For many sufferers of vertigo, that spinning feeling is something they learn to simply put up with, usually after a few visits to the GP or specialist.

What many people may not realise though is that a physiotherapist can play a critical role in treating the symptoms of vertigo, as well as determining the cause.

Most often, vertigo is the feeling that you're moving when you’re not actually moving.

“The most common sensation is a spinning feeling,” says Matthew Holmes, Clinical Director at Focal Allied Health.

“It’s worth pointing out that vertigo and dizziness are not the same thing to a practitioner. 

“Vertigo is that feeling of movement without actually moving, whereas dizziness can be light headedness, unsteadiness, nausea, and many other things.”

While the most common sensation is a spinning feeling, some people will experience a side-to-side or up-and-down movement sensation, along with nausea, headache, or even vomiting.

The severity of vertigo varies from person to person, and at its worst, can be debilitating for the sufferer.

While vertigo is a symptom, rather than a condition in and of itself, it can lead to or occur alongside other symptoms, such as:

• balance problems
• light headedness
• a sense of motion sickness
• nausea and vomiting
• ringing in the ear/tinnitus
• a feeling of fullness in the ear
• headaches
• nystagmus (eyes moving uncontrollably, usually from side to side)

There are also a wide range of causes, with the most serious being a tumour or stroke, although both are relatively rare.

“The most common cause is benign paroxysmal positional vertigo, which is where loose crystals in the ear move the fluids in the ear when they shouldn’t, producing a feeling of vertigo,” says Mr Holmes.

“Other common causes include Meniere’s Disease and viral infections of the ear.”

The same applies to dizziness.

“Dizziness is what we call a non-specific symptom, that is, it can be caused by such a wide variety of conditions that it often doesn’t help the practitioner much in localising the cause. 

Some of the possible causes of dizziness include heart and blood pressure problems, infections, balance issues, and myriad others.”

For most people experiencing vertigo or dizziness, the GP is normally the first port of call.

“Probably because that’s traditionally what people would do,” says Dr Holmes.

“They will then often be referred to an ENT specialist or neurologist, or given medications.”
In most cases, they’re only referred to the physiotherapist after those steps. 

But things are starting to change, with an increasing number of people becoming aware of the benefits of physiotherapy, and making the choice to start there.

“The physiotherapist can assess the patient and determine if there are any red flags that would suggest the vertigo has a more serious cause and would need to be assessed by the GP.

“Through looking at the patient’s symptoms and doing specific tests, they can often identify the cause.

“If there’s not a serious cause, the physiotherapist can then prescribe exercises to treat the problem. 

“Depending on the cause, they may use repositioning manoeuvres such as the Epley manoeuvre or vestibular rehabilitation exercises.

“Repositioning manoeuvres are used to treat Benign Paroxysmal Positional Vertigo, which is the most common cause of vertigo. 

“They are designed to move the loose crystals in the ear that cause BPPV to an area where they cause less problems. 

“Vestibular rehabilitation therapy involves a number of different exercises that can be prescribed to help the brain adjust to problems with the balance system.

At-home exercises might also be recommended, and these may include:

• lying still in a quiet, dark room when the spinning is severe
• sitting down as soon as the feeling of dizziness appears
• taking extra time to perform movements that may trigger symptoms, such as getting up, looking upward, or turning the head
• squatting instead of bending over to pick something up
• using a cane when walking, if necessary
• sleeping with the head raised on two or more pillows
• making adaptations in the home
• turning on lights when getting up at night to help prevent falls

While physiotherapists learn about balance rehabilitation in their undergraduate training, post-graduate training is recommended when it comes to diagnosing and treating vertigo.

“It is helpful to have additional training,” says Mr Holmes.

“We run in-house specialist training in the assessment and treatment of vertigo for our physiotherapists.

“We educate our practitioners on the more advanced aspects of vestibular disorders (as vertigo is known), such as the underlying brain anatomy and physiology, plus the diagnosis and management of vestibular conditions such as Meniere’s Disease, viral labyrinthitis and other balance disorders.

“Like any problem, it’s always worth asking if the person you’re going to see has experience in this area.

The main risk of seeking treatment from a practitioner who hasn’t undergone specialised training, is delayed diagnosis, particularly if the cause is a serious condition such as stroke.

“However, most physios should be able to detect the warning signs in those cases.”

“Having said that, finding someone with this expertise can sometimes be difficult, in which case rehabilitation from a physiotherapist who’s just done their undergraduate training is better than nothing at all.”