Is vertigo stopping you from living a normal life?

Does this describe you?

• Are you suffering from dizziness or vertigo that is ruining your every-day life?
• Is your dizziness or vertigo starting to take over your life?
• Is it stopping you doing the things that you love doing?
• Are you worried that your dizziness will reduce your independence or even stop you spending time with your family and friends?
• Do you already find yourself avoiding social interaction and not wanting to leave the house?
• Are you starting to worry that this will not get better and never go away?

At Wandsworth physiotherapy and osteopathy our highly experienced vestibular physiotherapists treat people just like you and help them get back to what they love doing without the fear of further episodes of dizziness or vertigo.

Balance function comes from a combination of the input from our eyes, ears (including hearing as well as the vestibular organs – the otoliths, semi-circular canals and vestibular nerves) and proprioception from the sense of our feet being on the floor and the position of our posture and our joints that are sensed in our brain. Our brain processes all this information to establish where we are in space and our balance. Dizziness can be caused by faults in these systems.

Commonly one or both of the vestibular organs (the semi-circular canals) become dysfunctional or the vestibular nerve becomes inflamed and we can suffer from sudden onset, severe, transient vertigo/dizziness. This can be extremely stressful inducing nausea, vomiting, anxiety, panic attack, dizziness and falls.

There are a number of different conditions that can affect balance and require vestibular physiotherapy. Some are more serious than others. We can help to diagnose these problems for you and where necessary, refer you to your GP or A and E. However we can help to manage the symptoms of these disorders:

• Benign Paroxysmal Positional Vertigo (BPPV)
• Vestibular Neuritis
• Labyrinthitis
• Ménière’s disease
• Vestibular migraine
• Persistent Postural Perceptual Dizziness (PPPD)

BPPV

BPPV is the most common vestibular disorder. This happens when crystals become dislodged in the semicircular canals in the inner ear. This causes short episodes of dizziness when moving your head from side to side, rolling in bed or when looking up or down.

BPPV can be assessed and diagnosed from your symptoms and by using a Dix-Hallpike manoeuvre or head roll test. BPPV can affect the posterior semicircular canal and is very effectively treated with The Epley manoeuvre or Semont manoeuvre to try to remove and settle the crystals from the inner ear. BPPV can also affect the lateral semicircular canal and a head roll test and BBQ roll or Gufoni manoeuvre is useful. There are home exercises that can be used as well such as the Cawthorne-Cooksey exercises or the Brandt-Daroff exercises.

Acute Vestibular Syndrome

Another condition that causes dizziness is an infection of the vestibular nerve in the inner ear disrupting your sense of balance. This is called vestibular neuritis. Viral infections of the inner ear are the most common cause of vestibular neuritis and cause anything from mild to severe dizziness, spinning and sometimes nausea and vomiting. Bouts of dizziness are distinctly different from BPPV in that they can last for longer than 24 hours and can be accompanied by nausea and vomiting. Using a head impulse test can be useful in helping to make a diagnosis with a catch-up saccades often occurring on the positive side.

Treatments can include the short term use of medication for a few days whilst the worst of the symptoms pass, mobilisation and massage to the neck area, acupuncture and the guidance through specific vestibular rehabilitation exercises such as the Cawthorne-Cooksey exercises or Feldenkrais exercises.

Labyrinthitis 

Labyrinthitis is often used to describe the same condition. However, people with labyrinthitis usually experience hearing loss as well as balance problems and dizziness. This often occurs after a upper respiratory tract infection such as sinusitis.

Ménière’s disease

Ménière’s disease is a condition of the inner ear that causes sudden attacks of vertigo (feeling like the room is spinning), tinnitus (ringing in the ear), a feeling of pressure in the ear and hearing loss and sometimes drop attacks. It can be quite debilitating and is difficult to diagnose and can often be a diagnosis by exclusion. Although there are no easy fixes to this coping and management strategies are readily used.

Find out more about Ménière’s disease here.

Vestibular migraine

Vestibular migraine involves bouts of dizziness that are accompanied by headache or migraine symptoms. Read more about migraines here.

More serious causes of sudden onset severe dizziness accompanied by unsteadiness on your feet, nausea, vomiting could be indicative of having a stroke and needs urgent assessment in A and E.

Find out more about vestibular migraine here.

All appointments are secured with payment. All appointments cancelled within 24 hours of the start time or not attended will not be refunded.

We will endeavour to assess your symptoms of dizziness as well as the range of motion in your shoulder, neck and jaw and put a treatment plan together to restore optimal movement in these area. This may include joint mobilisation and massage, as well as acupuncture.

We can use canal repositioning manoeuvres that are so effective for BPPV. We will also put together and guide you through specific vestibular rehabilitation exercises to help you manage the symptoms of your dizziness.

Vestibular rehabilitation is about adaptation, habituation and substitution incorporating customised physiotherapy exercises

• Adaptation – recovery of vestibulo-occular reflex (VOR) and vestibulo-spinal reflex (VSR). Herdman’s gaze stabilisation exercises for VOR (low to high frequency – do until point of symptoms). Gaze shifting and training saccades.
• Habituation – reduce symptoms by repetitive exposure to the movement and sensory stimulation evoking dizziness.
• Substitution – re-weighting of the other senses (vision, proprioception, vestibular). This includes proprioception exercises such as training the VSR: stand and close eyes doing Romberg’s test and progressions.
• Management of stress anxiety.

We can also help those with Persistent Postural Perceptual Dizziness (PPPD), which is a chronic dizziness disorder. Our latest understanding is that this develops through having an initial episode of dizziness, that then radically changes behaviour leading to fear and avoidance of dizzy spells, reinforcing a lack of movement, stress, anxiety and avoidance of everyday life.

Meet The Team