You Spin Me Right Round!
Vertigo, Dizziness and How You Can Get Back to Balance. 

Vertigo, dizziness, light headedness, are they all the same thing? What's the difference between them? Can they be treated?  These are terms that many people use to describe symptoms they experience that could be related to dysfunction of their vestibular system. Sometimes these symptoms get brushed under the table, or ignored because people think, or maybe have been told, that nothing can be done to treat them. But that's not the case!

Vestibular disturbances can be treated with Physiotherapy! 

Let's talk about the vestibular system and two common vestibular issues people experience and how Physiotherapy can help. 

The vestibular system is a sensory system that gives your body the sense of orientation to its surroundings and balance. 

The vestibular system involves an expansive system of neural pathways that combine sensory information to give your body a sense of stability. A large part of this system is located in the labyrinth of your inner ear. The labyrinth is made up of two components, the cochlea which is the main structure involved in hearing and the vestibular apparatus which works to keep you in balance.

The vestibular apparatus can be further broken down into a few more parts that work together to tell our body about our head position. First, there are the three semicircular canals, an anterior one, a posterior and a horizontal. These canals are filled with a fluid called endolymph and detect rotational motion of the head. Movement of the head causes movement of the endolymph within the canals, which in turn stimulate cells in the canal and relay information to our brain about which direction our head is turning. 

(Graphic from 'Teach Me Anatomy' learn more about the inner ear: Teach Me Anatomy ) 

There are also two organs called the utricle and saccule that detect linear acceleration of the head or the head in reference to gravity. Instead of fluid moving through the canal, crystals made up of calcium bicarbonate sit on specialized cells. When the crystals move and respond to gravity, the cells are stimulated and relay information to our brain about which direction our head is traveling in. These crystals are called otoconia. 

It can be surprising to learn that balance is partly regulated by tiny crystals and fluid in your inner ear! But these aren't the only inputs into your balance.  Along with the visual system, brain, spinal cord, input from the joints and receptors on the skin, the movements of the endolymph and otoconia, help the body know where it is in space.

If this system, or a part of this system isn't working as it should, you can experience vestibular disturbances and symptoms such as vertigo. 

Are Vertigo and Dizziness the same thing? 

Dizziness is a general term and can account for any range of feeling off-balance. Common terms people use to describe this dizziness can include being lightheaded, unsteady, woozy, feeling faint or just feeling as if something is “off”.

Vertigo is a type of dizziness, specifically a false sensation where you feel like your surroundings are spinning.

When we talk about vertigo, we're talking about the sensation of the room spinning after you move in a certain way. It's actually a pretty common symptom. A disruption in the vestibular system is responsible for giving you that uncomfortable feeling of the spins.  

There is no singular cause of vertigo. It is a symptom that can be the result of a number of different underlying causes. Let's talk about one of the most common causes for vertigo. 

Sometimes the otoconia from the utricle and saccule get dislodged and end up floating around in the endolymph of the semicircular canals. This causes the crystals to shift during sudden head positional head changes, in turn sending false signals to the brain about where the head is in space, and thus triggers vertigo. 

We call this Benign Paroxysmal Positional Vertigo or BPPV and it is not the only cause of vertigo, but it is the most common.

BPPV is characterized by recurrent spells of vertigo, lasting a few seconds to about 1 minute, that are triggered by certain head positions. Benign means that it is not life threatening and paroxysmal means rapid sudden onset. Attacks seem to occur for no reason and settle on their own before recurring again every few months.  Despite the condition being non-life threatening, vertigo and dizziness can be quite uncomfortable and cause fear of movement into certain positions. Not only that, but they also have the potential to lead to falls which in themselves can be dangerous events leading to hospitalization. Although benign, BPPV is still a condition that should be addressed.

It is not well known why BPPV occurs but there are a number of theories why the otoconia get dislodged and settle in the canals. Since the prevalence of BPPV increases with age, it is thought that normal degenerative age related changes can be responsible for it, but it can also occur after head trauma or after an ear infection. Research has also suggested that there may be a relationship between BPPV, osteoporosis and vitamin D levels. This may imply that having abnormal blood calcium levels can play a role in developing BPPV, but this has not been found to be a definitive cause. 

How is BPPV Diagnosed?

BPPV is diagnosed through taking a detailed history of when your vertigo first started, triggers for it and the details about your symptoms. It is important to differentiate whether or not a person is experiencing true vertigo (false sense of the environment spinning) or symptoms from general dizziness. 

Physiotherapists with vestibular training can assess you and help determine the cause of your symptoms.

A technique called the dix hallpike maneuver can be used to distinguish BBPV from other causes of vertigo. It can confirm the existence of BPPV, and identify which canal and which ear is affected.

During this test, with your head turned to one side, you quickly lie back maintaining your head position with your head slightly hanging off the edge of the bed with the assistance from your clinician. The clinician will look for nystagmus which is rapid eye movement. The direction and duration of this nystagmus can tell us about the type of BPPV that may be present. This test will be done on both sides. 

Yes! Physiotherapists with vestibular training can treat symptoms of BPPV. 

BPPV can be treated using something called canalith positioning maneuvers, which are often successful in eliminating or at least reducing symptoms of vertigo. 


These canal repositioning maneuvers involve going through a set of movements with your neck and trunk to try to displace the otoconia and put them back where they should be. This will stop the false signals being sent to your brain and thus eliminating your vertigo.  The most common canalith maneuver that you may have heard of is called the epley maneuver but there are other ones too, depending on the type of BPPV you have and which semicircular canal the otoconia are in. The epley maneuver is given to treat BPPV where the posterior canal and anterior canal are affected, which is 80% of all BPPV cases. 

Now that we've discussed the vestibular system, vertigo and BPPV, lets talk about dizziness.

Although they sometimes get lumped together, dizziness and vertigo are not the same thing. 

There are many causes of dizziness.  A common one we see in the clinic is cervicogenic dizziness.

Cervicogenic Dizziness

Do you ever get feelings of dizziness/lightheadedness that are hard to describe? Or do you ever just feel off? Do you also have a stiffness/sore neck?

Although it might not be obvious, the neck plays an important role in our sense of balance. Our muscle tendons in our neck are full of receptors. These receptors send signals to our brain about our head positioning and where our head is currently sitting in space. Input from the neck also plays a role in our balance and being able to maintain our posture and even our oculomotor function/eye movements. 

Sometimes the input from these receptors are off which can create feelings of dizziness and/or disequilibrium. This is referred to as cervicogenic dizziness which is defined as “altered orientation or disequilibrium from abnormal input from the neck”. 

How Can the Neck Cause Dizziness? 

Cervicogenic dizziness is explained by what is referred to as the multi sensory mismatch hypothesis. Any inflammation of the neck, irritation of the nerves, joints or muscles are going to cause muscle imbalances. Our deep neck muscles carry most of the receptors but when there is dysfunction in the neck, there is a tendency for the superficial neck muscles to be overactivated and the deep neck flexors become less active. This can result in improper sensory input from the neck to the brain.

This input is mismatched with the input the brain is getting from the vestibular system, visual system and the rest of the body which leads to those symptoms of feeling “off”, especially during head movements. Since this type of dizziness is arising from the neck, symptoms of vertigo (or feeling like the room is spinning) is not usually a feature of cervicogenic dizziness. 

With cervicogenic dizziness, people may also report problems with their vision, such as blurred vision, light sensitivity, eye tracking issues etc. This is because of the role the neck plays in oculomotor function. 

Because of the feeling of dizziness, people will try to hold their neck still to give themself a relief from these feelings. This ends up creating further stiffness in the neck making the feelings and dizziness worse and it becomes a vicious cycle. 

How Can Cervicogenic Dizziness be Diagnosed and Addressed? 

During a vestibular assessment, your physiotherapist will take a look at your neck for any sign of dysfunction and see if there is a relationship to the dizziness you are experiencing. 

Other aspects that will be assessed include a vestibular-ocular motor screen where your physiotherapist will assess your ability to track objects, stabilize your gaze and perform certain eye movement and test your head-eye coordination.  

Based on their findings, an individualized exercise program will be given to you. 

Some of the possible exercises include:

• Deep neck flexor training
• Gaze stability training
• Exercises that train neck proprioception such as head repositioning (Joint position error test) and tracing (head movement awareness) 

Dizziness and vertigo are not symptoms you have to suffer through!

Registered Physiotherapists can help identify what is contributing to your symptoms, whether you're experiencing vertigo or cervicogenic dizziness, or if there are other factors contributing to your symptoms and develop a plan for treatment to address them.  

We have four physiotherapists with additional vestibular training who are ready to help you address your dizziness & vertigo symptoms.

Call, email or book your appointment online. 

Ally Ferguson is a Registered Physiotherapist who has additional training in treating vestibular issues and concussion. She is passionate about exercise and helping her clients address pain and limitation so they can do the things they love!  Ready to say goodbye to vertigo and dizziness?  Book with Ally!