A Balanced View of Vestibular Physiotherapy

We often take good balance for granted, and don’t often think about the intricate systems controlling our ability to stay upright. Vestibular physiotherapy is the field responsible for all things balance and dizziness, with physios being able to assess, diagnose and treat various disorders of the vestibular system. In this post, we’ll go over the basics of this system, conditions and treatments, and the role of physiotherapy.

The vestibular system: what is it?

Pronounced ‘vest-ib-u-luh’, this system lies deep within the inner ear and controls our sense of balance and spatial orientation. It is comprised of various structures, including semicircular canals, otolithic organs, and vestibular nerve. When one (or multiple) of these structures are compromised, it results in varying symptoms. These can include, but are not limited to: dizziness and disorientation, vertigo, falls, blurred vision, nausea, and ringing in the ears. Injury, illness, and aging can all impact the vestibular system.

Common conditions

Vestibular physiotherapy is effective in managing a wide range of vestibular disorders, including:

·         Benign paroxysmal positional vertigo (BPPV)

·         Vestibular neuritis

·         Meniere’s disease

·         Labyrinthitis

·         Vestibular migraine

·         Post-concussion syndrome

The role of physiotherapy

Physiotherapy aims to address the various dysfunctions that can occur within the vestibular system to help reduce symptoms. All physios receive training in this area, however they can go on to do further training and specialise in vestibular physiotherapy. Through a thorough discussion of symptoms and physical assessment, physios can diagnose vestibular conditions and develop individualised treatment plans to manage symptoms.

Assessment and diagnosis

Your physiotherapist will ask a lot about your symptoms to get a detailed picture – when they occur, duration of symptoms, what eases or aggravates, and associated symptoms like hearing loss. Knowing about your medical history is an important part of the assessment procedure, as things that may seem insignificant or unrelated to you can actually affect the vestibular system, and physiotherapy assessment and treatment.

After this discussion, various physical assessments will be performed depending on the nature of symptoms you experience. These could include looking at balance, eye and head movements, among others. Your physio will explain each of the tests to ensure you know what to expect with each. Based on findings from the subjective and medical history, and assessment procedures, a diagnosis and treatment direction can be determined.

Treatment techniques

Once a diagnosis is established, the physiotherapist develops a tailored treatment plan to address the patient’s specific needs. This plan often incorporates a variety of techniques, including:

·         Balance training: exercises designed to improve stability and reduce the risk of falls

·         Gaze stabilization exercises: targeting eye movement to enhance visual focus and reduce dizziness

·         Canalith repositioning manoeuvres: used to treat benign paroxysmal positional vertigo (BPPV) by repositioning displaced inner ear crystals

·         Habituation exercises: gradual exposure to movements or environments that trigger symptoms, helping the brain adapt and reduce sensitivity

·         Education and lifestyle modifications: providing guidance on strategies to manage symptoms and minimize their impact on daily life.

Further investigations

For certain conditions, you may be referred on for different management instead of physiotherapy. Our job is to identify when patients need more specialised interventions, and refer appropriately when physiotherapy is not the best option for treatment.

A final note

Seeing a physio isn’t a lot of people’s first thought when it comes to episodes of vertigo and nausea. However, physiotherapy management for vestibular conditions not only improves symptoms and quality of life, but can also reduce reliance on medications and prevent recurrence of symptoms in future. Whether you or a friend isn’t feeling quite right on their feet, or has this dizziness they just can’t shake, our team of friendly physios are always here to help get your head back in the game!