Impacting the systems that give us balance, coordination and a sense of where we are in space, the likelihood of suffering from vestibular conditions – bringing on dizziness and vertigo – increases as we get older.
But such conditions can affect anyone at any stage of life, with a majority of cases remaining unreported. Treatment may be easier and more accessible than you think, though, with hands-on physiotherapy helping to reduce the symptoms and desensitise the triggers that cause them.
SoGlos chats to specialist vestibular physiotherapist at Cheltenham clinic Pea Green Physio, Paul Jovero, to find out more about vestibular conditions, their causes and how the clinic helps patients regain normal function, through assessment, tailored therapy and ongoing monitoring.
What are the most common vestibular conditions patients can experience?
There are actually two systems in play when it comes to our sense of balance, coordination and movement – the peripheral sensory apparatus and the central nervous system.
Physiotherapy can help with ailments and conditions that arise in the peripheral sensory apparatus, the most common being BPPV (benign paroxysmal positional vertigo), vestibular neuritis, labyrinthitis and Ménière's disease. Vertigo and dizziness are amongst the major symptoms of all of these conditions.
What's actually happening when these conditions strike – and how can physiotherapy help?
Our inner ear has three main canals that give us a sense of where we are in space, where we are in relation to gravity, where we're moving and at what speed. The way our brain makes sense of that is from fluid and very small hair inside those canals.
As our vestibular system deteriorates, calcium carbonate particles can get dislodged and get stuck in these canals or in the main area, which we call the cupula.
This creates a discrepancy between where we feel we are and what the inner ear is actually telling us – that's what causes the vertigo and dizziness.
What we need to do as physiotherapists is determine where the problem lies; and if it is peripheral, which of these canals are affected. Then we need to find ways to get the particles out of the canals or cupula so that they can be naturally absorbed by the body.
Why do they occur?
A majority – between 50 to 70 percent of cases – are idiopathic, meaning no one really knows. Head trauma can contribute up to 20 percent of any of these conditions; and there is also age-related degeneration of the ear.
The vestibular receptors in our ear are lost as we age – their deterioration affects around 35 per cent of people over the age of 40. Vertigo and dizziness actually affects 15 to 20 per cent of adults. This also contributes to falls, as dizziness is the most common presenting complaint to GPs in patients older than 75 years of age.
There are other causes, too. Prolonged bed rest can lead to BPPV, for example. And then there's metabolic factors as well, like diabetes, stress and psychological factors.
What treatments do you offer patients with vestibular conditions at Pea Green Physio?
When patients come to us, we'll conduct a thorough assessment to determine where the problem lies. If it's the central nervous system, we can highlight that early and make referral recommendations to see an ear, nose and throat specialist or a neurologist, for example.
If it's peripheral, we need to determine which of the canals are affected; and then decide on a treatment programme to get those calcium carbonate particles out of those canals or the cupula.
We do hands-on treatment – manoeuvres, as we call them – to reduce that dizziness, which involve turning the head and moving the body, in sitting and lying down positions. These problems never occur in isolation, so there are associated limitations when it comes to balance and coordination – the physiotherapy can help with that, too.
We also do adaptation exercises to help the patient become desensitised to any triggers that may set off their dizziness and vertigo. The aim of all of this is to increase the confidence of a patient in their daily activities and ultimately, to increase their quality of life.
If vertigo causes reduced balance and coordination, we do things like tightrope and other strengthening exercises.
We also do perception training. Similar to a muscle, you can train a person's ability to know where they are in space, because the ears and the eyes are only two of three systems in the peripheral apparatus that help us gain balance and coordination. Up to 70 per cent is actually dependent on receptors we have in our muscles, in our joints and on our skin.
So as physiotherapists, we can do quite a lot in terms of improving a person's ability to know where they are in space, their balance and their coordination.
We take a very personalised approach to rehabilitation, centred around a patient's specific goals – what they want; and the functional ability they want to regain.
What does the ongoing monitoring of that look like?
We provide patients with a personalised home exercise programme to increase balance and coordination, which we monitor. And because that is very centred on what it is they want to achieve, we can very much help them along the way.
It's also about adjusting, fine tuning and monitoring the impact of treatment. We accompany the patient throughout the entire rehabilitation process.
How can people book an appointment with Pea Green Physio?
To book in for an initial appointment for vestibular physiotherapy, patients can call 01242 420810, email info@peagreenphysio.co.uk, or visit peagreenphysio.co.uk.
