By Vanessa Service, Physiotherapist
What does my vestibular system do?
Your vestibular system’s job is to process sensory information that is required to control balance and eye movements. This means that information from the inner ear, the visual system, and from the muscles and joints is analysed by the brain. Integrating this information allows you to1:
– Maintain clear sight while you move your head,
– Figure out the orientation of your head in space in relation to gravity,
– Identify how fast and in which direction your are moving, and
– Make fast and automatic adjustments to your posture so you can maintain balance (stay in your desired position).
In other words, your vestibular system coordinates your movement with your balance, allowing you to navigate through and adapt to the world. It is this process that allows you to walk down the sidewalk, to step off a curb, to sit down and stand up again and to turn your head while walking. Anytime your head moves through space you’re depending on your vestibular system.
What are vestibular disorders and what are the symptoms?
If the vestibular system encounters disease or injury, such as a viral infection or head trauma, the result may be a vestibular disorder. However, aging, some medications, and genetic or environmental factors may also cause vestibular conditions.
Symptoms of damage to the vestibular system may include:
– Vertigo (a sense of the world spinning around you)
– Dizziness (feeling lightheaded or floating/rocking in space)
– Imbalance and special disorientation (stumbling, staggering, drifting to one side while walking)
– Difficulty with changes in walking surfaces
– Tinnitus (ringing or buzzing in the ears)
– Discomfort in busy visual environments (such as the grocery store) or when looking at screens/television
Examples of vestibular disorders include:
- Benign paroxysmal positional vertigo or BPPV (a common condition where loose debris or “crystals” collect in a part of the inner ear)
- Vestibular neuritis or labyrinthitis.
- Migraine associated vertigo
- Endolymphatic hydrops
- Acoustic neuroma
- Meniere’s disease
How can a vestibular physiotherapist help?
The effect of a vestibular condition on a person’s life can be profound. Dizziness and balance problems are often a barrier to activities of daily living, to independence, and to engaging with the community. This negative impact on daily function and socialization may also contribute to anxiety and depression. As such, appropriate management of vestibular conditions is an essential component to improving quality of life for individuals and families affected by vestibular disorders.
A vestibular therapist will interview you about the history of your symptoms and perform a series of vestibular, balance, and visual tests. Treatment will depend on what is found in the assessment. For example, if you are diagnosed with BPPV, your therapist will perform a manoeuvre to reposition the associated crystals. Other vestibular disorders are treated with specific exercises and strategies that your vestibular therapist will teach you and help you progress through to reach your specific goals.
Although for most people a vestibular disorder is permanent, an exercise based plan can be designed to reduce dizziness, vertigo, and balance and gaze stability problems1. This is made possible by your brain’s incredible ability to adapt its other systems in order to effectively compensate for an improperly functioning vestibular system. Vestibular rehabilitation is a non-invasive and drug free intervention that helps to promote and maximize the amount of compensation that occurs. Current research supports the use of vestibular rehabilitation in the management of vestibular conditions2, demonstrating reduced dizziness, balance issues, and increased independence with regard to activities of daily living 3. Additionally, no adverse effects associated with vestibular rehabilitation have been reported2. As such, vestibular rehabilitation can provide a pathway to improved quality of life for those living with a vestibular condition.
1. About Vestibular Disorders (n.d) Retrieved from https://vestibular.org/understanding-vestibular-disorder
2. Hillier SL et al., Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Cochrane Database of Systematic Reviews 3, 2011.
3. Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70
Feeling dizzy? You Could Have a Vestibular Disorder
Do you experience dizziness? Perhaps when rolling into or over in bed, or turning your head to one side?
Dizziness can be more than dehydration, a big night out, or a compulsion to spin in circles on your office chair. It can be a symptom of asymmetry in your body’s sensory systems.
The most common condition that causes dizziness is benign paroxysmal positional vertigo, or BPPV. The brain has three main mechanisms for perceiving how we interact with the environment around us. These are the visual, proprioceptive, and vestibular systems.
The visual system is self-explanatory. The proprioceptive system is a network of nerves in all of your muscles and joints that relay information about the position of those muscles and joints back to the brain. It is how you can close your eyes and still accurately position your arms and legs in different poses.
The vestibular system is located in your inner ear and is used to identify the position and movement of the head in space. This is the system commonly linked to dizziness and vertigo.
The vestibular system is made up of three perpendicular fluid filled canals in each ear, which relate roughly to the planes of movement.
These canals each have sensory nerves at one end that are made up of crystals resting on fine hairs. When you turn your head, the fluid moves through the canals and pushes on the crystals. This causes the hairs to move and stimulates the nerves.
Your response in each ear should be equal and opposite, and work in tandem with your visual and proprioceptive systems. If things are not working in tandem, then dizziness, vertigo (room spinning), or nausea may result.
Have you ever felt nauseated in a car, or on a boat? This is because your vestibular system recognises that your head is moving but according to your eyes, you are still or moving a different way.
Someone may have suggested looking out the window or finding the horizon. This is great advice as fixating on something which the car or boat is moving relative to, provides a visual reference point and reduces or eliminates the disagreement between the visual and vestibular system.
In patients suffering BPPV, a similar disagreement occurs but it is completely internal. It occurs when crystals in one ear canal become dislodged from the hairs and drift down into the canal. This can happen as a result of trauma but is just as frequently unrelated to any incident.
When the head is turned, the nerve stimulation in one ear is different to the other and a combination of dizziness, vertigo, and nausea can result.
Generally, this resolves in seconds, or in more severe cases last up to two minutes. Usually only one canal will be affected at a time so symptoms are commonly worse to one side, and occur most severely in a single plane of movement.
If you are dizzy due to asymmetry, then your physiotherapist can assess and treat it. Assessment of specific movements can isolate which ear and which canal is causing the problem and treatment involves techniques designed to use gravity and inertia to relocate the crystals back to where they belong at the end of the canal.
NOTE: If you are suffering from severe, sudden onset headache, or persistent dizziness, double vision or nausea that seem unrelated to any particular movement then consult a medical doctor immediately.
A new study published in The Journal of Pain reports that 39 million people in the United States or 19 percent have persistent pain, and the incidence varies according to age and gender. The Journal of Pain is the peer-reviewed publication of the American Pain Society, www.americanpainsociety.org.
Researchers at the Washington State University College of Nursing conducted the study. They defined persistent pain as frequent or constant pain lasting longer than three months. The intent of their research was:
• Identify groups at higher risk for persistent pain
• Identify body sites, chronic conditions and disabilities associated with persistent pain
• Assess the relationship between persistent pain and anxiety, depression and fatigue
• Describe the individual experience of persistent pain.
The study was performed using data from the 2010 Quality of Life Supplement of the National Heath Interview Survey (NHIS) to calculate the prevalence of persistent pain. Results of the analysis showed that approximately 19 percent of U.S. adults reported persistent pain in 2010, and older adults were more likely to experience persistent pain than younger adults. Women also had slightly higher risk than men.
The authors noted that persistent pain correlated with other indices of health-related quality of life, such as anxiety, depression and fatigue. Individuals with those conditions were far more likely to report persistent pain.
In 2011, the Institute of Medicine reported that 100 million Americans have chronic pain. The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain.
In the 2010 NHIS, an estimated 60 percent of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42 percent of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.
From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.
The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.
Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, Sterling McPherson. Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey. The Journal of Pain, 2014; 15 (10): 979 DOI: 10.1016/j.jpain.2014.05.009
By Rachel Noble Benner January 12 – The Washington Post
These steps, distilled from research and experience, can help manage chronic pain.
Embrace physical therapy.
The more you move, the better you feel. Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.
Avoid loneliness by engaging in activities with friends and family members. If you have physical limitations, find accommodations that will allow you to enjoy the company of others. Use your problem-solving skills to create solutions and avoid excuses. The emotional and physical benefit of engaging with others is immeasurable.
Treat depression and anxiety.
Depression and anxiety can cause physical pain in addition to psychological distress. Talk with a doctor who treats chronic pain if you are experiencing symptoms such as low mood, significant weight loss or gain, fatigue, trouble sleeping, lack of concentration, hopelessness, lack of interest in activities, agitation, worry, fear or panic. Treating depression and anxiety can significantly reduce chronic pain.
Practice mindfulness and relaxation.
Stress increases pain, so meditation, biofeedback, positive visualization and progressive relaxation all provide powerful tools to decrease stress and discomfort. Each of these techniques can train your body to relax muscles, increase blood flow and reduce chemical stress responses that are harmful to your body. These activities also decrease anxiety, elevate mood and ease pain. A good counselor or relaxation specialist can help you master these skills.
Join a support group.
Often, an individual suffering from chronic pain feels as though he is the only person in his social circle struggling with this issue. Support groups offer a space for people to share and learn from one another. The American Chronic Pain Association, the American Pain Society and Pain Connection can point you to local resources. Support groups also can be an excellent place to get contacts for physical therapists and counselors who work with people affected by this life-corroding illness.
Avoid extended use of addictive pain medications.
Opioids and benzodiazepines are excellent for acute pain, but they should not be taken over many years because they can make pain worse. It’s important to work with an experienced pain management doctor to transition from addictive — and often ineffective — medications to helpful, nonaddictive medications.
Discover meaning and purpose.
Having purpose in life is essential for boosting your physical and mental well-being. For example, you might be able to volunteer in a library or with your church or a local hospital. Find ways to share your talents at work as well as by volunteering and giving back to your community. This can be a huge challenge for someone whose life and identity have been dismantled by chronic pain. A good counselor can help you navigate this difficult transition.
Whether you have lived with chronic pain for a few months or many years, the tasks detailed here may seem daunting. The Mayo Clinic encourages chronic pain sufferers to reach out for professional help, saying: “Your physical health can directly affect your mental health. Denial, anger and frustration are common with chronic illnesses. . . . A therapist, counselor or other professional may be able to help you put things in perspective. They also may be able to teach you coping skills, such as relaxation or meditation techniques.”