Many people have experienced some form of “dizziness” in their life. Dizziness is a broad term often used to describe symptoms such as vertigo, disequilibrium, giddiness, faintness, syncope, light-headedness or imbalance. While these terms get used interchangeably, they represent states of dizziness with distinct and very different symptoms.
- Dizziness is the feeling of light-headedness, giddiness and unsteadiness.
- Disequilibrium is the feeling of being imbalanced and is a sensation of being disorientated within your surroundings.
- Syncope is losing consciousness and fainting.
- Vertigo is a sensation that you, or the room you are in, is in motion and is commonly felt like a spinning sensation.
Our ability to remain balanced is determined by information received from our peripheral balance systems such as our eyes (visual system), ears (vestibular system) and sensory nerves in our muscles, joints, tendons and ligaments (proprioception). Our central nervous system (brain, spinal cord, nerves) receives this information and then must process it to maintain our balance and keep our eye line level.
Problems occur when something goes wrong with any one of these systems. It can be normal for someone to have problems occurring in more than one system. Physiotherapists commonly assessment and manage peripheral balance disorders. These include BPPV, dizziness caused from the neck and changes to our balance input systems; injuries such as ankle sprains or knee injury or poor balance due to ageing.
Vestibular – Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo, or BPPV, is a very common cause of dizziness seen and treated by physiotherapists. It is one of the leading causes of vertigo in adults (Bhattacharyya et al 2008) and is very common as we age, thought to occur in up to 50% of vertigo reported by the elderly (Oghalai et al, 2009) and can be the cause of 20% of vertigo seen by General Practitioners in all age groups (Uneri and Turkdogan, 2003).
The symptoms of BPPV are usually quite distinct and are triggered by changes in head position relative to gravity. Typically someone with BPPV will set off their symptoms by a simple movement such as rolling in bed or looking up to hang out the washing or reach for something up high. It is often referred to as “top shelf vertigo”. Symptoms usually have a slight delay of 5-20 seconds between head movement on the onset of vertigo. Episodic vertigo felt by those suffering from BPPV is usually no longer than 60 seconds in duration. It is normal to feel nauseous and a bit “woozy” or off balance in between discrete BPPV episodes.
The cause of BPPV occurs within the inner ear. The inner ear is made up of the cochlea, which is the hearing centre; and the vestibular system which detects rotational, vertical and sideways movements of the head. BPPV occurs when small crystals (otoconia) form and are dislodged (from head trauma, infection, or just age) within the semi-circular canals of the vestibular system. With movements of the head, and incidentally the inner ear, these crystals will move about, giving the incorrect sense that you or the room is spinning.
BPPV can be diagnosed quite simply. Your physiotherapist will take a thorough history of your symptoms and general health. The examination process is not exhaustive and will likely encompass:
Another common cause of dizziness seen by physiotherapists is neck pain or neck-related headaches. Neck pain caused by injury or dysfunction of cervical joints, muscles or nerves will alter the sensory information received by the brain. As this information is compiled by the central nervous system along with information from the eyes and inner ear; conflicting input from the neck will add confusion to the processing of this information and in turn can result in dizziness. In some people, neck pain does not cause dizziness because they are able to compensate well and their brain is able to ignore the incorrect information.
Cervicogenic dizziness is diagnosed with a careful history and physical examination in order to exclude other peripheral or central causes of dizziness. Key criteria for cervicogenic dizziness is the presence of neck pain with a restricted range of movement and reproduction of symptoms with an assessment of the neck (joints, muscles, proprioception).