Dizziness is a symptom of the way the brain is interpreting something that is not right. The feeling can be described as wooziness, unsteadiness, light-headedness, spinning, and many more descriptions. It’s your feeling and often quite frightening. And you want help to understand what it is and how to get rid of it.
Dizziness is often associated with a problem with your vestibular system. This is located in your inner ear and provides you with essential information for balance and where your body is in space – whether you are right-side up or upside-down. It is a complex system that collects this information to send to the brain, where it is integrated with other sensory information from your body to keep you moving with smooth and coordinated movements. When things go wrong somewhere in your system, you need help to find out what is causing it and how you can get better.
At Neurospace we look at you very holistically. We take a detailed past and current medical history and description of your symptoms and associated events. We also look at stressors and lifestyle patterns. We then focus our assessment and management on changes to the balance system in the inner ear, the brain and movement control, weaknesses and biomechanical changes that exacerbate unsteadiness, and psychological factors that might exacerbate the anxiety around symptoms. If there are things that are beyond our capability to manage such as undiagnosed neural issues, heart or other medical issues we will recommend further investigation.
Dizziness often presents in very clear patterns of symptoms and signs. Using these patterns, we can make a diagnosis with confidence. Confirmation may be sought with additional testing by an audiologist, but it usually does not change our management.
Our team is led by Deborah Carrera who has been working with vestibular clients since training in the vestibular field in 1991 in America. She then went on to do her Masters by research with people experiencing dizziness. She has taught courses for the APA about Vestibular work and trains our Neurospace team in her approach to dizziness assessment and management.
What conditions can we help with?
This is a biomechanical problem where very small calcium crystals in your inner ear that detect movement, are moving in the wrong part of the balance canal system. This distorts the sensory signal going to the brain. You will often get an intense sensation of the room spinning, usually with a particular movement such as rolling over in bed. The symptoms will resolve within seconds to minutes but will return again with the aggravating movement. The cause is often unknown, it tends to occur in older women starting to get osteoporosis changes but will also occur in younger people. The onset can be associated with falls, a blow to the face, excessive jaw clenching or in association with other vestibular issues such as Meniere’s disease.
Treatment is quite simple, using a sequence of head movements called ‘Manoeuvres’ to reposition the loose crystal back into the correct place. The type of manoeuvre depends on the assessment finding (there are three interlinked canals that can cause this problem) and is often successful in just one to two sessions. We usually resolve the initial symptoms with one treatment but can also help manage concurrent symptoms and problems you have in other areas of your body.
We strongly recommend you don’t do by these manoeuvres yourself, as performing the wrong manoeuvre can make your symptoms much worse. We find this particularly with the Brandt Daroff technique which is distressing and often damaging to your neck. There is also evidence to support that this method is often unsuccessful in repositioning the crystals.
Vestibular hypofunction refers to decreased or insufficient functioning of the vestibular system. There are several conditions under this umbrella – age-related changes, Meniere’s, vestibular neuronitis and labyrinthitis.
Age-related changes due to sensory loss in the ear. Symptoms are usually around feeling unsteady with associated hearing loss. We work with you to improve your balance, addressing sensory and musculoskeletal changes and working through a systematic program to improve your stability in a range of environments.
Meniere’s is a fluid imbalance in the ear causing a feeling of fullness and dizziness, with symptoms of hearing loss and unsteadiness. We help manage this by improving fluid movement around the ear with laser therapy and restoring balance.
Vestibular neuronitis and labyrinthitis are caused by a viral infection along the vestibular nerve or within the ear itself. You may feel very unwell with nausea and vomiting and very unsteady, often unable to walk. The symptoms are worse where we find concurrent issues related to neck or body weakness. We use laser therapy to help the nerve heal and restore the capacity of the balance system with exercises for sensory integration, coordination, core control and functional strength. If there is permanent damage to the balance mechanism, we look for compensatory measures you can use to improve your function.
Other causes of vestibular hypofunction can be loss occurring with acoustic neuroma removal, facial fractures and even in association with whiplash. We work with you to improve your balance, addressing sensory and musculoskeletal changes and working through a systematic program to improve your stability in a range of environments.
In cervical vertigo, the cause of your dizziness is your neck rather than the vestibular system. There are many sensors in the neck; we have many joints, spinal discs, muscles and fascia. The joints and trigger points in the neck muscles can refer an error message to the brain that is interpreted as dizziness. Triggers can be varied: this can occur just sitting at a desk, reading, or can be associated with turning your head. The symptoms can start as a result of posture changes or secondary to neck injury and whiplash. Symptoms are exacerbated with poor neck posture and over-use of the arms, when standing up or in use of a walking frame. We see further worsening is if the neck is used as a strategy to balance rather than the hips and ankles.
Our management includes understanding why the neck is reactive and addressing the underlying causes, which can be postural, asymmetrical muscle weakness, poor activation of the stabilising muscles etc. Our treatment is holistic, aiming to restore symmetry, mobilising parts of the neck if needed, and strengthening not only the neck muscles but the whole body in order to support the neck. As strength and alignment are corrected balance retraining is introduced. Concurrently other strategies to manage stress can be used. A tight jaw can also be a contributor to dizzy feeling and may be addressed with the neck.
Migraines can give dizziness with or without any headache. There is debate about the cause of migraines. We treat the migraine following the Dean Watson headache approach, where most of the symptoms can be improved by treating and managing your neck. We then follow a rehabilitation pathway similar to cervical vertigo to give you optimal recovery and function.
The feeling of unsteadiness is quite different from the spinning vertiginous feeling that is part of BPPV. Usually you will feel fine when sitting but feel worse when you stand up and move around. Here we try to identify and address all the factors that contribute to the unsteadiness and work out how to manage them to tune up the total body system to be the best it can be. This includes looking at footwear, skeletal alignment, strength, and maximising use of all the senses and motor control. We offer a 6-week Balance program, offered as a shared session, to help improve your steadiness in a systematic way and integrate improvements into functional activities.
In some cases, we will recommend a walking aid and can suggest supports that suit your lifestyle. Occasionally we recommend and fit foot and ankle supports to further enhance your stability.