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Vertigo and dizziness in physiotherapy!

Dizziness is one of the common causes of medical consultation that affects many people daily. What people often don't know is that physiotherapy can help a large proportion of people with vertigo. Thus, a physiotherapist trained in vestibular rehabilitation will be able to adequately assess your condition and provide appropriate solutions.

Dizziness and dizziness: the difference!

They are not described in the same way, but they are often misunderstood or confused by patients. Especially since it is not always easy for the patient to put his feelings into words.

First of all, vertigo is defined as a sensation of spinning in space. It is possible to feel that the room is spinning around us (external vertigo) or that we are spinning in the room (internal vertigo). Patients who consult us will often mention that they have the impression of being on a roller coaster or in a rotating game, as we find in certain parks.

Regarding dizziness, these are described as a feeling of intoxication (without having consumed alcohol of course) or the impression of floating (in the air, as on a cloud, or on water, as on a boat). Many also mention having their head in slow motion, in the "jello", heavy or even having a delay between the perception of movement by the brain and the movement itself.

Of course, vertigo and dizziness will have different pathological sources, different intensities and will not be caused in the same way. Hence the importance of properly assessing the patient's condition in order to be able to apply an adequate and adapted treatment plan.

Why is it spinning?

Vertigo is the main reason for consultation in vestibular physiotherapy. The causes and origins are numerous.


Benign paroxysmal positional vertigo (BPPV) is the most well-known cause of vertigo and the most frequent cause of physiotherapy consultation. This type of vertigo is caused, in affected patients, by specific changes in position. The most common example is going from sitting to lying down (going to bed in the evening) or vice versa (getting up in the morning). Alternatively, patients also report that dizziness is induced when they roll over in bed, lean forward, or look up. The patient will then write a dizziness (internal or external) of short duration (usually a few seconds) which decreases and stops if he maintains the position. Dizziness is sometimes accompanied by nausea, cold sweats, rapid feeling of fatigue and even vomiting. However, hearing is preserved in these situations (unless BPPV is combined with another pathology) and no pain is felt directly related to BPPV.

BPPV is caused mechanically in your body. What you need to know is that your inner ear is composed, among other things, of three (3) semicircular canals (three (3) left and three (3) right) attached to a reservoir (utricle), all filled with liquid. In the utricle, there are crystals stuck to its wall. These crystals send information to the brain about the position of the head in space. In a case of BPPV, for an often misunderstood reason, the crystals break off and slip into one of the semicircular canals. The role of these channels is to detect rotational movements of the head. When the crystals are there, the person then feels dizzy when changing position, since the crystals move by gravity in the semicircular canal, creating a movement of the liquid although the body has come to a standstill. This will give the impression to the brain that the affected side is moving while the other side is not. The brain no longer knowing where to place itself, the patient then feels dizzy. This will create an uncontrollable eye movement, called nystagmus, which will differ depending on which semicircular canal is affected.

The role of the physiotherapist in vestibular rehabilitation will then be to assess the situation to understand in which channel the crystals have slipped and thus apply a treatment technique to make the crystals migrate into their reservoir (utricle). These techniques are often very effective in the short term, even if the problem has persisted for a long time.

Inner ear infection

Other causes of vertigo are categorized as inner ear infections, such as labyrinthitis, vestibular neuritis or other infections. Infections will attack different components of the inner ear to modify the information that these components transfer to the brain. There will then be a difference between the information transferred by the left and right ear and the brain will have difficulty analyzing the situation, which will then turn into vertigo or dizziness.

The physiotherapy professional trained in vestibular rehabilitation can then assess the deficits caused by the situation and help to rehabilitate them. The physiotherapy professional will aim to teach the brain to adapt and correct the problem on its own. Generally, this will be done through exercises specific to the condition.

Other causes

There are obviously several other causes of vertigo and dizziness. These causes are more often benign, but there are causes that must be taken care of quickly, such as stroke (cerebrovascular accident). So, when you have a first episode of severe vertigo/dizziness that would be accompanied by headaches, loss of balance, speech disorders, blurred vision and more, it is very important to consult a health professional quickly. You can then be adequately cared for and limit the risk of sequelae, while optimizing recovery.

If you have any questions about vertigo and dizziness, we will be happy to answer them. At VIVA Physio Santé, we have skilled physiotherapists in vestibular rehabilitation to help you. Make an appointment online for a vertigo physiotherapy assessment or call the clinic at (450) 641-4610.


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