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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Persistent pain in the upper and lower limbs

I have treated several patients suffering from persistent pain in the upper and lower limbs. Despite imaging exams that did not reveal lesions in the painful region, and despite having undergone other treatments, these patients continued experiencing symptoms. In most of these cases, the main cause of the issue can be found above or below the problematic area. As an example, pain in the elbow can be triggered by a biomechanical issue at the wrist, or originate from the neck due to the nerve connections. By a similar reasoning, a lack of hip or ankle joint mobility, or nerve irritation stemming from the low back, can lead to knee pain. A detailed assessment will allow us to formulate a treatment plan that will consist of manual therapy and specific exercises. For further information, or to schedule an appointment with me, please leave me a message at 514-934-2334 ext 509.

Headaches

There are certain types of headaches that can be treated by physiotherapy. Joint stiffness in the neck, and tension in the upper back as well as in the sub-occipital muscles located at the back of the neck and just below the skull can provoke headaches. The treatment regimen consists of manual therapy (joint mobilizations) and specific exercises. If, however, you are experiencing intense and unrelenting headaches, it is strongly recommended that you consult a doctor.

Diaphragmatic Breathing

Diaphragmatic breathing involves the adequate contraction of the diaphragm while breathing in. Many people tend to overuse the muscles of the neck during respiration, which can lead to negative consequences:

 - pain in the neck and upper back due to excess muscle tension and stiffness in the spine and ribs
- a reduction in oxygen intake by the lungs due to the insufficient contraction of the diaphragm, which acts as a pump
- pain in the low back and the pelvic area resulting from a decrease in diaphragmatic contraction, which can contribute to a lack of muscular stabilization in the back and the pelvic region

A method for practicing diaphragmatic breathing:

- place the hands on the abdomen
- take a deep and slow breath through the nose while applying a light pressure on the abdomen with the hands to stimulate contraction of the diaphragm
- exhale slowly through the mouth

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924606/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183256/

For further information, you can contact me at 514-934-2334 ext 509.

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.