Welcome to part 2 of our 3 part series on Vestibular disorders. In part 1, we discussed some of the common symptoms of vestibular disorders, and touched on the population groups that can be affected. In part 2 we are going to explore these conditions in more detail and explain how different types of treatments can help.
Benign Paroxysmal Positional Vertigo (BPPV)
Definition: BPPV is a condition where floating calcium particles are present in the inner ear canal, have become dislodged from their usual position. These crystals migrate into one of the semicircular canals of the inner ear. When the head is reoriented, the gravity-dependent movement of these particles cause abnormal fluid displacement and can impart the sensation of vertigo (spinning room sensation).
It usually affects one side, however can occasionally be bilateral which is usually associated with trauma.
Management: BPPV is managed conservatively with the Epley Manoeuvre which can be performed by a vestibular physiotherapist. If symptoms are not alleviated after two weeks, treatment with supervised balance retraining is necessary or may require further investigation by a specialist.
Definition: Vestibular Neuritis is an acute vestibular disorder that is caused by inflammation of the vestibular nerve. This inflammation disrupts the transmission of information along the vestibular nerve. It can be viral or degenerative. A head thrust test can confirm the diagnosis to rule out a stroke.
Management: Treatment consists of supervised balance retraining to assist with imbalance/unsteadiness through the concept of central compensation. Central compensation is the central nervous system’s ability to compensate for a loss in vestibular function. Timeframes vary based on the person, and the good news is many individuals have complete resolution of symptoms.
Definition: A disorder of the inner ear that relates to a build-up of fluid in the inner ear canals that can lead to swelling and pressure with dizziness, fluctuating hearing loss and tinnitus (hearing of non-present sound).
Management: Balance retraining is important to assist with central compensation and compensation strategies can be implemented for acute episodes.
Cervicogenic Dizziness (neck-related dizziness)
Definition: This consists of dizziness associated with a musculoskeletal condition of the neck. Symptoms can include neck pain and stiffness, dizziness and headaches.
Management: For best management, manual physiotherapy is recommended once other dizziness causes have been ruled out. In addition to manual treatment, a Exercise Physiology intervention for postural retraining and strengthening of the periscapular and paraspinal musculature to prevent reaggravation of the injury would be recommended.
Presbystasis (age-related balance loss)
Definition: As we age, our balance system degenerates through the three balance pathways: vestibular, visual, and somatosensory (proprioception). A reduction in lower limb muscle strength and mobility, and increase in joint pain, along with reduced brain central processing speed lead to reduced balance and unsteadiness during walking. An increase in anxiety as a result of this can reduce confidence and lead to social isolation.
Management: Medical investigations are conducted to rule out differential diagnoses and an individual’s static and dynamic balance, lower limb strength and gait are assessed by a Physiotherapist or Exercise Physiologist. The next step is then to explore walking (gait) and balance retraining, lower limb strengthening and advice regarding activities of daily living adjustments to reduce falls risk.
The goal is not to cure, but to improve quality of life and independence.
Superior Semicircular Canal Dehiscence (SCCD)
Definition: Vertigo induced by sound or pressure due to thinning of bone overlying one of the canals of the inner ear. Chronic loss of balance when walking, dizziness with severe head movements (can be from sneezing, swallowing, etc.) and the sensation that objects are moving when they aren’t.
Management: Balance retraining can assist with reducing falls risk and to enhance quality of life.
Imbalance following ear surgery or head injury
Definition: Due to change in pressure and inflammation within the inner ear, a loss of balance can occur following surgery or trauma to the head and ear.
Management: Balance retraining can assist to reduce falls risk in these acute populations. Balance retraining is supervised by an exercise physiologist and implemented initially within the clinical gym, where the progression from static, stable surface training is built towards dynamic, unstable surface exercises allows for simulation of external factors such as crowds, uneven ground and weather within a closed environment.
Part 3 of this series will demonstrate some of the common manoeuvres and exercises that these patients are prescribed for their vestibular treatment and balance retraining.
Vestibular disorders are a common presentation amongst the community that we treat at Essendon Physio Group. With our strong network of ear, nose and throat specialists, we collaborate to ensure the best possible outcomes for those with vestibular disorders.
Vestibular disorders occur when parts of the inner ear and brain, that process the sensory information such as balance and eye movements, are damaged by a disease or an injury. It can occur for unknown reasons, but can also result or be worsened by genetic and environmental conditions.They can affect both children and adults. In addition to damage of motor development and balance, vestibular deficits may cause poor gaze stability that suppresses children from learning to read. Children are not screened for these disorders, which results in a failure to receive early medical attention and treatment.
Some of the most common symptoms of a vestibular disorder are:
Vertigo (sensation of the room spinning)
Unsteadiness during gait (disequilibrium)
All these symptoms can lead to a reduced ability to perform daily functional tasks, reduced confidence and social isolation.
At Essendon Physio Group, we will be able to conduct an appropriate and thorough assessment and outline a detailed management plan. This can involve formal physiotherapy rehabilitation, cross- referral to the exercise physiologists at Exercise for Rehabilitation and Health for vestibular balance retraining and a home exercise program, or a referral to another health professional such as an ENT specialist or neurologist.
Vestibular conditions that we can assist with include:
Benign Paraoxsysmal Positional Vertigo (BPPV)
Cervicogenic Dizziness (neck-related dizziness)
Presbytasis (age-related balance loss)
Superior Semicircular Canal Dihiscence (SSCD)
Imbalance following ear surgery or head injury
Part 2 of this series will go into more detail on some of these vestibular disorders and touch on how physiotherapy and exercise physiology interventions can assist. Part 3 will define some of the techniques that we employ to assist with the treatment of these vestibular disorders.
Essendon Physio Group was delighted to share their vision of helping the local community with many of their health needs with Local MP, Ben Carroll who visited the practice on Thursday 14 August 2014.
Ben was quite impressed with the range of services the practice offers to the local community, not only treating a variety of musculoskeletal conditions but also assisting people to manage and prevent chronic disease.
Our team of experienced physiotherapists and Exercise Physiologists work together to achieve the best possible health outcomes for all our patients.
The immediate treatment of any soft tissue injury consists of the RICE protocol for the first 48 - 72 hours to reduce internal bleeding of the injured soft tissue and severity of injury.
REST: to protect the injured area by either ceasing activity or using crutches.
ICE: 20 minutes/2-3 hours is recommended to effectively vasoconstrict the blood vessels and minimise bleeding to the injured region.
COMPRESSION: using bandaging techniques to further minimise bleeding.
ELEVATION: of the injured area (if possible) above the level of the heart.
The No Harm protocol should also be followed along with the RICE principle to further minimise the extent of the injury and minimise soft tissue recovery.
No Harm Protocol:
Running (or activity)
Massage (deep massage is not recommended within the first 72 hours after an acute soft tissue injury).
The experienced physiotherapist team at Essendon Physio Group will be able to diagnose the extent of your injury and guide you through the appropriate rehabilitation and safe return to activity. Book your appointment today.
The team at Essendon Physio Group would like to take this opportunity to wish
you all a safe and blessed Easter break. We hope you find some time
amidst the holiday celebration to wind down and relax with your loved
While we'll be closed over the Easter break, Good Friday through to Easter Monday, it will be
business as usual for us here over the school holidays. If you require
any of our services immediately before or after Easter, please book you appointment
early to guarantee your preferred date and time.
We're back with this month's Blog post to assist you with soft tissue injuries. Symptoms of soft tissue injuries can vary between people and the extent of the injury, but generally they are as follows:
Bruising (contusion, cork)
Bruises are caused when a direct force is applied to a body part and bleeding into the soft tissue (hematoma) can result. Swelling and discoloration of the affected region can often be observed.
Sprains are caused when the joint is forced beyond its normal limits, resulting in overstretching and tearing of the ligaments that support the joint. Swelling, loss of power, possible discoloration, bruising and sudden onset of pain can result. Common sites for ligament sprains are the ankle, wrist, knee and shoulder joint.
Strains are caused by muscles over-stretching and then contracting too quickly. As a result partial or complete tears of the muscle can result. Swelling, bruising and pain with muscle contraction or stretch can result. Common muscle strains are hamstring, calf and back strains.
Overuse injuries occur as a result of repetitive movement and usually develop over a period of time. Symptoms develop slowly and are at their worst in the morning upon waking and can be eased with movement or a warm shower.
Soft Tissue Recovery Times
The recovery of a soft tissue injury depends on three main factors:
Severity of the injury
An experienced physiotherapist will be able to diagnose the extent of your injury and guide you through the appropriate rehabilitation and safe return to activity. Contact us to book an appointment if you are experiencing any of the above symptoms.
At the practice I am often asked about Soft Tissue Injuries, so thought I would begin a series of Blog posts on this subject to answer client questions and concerns.
What are soft tissues?
Soft tissues mainly comprise of muscles, tendon and ligaments.
Muscles: are responsible for movement.
Tendons: connect muscles to bones.
Ligaments: connect bone adjourning bones as well as provide structural support to joints.
What are soft tissue injuries?
When we talk about soft tissue injuries, we are mainly referring to injuries of muscles, tendons and ligaments.
Muscles injuries are also known as ‘strains.’
Ligament Injuries are also known as ‘sprains.’
Tendon Injuries can result from either overuse (tendinopathy, tendinosis or tendinitis) or tendon tears/ruptures.
That's it for this post. If you are suffering from any of the above, make an appointment. One of our experienced physiotherapists will be able to diagnose the extent of your injury and guide you through the appropriate rehabilitation and safe return to activity.