VERTIGO & VESTIBULAR PHYSIOTHERAPYOur physiotherapists will screen for vestibular conditions that can be responsible for symptoms of dizziness, nausea, difficulty with gaze stability, involuntary eye movements or vertigo.
What is Vertigo and Vestibular Rehabilitation?
Our physiotherapists will screen for vestibular conditions that can be responsible for symptoms of dizziness, nausea, difficulty with gaze stability (often with reading/phone use, especially in the car/plane or while walking), involuntary eye movements (nystagmus) or vertigo. Vertigo is a specific kind of dizziness defined as the illusion of the movement occurring in the environment (often described as the room spinning), while dizziness usually refers to a person feeling off-balance/light-headed or disorientated. As there are many causes of dizziness other than the vestibular system, including the cardiovascular system, neurological dysfunction, and visual dysfunction, we will do a thorough history and then a series of assessments to determine whether the vestibular system is contributing to your symptoms. If we do not think the primary contribution is the vestibular system, we will ensure an appropriate referral is made. Vestibular system disorders are often seen with head trauma (eg: whiplash, concussion), in older individuals, vestibular neuritis (infection), Meniere’s disease or those that have had direct damage through pressure trauma to the ear, acoustic neuroma or ototoxicity. Once we assess your condition, we will prescribe exercises that are specific to your deficit (these may involve vision exercises, vision and head movements, balance and much more) and that can easily be performed at home.
The most common cause of vertigo is BPPV (Benign Paroxysmal Positional Vertigo), which is often provoked by looking up, lying down flat quickly, bending forward and rolling in bed. It is a biomechanical problem that is assessed in the clinic, and if confirmed to be BPPV, can often be treated in 1-3 sessions.
We recommend that you bring a friend or family member with you on your first session, as your symptoms will be provoked during the assessment, which can make driving difficult.
Physiotherapists Specializing in Vertigo/Vestibular
Frequently Asked Vertigo / Vestibular Questions
What does a vestibular physiotherapist do?
A vestibular physiotherapist is a specialty-trained physiotherapist who can identify the problem in one’s vestibular (vestibular apparatus), or the sensory mechanism in our inner ears that help us keep our balance when we are walking or moving. A vestibular physiotherapist will make a comprehensive clinical assessment, check the patient’s medical history and symptoms to find out the cause of their vertigo, administer different tests to evaluate the patient’s condition, suggest a therapy that suits you best (manual therapy, or therapeutic exercise, occupational therapy, etc.) create a rehabilitation program that can promote central nervous system compensation through exercise-based practices, and create a program to improve the patient’s symptoms and balance disorders. The patient will then be advised on how they can control, improve, and adapt to the symptoms of dizziness or vertigo in their daily life. Part of vestibular rehabilitation therapy is a home exercise program that should be done regularly by the patient. This treatment plan is tailor-made to the patient’s condition and will be prescribed to ease the symptoms of his vestibular disorder. With consistency in performing these exercises, the symptoms should decrease over time, with the goal of resuming regular activities.
For individuals who are looking for a reliable vestibular physiotherapist in Vancouver BC, book a physiotherapy appointment with any of our practitioners today and let us help you boost your well-being and improve your quality of life.
Can I receive vestibular rehabilitation over tele-rehab (online physiotherapy)?
Absolutely! We offer our vestibular rehabilitation service over tele-rehab or our online physiotherapy services, especially to those who cannot attend appointments in person. Let our vestibular physiotherapist here in Vancouver help you manage your health from the convenience of your own home. If you are in need of vestibular therapy, we might just have the best treatment plan for you. We customize vestibular rehab exercise programs and provide you a home exercise that you can practice wherever you are, as well as strength and conditioning exercises based on your vestibular assessment and hearing test made. For management of sports injuries and injuries acquired from motor vehicle accidents, we offer our injury management consultation services, and we can set up rehabilitation plans, and do our post-operative follow-ups to check in on your vestibular condition.
However, if you feel like your dizziness or vertigo is triggered by eye or head movements, or if you have noticed that your eye makes an involuntary movement and you can’t control it, then this might be an indication that you are suffering from benign paroxysmal positional vertigo (BPPV). If you have experienced a similar symptom mentioned above, it would be better if you book an appointment soon with a vestibular physiotherapist for an in-person checkup at our audiovestibular clinic, since a series of physical tests and hearing tests will be done to check if indeed, you are suffering from BPPV. Know your vestibular condition, as well as the underlying causes of vertigo, and find the treatment, exercise, and therapy that’s exactly right for you. Feel our virtual care, even from a distance, here at Westcoast SCI in Vancouver BC.
Is vestibular damage permanent?
There are actually inner-ear infections that can cause permanent vestibular damage. If the inner ear infection is caused by a virus, it will either recover, go dormant, or flare up again. The Benign Paroxysmal Positional Vertigo (BPPV) or positional dizziness is a type of dizziness that is probably caused by labyrinthithis or neuritis. “Neuritis,” is the inflammation of the nerve, while the “labyrinthithis,” is the inflammation of the inner ear or labyrinth, which may result to permanent changes in one’s hearing. By undergoing a vestibular rehab program, the prevalence of vestibular symptoms such as dizziness and vertigo may be experienced on a daily basis at first, but after a couple more weeks of slow recovery, some patients are completely healed and free of these symptoms. Other patients, on the other hand, experience chronic dizziness if the virus has already damaged the vestibular nerve. If the infection is addressed early, then, chances are, the inner ear infections will not cause any permanent damage. This is why it is important that a balance disorder is diagnosed early because it can be a life-changing condition if left untreated.
How do you strengthen your vestibular system?
The vestibular system is made up of three components: vestibular (ears), visual (eyes), and somatosensory (information sent to the brain from pressure, touch, movement, position, temperature, and pain arising from the muscles, joints, and skin). If a disease or injury damages your vestibular system, you will have a vestibular disorder. To avoid experiencing this, there are numerous rehabilitation techniques that can be practiced to strengthen the vestibular system and improve symptoms of a vestibular dysfunction. One of these methods is by doing habituation exercises. This kind of exercise is prescribed to patients who often experience an increased dizziness when they move around, especially when they make sudden head movements. Note that their dizziness increases when they are in a visually stimulating environment. In habituation exercises, the patient is repeatedly exposed to a visual stimuli or specific movements that usually trigger the patient’s dizziness. The patient’s level of dizziness is expected to improve over time, as his brain learns to adapt and ignore the unnecessary signals it receives from the vestibular apparatus, or balance portion of the inner ear.
Another way of strengthening one’s vestibular system is through gaze stabilization exercises. By doing these exercises, one can control his eye movements so that his vision will be clear when doing a head movement. These exercises are appropriate for those who are having trouble seeing clearly while moving, because they see their background bouncing while they are trying to read or identify things around them. Doing these exercise programs are particularly beneficial for patients who have damage to both inner ears and no vestibular function, and to those who are having balance problems.
An essential part of our balance system, aside from the vestibular and visual factors, are our somatosensory receptors. These nerve endings in our feet called “proprioceptors” send information to the brain, which allows the body to control balance and make the right pattern of movements. One way of strengthening and restoring our proprioceptors and improving our balance is by using proper footwear and custom orthotics or shoe inserts. By using such, it can help distribute our body weight evenly, maximize cushioning, and minimize the undue stress in the bones and muscles at the back and lower part of our body.
It is also encouraged to practice proprioception training to improve one’s balance, knee strength, and walking speed on different terrains, since strength training exercises were found to enhance neuromuscular functions and reduce pain.
Does physiotherapy help with vertigo and other vestibular symptoms?
Research has shown that physiotherapy or vestibular rehabilitation improves one’s balance and helps decrease vertigo and dizziness symptoms. By working regularly on an exercise program, the symptoms will improve over time. With the help of a trained physiotherapist, a patient suffering from vertigo will be given a program of exercises that he can do at home. Some good examples of home-based exercises that one can practice to improve balance are tai chi, low-impact aerobics, and clinical Pilates.
For a patient who got involved in a motor vehicle accident, an active rehabilitation kind of physiotherapy is highly recommended. Doing the active rehab exercises can correct one’s posture and muscular imbalances, improve the patient’s mobility and flexibility, and reduce soft tissue pain.
If a patient is suffering from post surgery pain, poor motor control, muscular weakness, low back pain, or tendonitis, your physiotherapist might advise him to have an electrical stimulation as part of his treatment plan.
There is also a holistic approach that can help reduce neck pain and symptoms of vertigo, and that is through massage therapy. A trained and licensed massage therapist can do the Epley maneuver, which is usually recommended for those suffering from Benign Paroxysmal Positional Vertigo or positional vertigo.
Another good alternative to major surgery and painkillers that can help reduce symptoms aside from massage therapy, is shockwave therapy. Those who have suffered with chronic neck, knee, and back pains, tendonitis/ tendinosis, tennis and golfer elbow, and Achilles tendinopathy among other chronic complaints, will benefit from this treatment. Shockwave therapy is a nonsurgical, noninvasive, local kind of treatment, wherein a device is used to direct the shockwaves on the affected part of the body that needs healing. This kind of treatment can be used in a sport setting for an athlete or non-athlete, whose injuries aren’t responding to first-aid treatments such as ice, rest, orthotics, bracing, and therapeutic exercise.
You may also request to add acupuncture as part of your vestibular rehabilitation program. We offer an intramuscular stimulation IMS or acupuncture needle treatment that uses dry needling technique to treat stiff muscles and reduce pain.
If, on the other hand, you don’t want any equipment to be used to relieve your pain, then the manual therapy is the right kind of treatment for you. In this method, a physiotherapist will do a variation of massage and stretch techniques to your joints, ligaments, and tendons to promote healing in the affected parts of your body.
To manage chronic pain, you may consider undergoing occupational therapy. Your physiotherapist will be able to help you adapt to pain and still let you do your daily activities with this kind of treatment plan.
For patients suffering from concussion symptoms, such as dizziness, vertigo, nausea, and headache, a concussion rehabilitation is recommended for them.
As for cyclists who are suffering from joint and muscular pains, physical therapists advise a proper bike fitting evaluation. What can be a good indicator that it’s time for you to have a bike fit? When you ride your bike for an hour or less and you already feel pain and discomfort, it means you either need a new bike or you need to have parts of your bike adjusted to match with your flexibility, strength, size, or movement disorders.
Achieve the best outcome from your treatment. Seek medical advice from a trained vestibular physiotherapist who is experienced at treating symptoms related to disorders in the vestibular system. Check out our vestibular rehabilitation services in Vancouver BC here at Westcoast SCI.
How long does vestibular physiotherapy take?
Patients suffering from vestibular disorders who need to undergo vestibular physiotherapy are usually advised to finish the advised rehab program in about 6 to 8 weeks. Note that there are a couple of factors that need to be considered to see how long a patient should go through vestibular therapy. The number of physical therapy sessions will depend on the diagnosis of the patient, the severity of symptoms, and how the patient reacts to treatment.
What is the most common symptom of a vestibular disorder?
The most common symptom of a vestibular disorder is dizziness vertigo. The cause of vertigo is due to the dysfunctions in the vestibular structures in the central nervous system. Other symptoms include falling or going off balance, disorientation, having neck pain and blurred vision, while the uncommon symptoms include vomiting, nausea, diarrhea, and feeling anxiety or a change in one’s heart rhythm.
Can anxiety cause vestibular problems?
Anxiety, depression, and panic usually occur with vestibular problems, and these can actually make it harder for people with vestibular disorders to manage their symptoms. It is advised that patients with vestibular problems, who also have mental health concerns, to seek professional counseling to be able to deal with the emotional toll that goes with coping from a chronic illness.
How often should you do vestibular rehabilitation exercises?
Patients suffering from vestibular disorders who need to undergo vestibular physiotherapy, are advised to do it at least once or twice a week for about 6 to 8 weeks.