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Vestibular System: Treating Dizziness, Concussion, and Vertigo with Physiotherapy

Tue May 7

Many of us can get out of bed in the morning without feeling dizzy or losing equilibrium. We can also tilt our heads to see a bird pass by or stroll over a sandy beach. We might not even be aware that our bodies have a whole system devoted to tracking our position in space and maintaining our equilibrium as we move through it.

However, if you've ever tripped unsteadily, you know how important balance and equilibrium are to every action we take. Our vestibular system is the intermediary for this sense.

The vestibular system comprises the inner ear's sensory organs and the neck's position sensors. We maintain our equilibrium and body position in space with our vestibular system, which serves as our central source of balance. Additionally, it aids in maintaining our sight of the object we are focusing on even while our heads and bodies are moving.

You may have symptoms such as tinnitus (ear ringing), vertigo, balance issues, dizziness, or loss of balance when the vestibular system isn't working properly. Problems with the vestibular system are increasingly prevalent as we age. In fact, among elderly patients, symptoms of dizziness are the most common reason for doctor visits. (more info on that)

Defining concussion 

Although concussions may happen to anybody, they are more frequent in contact sports, the workplace, and older people. A mild traumatic brain injury is a concussion. A direct hit to the head or a quick acceleration-deceleration force to the brain can cause concussions. These forces can either be rotating or linear. (usually combined). 

Microstructural damage to the brain results from this trauma in the form of shearing and stretching forces that cannot be seen on an MRI or CT scan. As a result, imaging after a head injury is only done to check for brain bleeding. You most likely had a concussion injury if the MRI was clean.

What is BPPV (Benign Paroxysmal Positional Vertigo)

Imagine turning over in bed one morning, getting up, and then experiencing severe vertigo that causes you to feel as though the room is frantically whirling around you. These are typical signs that benign paroxysmal positional vertigo is beginning to develop. This happens when crystals in the inner ear move from the three semicircular canals to the otolith organs, resulting in an acute feeling of vertigo. In such cases, getting vertigo treatment in Calgary or a clinic nearby is important.

It frequently happens following a blow to the head (such as a concussion or injury sustained in a vehicle accident) or after having your head tilted back for an extended time. Most instances, however, are unknown in origin. BPPV is more likely to affect those who have suffered a head injury, are older than 50, or have been sedentary for a long period.

BPPV may be treated with physical therapy quite successfully. Your therapist can establish the location of the troublesome crystals. Afterward, the physical therapist will lead you through canalith-repositioning maneuvers to return the crystals to their appropriate resting spot. BPPV treatment is frequently rapid, taking just one to three sessions.

Vestibular rehabilitation

Vestibular therapy may not necessarily be required if you have vestibular symptoms after a concussion. You could suffer from benign paroxysmal positional vertigo (BPPV) caused by crystals that have been dislodged in the inner ear's semicircular canals while they should be at a different location. In essence, these loose crystals might cause dizziness. The good news is that vestibular therapists may use specific techniques to reposition the crystals from the semicircular canals to where they belong. Often, as this is finished, the dizziness also goes away. 

However, there are situations when lingering dizziness that is not vertigo requires vestibular therapy. In addition, there are other causes of vestibular dysfunction after a concussion that cannot be resolved with straightforward techniques because they involve processing mistakes rather than dislodged inner ear crystals. Therefore, vestibular therapy should also consider these causes of vestibular impairment. 

In essence, vestibular rehabilitation relies on the vestibular system's adaptation, replacement, and habituation to reestablish normal gaze stability and postural control. Vestibular compensation takes the form of adaptation, habituation, and replacement, and when they are successful, they can result in complete or almost complete symptom relief. There may, however, be a maximum point of recovery depending on the malfunction. Regrettably, this depends on several variables that require too much time to detail. 

Additionally, neck pain or oculomotor system malfunction can cause vertigo and dizziness. A well-informed and thorough examination should determine which system is primarily at work because these systems are frequently addressed differently. Quite frequently, many systems are in operation. 

Types of exercises physiotherapists might employ 

Exercises for adaptation assist in improving the vestibular-ocular reflex (VOR) and strengthen the neural pathway that connects our ears, eyes, and brain.

Exercises involving substitution teach the body to use information from the eyes and other joints to tell us where our body is in space. These exercises can assist in teaching our eyes to focus on a goal without causing us to lose our equilibrium.

During habituation exercises, the vestibular system gets worn down by repeatedly exposing a patient to an irritating stimulus. As the system adjusts to the new stimuli, the severity of the vestibular dysfunction decreases.

In certain circumstances, the duration of treatment for vestibular hypofunction might range from a few weeks to a few months. Vestibular rehabilitation can assist in lessening and controlling symptoms of some illnesses and completely eradicate symptoms of others, enabling the patient to lead a more normal life.