Understanding Vestibular Physiotherapy

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Vestibular physiotherapy is a holistic therapy that involves a combination of assessment, education, manual therapy and targeted exercises. Maintaining balance and coordination is a complex task that relies on the seamless interaction of various sensory systems within our body. The vestibular system, located in the inner ear, plays a crucial role in this process. The vestibular system is highly integrated with our vision and our positional awareness. Many of our position receptors are concentrated in our neck and our feet. When issues arise within the vestibular system, individuals may experience dizziness, vertigo, and difficulty with balance. Vestibular physiotherapy is a safe and effective way to address these challenges and restore a sense of stability to those affected.

Who Benefits from Vestibular Physiotherapy?

Vestibular physiotherapy is designed to assist individuals experiencing a range of vestibular disorders. Vestibular therapy is broad and can be beneficial for a variety of conditions.

Vertigo solutions

Vestibular physiotherapy can be particularly beneficial for individuals who suffer from acute and chronic vertigo. In acute cases, a particle repositioning maneuver such as the Epley is often the best treatment. Some will benefit from vestibular therapy after an acute vertigo episode to help their nervous system readjust after having vertigo. Having multiple episodes of vertigo in the past, having other conditions that affect pressure regulation in the head and torso can make this more likely, as can having a history of motion sickness as a child. In chronic cases addressing the root cause of the symptoms with hands on treatment and targeted exercises is helpful.

Concussion recovery

Those who have suffered a concussion can also encounter vestibular dysfunction. Vestibular physiotherapy can aid in alleviating symptoms such as dizziness and imbalance, helping patients regain their sense of equilibrium in conjunction with traditional concussion rehabilitation. 

Boys playing football

Active aging and fall prevention

Aging can bring about changes in the vestibular system, leading to an increased risk of falls and diminished balance. A study of postural stability in adults over 40 years old found that 35% had dysfunction on the Rhomberg test. In an aging population, 85% of those over 80 showed poor balance and were unable to maintain upright posture when standing with their eyes closed. Vestibular physiotherapy offers tailored exercises to enhance stability, minimizing the risk of falls among the elderly.

Crowded walkway with pedestrians

Inner ear disorders and sinus pressure

Conditions such as Meniere’s disease and vestibular neuritis can disrupt the normal functioning of the inner ear. Those with sinus conditions and allergies can also benefit especially from manual therapy and self drainage techniques. Vestibular physiotherapy can assist in managing these conditions by improving adaptation and compensation mechanisms.

After ear, nose, throat surgery

Some surgical procedures, particularly those involving the ear or head, can impact the vestibular system. Vestibular physiotherapy plays a crucial role in post-surgery rehabilitation, aiding patients in regaining balance and reducing dizziness.

Vestibular assessment

Susannah assessing balance

The key components of vestibular physiotherapy include history taking, assessment of neck movement, eye movement, coordination, balance and positional tests such as the Epley Maneuver.

Vestibular treatment

Vestibular treatment is customized to each individuals condition, goals and needs. It includes a blend of manual therapy, vestibular exercises that target the head neck and eyes, balance exercises, habituation exercises, and education on your condition. Where needed referral is made to the appropriate providers.

Susannah walking a man through a balance drill

Manual therapy

Manual therapy is a key part of treating vestibular conditions. Manual therapy is a hands on therapy that targets the nerves, blood vessels and soft tissues around the inner ear. The dural membrane or meninges are a key structure in the brain that many of the nerves and key blood vessels pass through. Ensuring good movement in the dura allows for accurate sensory information to pass between the inner ear, the neck and the brain. 

A patient recieving manual therapy

Customized exercise programs

Based on the assessment findings, physiotherapists design personalized exercise programs to address the individual’s unique challenges. These exercises may focus on gaze stabilization, head and body movements, and balance training to enhance overall stability.

A patient doing balance work by the ocean

Habituation exercises

Individuals with vestibular disorders often experience symptoms triggered by certain movements. Habituation exercises involve gradual exposure to these movements, helping the brain adapt and reduce symptoms over time.

Susannah teaching motion sensitivity exercises

Education and Lifestyle Modifications

Vestibular physiotherapy includes educating patients about their condition and providing guidance on lifestyle modifications. This may involve suggestions for improved posture, changes in daily activities, and environmental adjustments to minimize triggers.

Referral

When appropriate, At Ease Physio makes referrals to other providers such as your family doctor, optometrist, or neurologist that may be accompanied by a report on the findings.

In conclusion

Vestibular physiotherapy stands as a beacon of hope for individuals grappling with the challenges of vestibular disorders. By addressing the root causes of dizziness, vertigo, and imbalance, this specialized form of therapy empowers individuals to regain control over their movements and enhance their quality of life. Whether it’s managing chronic vertigo, recovering from a concussion, or navigating the effects of inner ear disorders, vestibular physiotherapy offers a tailored and effective approach to fostering stability and well-being. If you or someone you know is experiencing vestibular issues, consulting with a physiotherapist could be the first step toward finding solid ground in the journey towards recovery.

Agrawal Y, Ward BK, Minor LB. Vestibular dysfunction: prevalence, impact and need for targeted treatment. J Vestib Res. 2013;23(3):113-7. doi: 10.3233/VES-130498. PMID: 24177344; PMCID: PMC4069154.

Carender WJ, Grzesiak M, Telian SA. Vestibular Physical Therapy and Fall Risk Assessment. Otolaryngol Clin North Am. 2021 Oct;54(5):1015-1036. doi: 10.1016/j.otc.2021.05.018. Epub 2021 Jul 23. PMID: 34304897.

Galeno E, Pullano E, Mourad F, Galeoto G, Frontani F. Effectiveness of Vestibular Rehabilitation after Concussion: A Systematic Review of Randomised Controlled Trial. Healthcare (Basel). 2022 Dec 28;11(1):90. doi: 10.3390/healthcare11010090. PMID: 36611549; PMCID: PMC9819464.

Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol. 2011 Dec;7(4):184-96. doi: 10.3988/jcn.2011.7.4.184. Epub 2011 Dec 29. PMID: 22259614; PMCID: PMC3259492.

Sedeño-Vidal A, Hita-Contreras F, Montilla-Ibáñez MA. The Effects of Vestibular Rehabilitation and Manual Therapy on Patients with Unilateral Vestibular Dysfunction: A Randomized and Controlled Clinical Study. Int J Environ Res Public Health. 2022 Nov 16;19(22):15080. doi: 10.3390/ijerph192215080. PMID: 36429797; PMCID: PMC9690966.