Why You Should Make All Care Physiotherapy Your Vestibular Physiotherapist in Brisbane
All Care Physiotherapy are specialists in treating Vertigo. We are based in the Brisbane CBD but we see clients from all over Brisbane who come to see us overcome their bout of vertigo.
Let us discuss the path of treatment of our recent client, Ellen, who we have seen recently and an explanation of the anatomy behind the cause of vertigo and why our treatment is effective.
Ellen was a 54-year-old office worker who woke up one morning to get ready for her day. As soon as she sat up, she suddenly felt the room start spinning! Poor Ellen felt extremely nauseous and nearly vomited, but after she sat still for a while the symptoms settled.
Ellen kept getting ready for her day morning, moving very slowly. She found it easier to keep her head completely still because whenever she turned her head from side to side she felt a mild sense of the room spinning again.
Everything was going ok until Ellen sat down and lent forward to tie her shoes up. She suddenly felt the room spinning again, along with the nausea and vomiting. Ellen realized that her dizziness hadn’t gone and she was worried she wasn’t going to be able to get through the day at work, so booked an appointment with her GP.
Ellen’s GP suspected that she might have had a condition called BPPV, or Benign Paroxysmal Positional Vertigo, and referred her to a Vestibular Physiotherapist at All Care Physiotherapy.
What is BPPV?
Benign = not harmful or dangerous
Paroxysmal = sudden in onset
Positional = affected/brought on by changes in position
Vertigo = a false sensation of spinning/dizziness
To understand what BPPV is, we need to look at the vestibular system in a little more detail. Your vestibular system, along with your cochlea, make up your inner ear. You have one on each side of your head.
Your vestibular system is made up of:
- 3 semicircular canals (anterior, horizontal, posterior)
- 2 vestibular organs: your utricle and your saccule
In each of your vestibular organs, there are receptor cells that send signals to your brain about how you are moving. On top of these receptor cells, there is a gelatinous membrane that contains calcium carbonate crystals called otoconia. These crystals make the receptor cells in the vestibular organs respond to gravity when you move your head.
Sometimes, these crystals can become dislodged from their membrane, and they can then enter your semicircular canals. Normally, your semicircular canals only contain fluid. However, once these calcium carbonate crystals (otoconia) enter your semicircular canals, they disrupt and alter the signals going from your inner ear to your brain.
This means your brain is receiving mismatching information between your affected inner ear (where the crystals are) and the other systems that are responsible for telling your brain how you are moving (including your other inner ear, your eyes and the joints and muscles in your body).
In response to the mismatched signals, your eyes will jerk around quickly and involuntarily. This is called nystagmus. This all results in you developing vertigo and you will feel dizzy, nauseous and like the room is spinning!
How Can All Care Physiotherapy Help with BPPV?
Caitlin, our vestibular physiotherapist, has extra training to be able to assess whether or not you have BPPV, and exactly identify which canal the crystals are in. Based on this, she can then treat your vertigo by pinpointing which canal is affected by the otoconia crystals.
To test for BPPV, Caitlin will use infrared video goggles to assess and record the movements of your eyes when your head is moved into different positions to test each of the individual canals. Using the goggles to assess the eye movements (nystagmus) is crucial to diagnosing which canal is involved and then specific treatment can be directed to resolve your BPPV. These tests will often reproduce your dizziness and symptoms; however this is important to help correctly diagnose your BPPV and instigate a successful treatment outcome.
Once Caitlin has determined where the crystals are with the positional testing, she is then easily able to treat your dizziness with crystal repositioning manoeuvres. These manoeuvres involve moving between 3-4 positions slowly, moving the crystal around the canal and out of the open end, back into the organ where it came from. Once the crystals have been put back into the vestibular organs, they can be absorbed by the body and will not be able to enter the canals again. This resolves symptoms of BPPV.
So What Happened to Ellen?
Ellen came to see Caitlin at All Care Physiotherapy and was lucky enough to get an appointment that afternoon.
She had a thorough assessment where Caitlin asked many detailed questions about her dizziness, including her main and any associated symptoms, aggravating and easing factors, and any past medical history. Caitlin then looked at the movements of Ellen’s eyes to exclude any other potential pathologies. Ellen also had her head/eye coordination assessed, as well as her balance. Then, Caitlin got Ellen to put the infra-red video goggles on and did the positional tests with her.
Based on Ellen’s testing results, Caitlin was able to determine that Ellen had a right sided posterior canal BPPV, which she treated using an Epley manoeuvre. Ellen felt dizzy again during the assessment and the treatment, however Caitlin reassured her that this was normal. After the treatment, Ellen was advised to wait in the clinic for 20minutes or so to ensure she felt balanced enough to walk safely. That night, she to sleep a little more upright than usual to ensure the crystals remained back in her vestibular organs, where they could be absorbed.
Ellen went back to Caitlin three days later and she was feeling much better! Since the treatment, she had not experienced any episodes of room spinning dizziness and had a vague floating feeling that was getting better each day the more she moved. At her next treatment, Caitlin assessed Ellen with the goggles again, which did not show that she had any crystals in her posterior canal anymore. Caitlin treated Ellen with another Epley maneuverand also taught Ellen how to do this herself in case her vertigo returned. Ellen started doing some vestibular rehabilitation exercises as well, to ensure that floaty feeling was gone.
Ellen saw Caitlin another 2 times over the next 2 weeks. She still had no room spinning dizziness or any floaty feelings andher symptoms were completely resolved. Ellen was back to normal doing her morning walks and yoga with friends and was over the moon her BPPV was resolved.