Victoria Balance, Dizziness & Vertigo Physiotherapy Clinic

What is Vestibular Rehabilitation?

Vestibular Rehabilitation is the use of specific exercises and manual techniques to eliminate or reduce vestibular, balance and equilibrium problems and their secondary effects. During your initial assessment our specially trained Victoria Physiotherapists Jennifer Kolot or Rosie Chamberlin will identify the exact circumstances that provoke your symptoms, for example rolling over in bed, turning your head to reverse the car, walking on uneven ground or in the dark. If appropriate you will be given an exercise program that has been designed to address your specific problems that were outlined in your initial assessment.  There is one condition that does not require ongoing exercises, that is Benign paroxysmal Positional Vertigo or BPPV, which you can be treated by Jennifer and Rosie.
Exercise programs usually involve repeated exposure to the circumstances which challenge your vestibular system until it’s response becomes more normal. That is, you no longer feel dizzy, nauseous, lose your balance or have blurred vision in those situations. This occurs due to a process called “vestibular compensation”. Our specially trained Kinesiologist Heidi Nottelman will create a custom exercise program for you. As you progress you will be challenged in different ways to continue to get the maximal benefits from your program.

Problems Arising From The Vestibular System 

Inner ear imageThe Vestibular system consists of the semi-circular canals and the Otoliths (utricle and saccule- in the inner ear, on both sides of the head, as well as specific parts of the base of the brain (the brainstem) called the vestibular nuclei. Information from the inner ear travels along the vestibular nerves to the brainstem. This information is analysed and the brain responds by sending messages along nerves to the muscles of the limbs, body and eyes. In this way the vestibular system is involved in the control of balance, and coordination of eye and head movements. This enables us to sit, stand and walk without falling, and to maintain clear vision, no matter the position or speed of movement of the head. Problems in one inner ear can lead to an imbalance in the information coming to the brainstem resulting in one or more of the following:

  • Vertigo – the sense that you or the world is rotating
  • Dizziness – various sensations including spinning or wooziness in the head
  • Light headedness
  • Blurred vision – often when moving your head
  • Disequilibrium – the sense of being off balance
  • Veering to one side when walking
  • Falls Problems in the inner ear on both sides of the head are often more severe than those experienced by people with problems on one side only.

When only one side is affected the unaffected side can take over some of the role of the damaged side and compensate for the loss, resulting in minimal reduction in function.

However, when both sides are affected the vestibular system has difficulty functioning normally. As a result you might experience:

  • Blurred vision when moving your head, walking or in a moving vehicle, this often results in: – objects in the distance appearing to jump or bounce – difficulty reading street signs – difficulty recognising peoples facial features at a distance this is known as oscillopsia
  • Disequilibrium – the sense of being off balance
  • Unsteadiness in standing or walking, especially with head movements, on uneven surfaces and in poorly lit or dark environments
  • Falls

In addition, secondary effects can develop, particularly in cases where the vestibular problems have been present for a while. These occur as a result of avoiding movements or activities that provoke your symptoms or make you feel unsafe. They can include:

  • Stiffness and/or pain in the neck from restricting head or eye movements
  • Headaches or eye aches
  • Reduced fitness or stamina
  • Inability or reduced ability to participate in recreational and sporting pursuits, or to perform certain work/home duties

Many patients have neck pain and headaches associated with their vertigo, dizziness or imbalance. Musculo-skeletal physiotherapy can provide some relief for these symptoms, however, if the problem is vestibular in origin then the neck pain and headaches are usually secondary problems. In this case treatment of the neck will not have a lasting effect and only resolution of the vertigo, dizziness or imbalance will achieve this.