to compensate for short comings in others parts of the balance system – habituation exercises are used to achieve this goal. In the case of dizziness arising from the upper neck, treating this area can lead to significant improvements.
Benign Paroxysmal Position Vertigo (BPPV) is a common problem where we believe some of the ear crystals (otoconia) become loose and find their way into one of the semi-circular canals. Here they disrupt the signals to the brain by sending the signal that movement is occurring, although you are stationary.
This results in nystagmus (rapid eye movements) which is very disorientating and unpleasant, potentially leading to vomiting, unsteadiness, staying still and being bed ridden. However, this nystagmus is very useful in allowing professionals to detect the location of the crystals and then how to treat it.
Although all three of the canals may be affected, the posterior is most common, followed by the horizontal, with the anterior canal being rarely affected.
Thankfully, through some repositioning movements the condition can be treated successfully with over 90% of cases said to be resolved after three treatments, with many responding positively to just one treatment.
However, as with many vestibular issues, there can be other underlying issues which may also need to be addressed.
For BPPV the key is to identify the correct canal and whether the crystals are free moving or stuck. There are then various repositioning techniques, designed to guide the crystals back into the otolith. The most famous of these techniques is the Epley maneuver.
For cervicogenic related dizziness the use of manual therapies to release tension and encourage normal movement in the upper neck are used. These may include gentle mobilisations or soft-tissue massage of the area (no manipulations or ‘neck cracking’ are performed) and sustained natural apophyseal glides (SNAGS) which are pain free movements combined with a sustained mobilisation of the neck.
Habituation exercises are designed to treat the whole vestibular system to compensate for any short-comings and train the brain in what is normal movement and function. There are numerous techniques involving various different stimuli to focus on your dysfunction and retrain that aspect of the system.
Due to the varied nature of dizziness, other treatments will be tailored to your individual condition, such as breathing control, balance exercises and other coping techniques.
No, however if you have had any recent medical investigations relating to your condition, they may be discussed to ensure we have a full picture of your health and condition which aids in getting an accurate assessment.
In the rare event any serious pathology is suspected, you’ll be guided to your GP or the Accident and Emergency department. A letter detailing your issues will be given or faxed through to your doctor.
Do I need a referral?
No – you are free to make an appointment with no referral.
However, if trying to claim on a medical insurance policy, your insurer may request a doctor’s referral first.
Check with your health insurance provider – some policies cover the costs, some partially cover some aspects, some cover some treatments but not others. In short, it is a confusing picture – so check with your policy provider first to see what is covered.
Please check prior to your appointment as no responsibility for their refusal to cover costs will be taken by the Dizziness, Balance & Concussion Centre.
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