Dizziness and Vestibular Rehab

Balance control is made up of 3 components: vision, proprioception, and the vestibular apparatus of the inner ear. All three work in concert to orient us within our physical environment. When there is a problem with one of these elements, it causes balance issues including dizziness and vertigo.

Dizziness means a sensation of instability in space. Vertigo is the phenomenon whereby one has the impression that their surroundings are spinning around them.

The most common vestibular diagnosis that physiotherapists treat is BPPV (benign paroxysmal positional vertigo). Within the vestibular apparatus of the inner ear (consisting of three semicircular canals), there are very tiny crystals that are fixed onto hair cells, which transmit information about the position of the head to the brain. In BPPV, these crystals have become detached from the hair cells, which confuses the signals coming from the vestibular apparatus and consequently elicits vertigo. To remediate this issue, the physiotherapist prescribes specific maneuvers to remove the detached crystals from the affected semicircular canal.

Dizziness is also one of the concussion symptoms that physiotherapy can address. Due to the cerebral trauma leading to a concussion, the coordination of various cerebral processes such as the oculomotor reflexes is disrupted. The oculomotor reflexes refer to the automatic eye movements that occur in response to the head movements. When these reflexes are affected, dizziness can ensue. In physiotherapy, the patient performs progressive exercises that improve the coordination between the eye movements and those of the head and body.

Cervicogenic dizziness is another form of dizziness which is caused by excess muscular tension and stiffness of the neck (cervical) vertebrae. Muscles and ligaments particularly those of the neck contain proprioceptors, which are nerves responsible for the orientation of the body part controlled by the muscles and ligaments. When there is significant tension and stiffness in the neck, the signals coming from the proprioceptors become confused, which can cause dizziness. Through manual techniques and certain exercises, physiotherapy can help resolve this problem.

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The Thoracic Region: an area less often explored

When talking about back pain, upper and low back issues are commonly seen. Even though we do not often hear about pain in the thoracic region (the mid-back), it is nevertheless an area that plays a significant role in problems in other segments of the spine and even in the arms.

Considering the spine is a chain, issues that arise in the neck and in the low back can indeed come from the thoracic spine. A significant lack of mobility or faulty biomechanics in the thoracic zone can lead to pain and tension in the neck, the lumbopelvic area (the low back and the pelvis), the shoulders, and the arms. The fact that arm movements entail vertebral movement and muscle activity in the thoracic area demonstrates the link between these two parts of the body. Therefore, treatment of the neck, the low back, the shoulder, and the arm can involve the thoracic region.