Vertigo, Inner Ear & Dizziness

Vertigo, Inner Ear & Dizziness

Home » Posts by Robina Palmer, B.Sc.PT, CAFCI, Vestibular Therapist

Vertigo, Inner Ear & Dizziness

Vestibular Rehabilitation’ is an area of focus in my physiotherapy practise – I am often asked what exactly that means. The vestibular system (involving your inner ear) is responsible for sense of movement, body orientation and balance. The vestibular system (along with our eyes, muscles, and joints) send constant feedback to our brain about our body’s movement and orientation.

Dysfunctions, disorders, trauma or viruses that affect the inner ear can be a potential cause of vertigo, dizziness, decreased balance, tinnitus (ringing in the ears) or a change in hearing. As a vestibular therapist I can assess the potential causes of the mentioned symptoms and provide treatment to help decrease dizziness, vertigo and improve balance.

Dizziness is the umbrella term that refers to a sensation of abnormal, unwanted, movement – a feeling of unsteadiness, lightheaded or feeling ‘off’. Vertigo is a more specific term and implies that there is a rotational component to your dizziness – either the room is spinning around you or you are spinning in the room. Both vertigo and dizziness are symptoms, not a diagnosis, so part of my job is to figure out the possible cause and provide treatment.

One of the most common conditions within the inner ear that I treat is a condition called BPPV – benign paroxysmal positional vertigo. BPPV is caused by a crystal that is free floating within the inner ear. The signs and symptoms are pretty easy to recognize (vertigo brought on when lying flat, rolling in bed, looking up to the ceiling or bending forward). Treatment for BPPV is also quite effective.

It is also important to recognize that not all causes of vertigo or dizziness are associated with problems in the inner ear. Cardiovascular (heart) disorders, thyroid conditions, anxiety, migraines, neck disorders/injuries and neurological conditions are all potential causes.

Vertigo & Dizziness

Vertigo & Dizziness

Physiotherapy » Posts by Robina Palmer, B.Sc.PT, CAFCI, Vestibular Therapist

Vertigo & Dizziness

It is the weirdest feeling. You get dizzy bending forward or looking up to the ceiling, lying down, getting up in the morning, or even rolling over in bed. It’s like the room is spinning and it makes you feel sick.  If you experience this, you may be suffering from Benign Paroxysmal Positional Vertigo (BPPV).

It is estimated that one in every five people will develop vertigo in their lifetime. The most common cause of vertigo is a condition in the inner ear known as Benign Paroxysmal Positional Vertigo. BPPV occurs when there is ‘debris’, or more specifically, a calcium carbonate crystal, which has been displaced within the inner ear. The presence of this displaced crystal within the inner ear can disturb one’s balance and equilibrium, and sense of motion.

These crystals are naturally occurring in the inner ear, attached to a specific structure, and not ‘free floating’. There are multiple causes for the crystals to be displaced but, more often than not, it tends to be spontaneous.  Other causes can include trauma (fall, hit to the head, whiplash), high dose antibiotics, age, and extreme changes in barometric pressure.

Most of my patients with BPPV report dizziness with certain positions. Most commonly, it is lying flat in bed, rolling over in bed, getting up in the morning, looking up to the ceiling, and bending forward.

Treatment for BPPV is very effective. It consists of ‘repositioning’ the crystal in the inner ear.  This is done through a series of head and body positions, which will move the crystals away from the sensitive hair cells within the inner ear.

Although BPPV accounts for a large percentage of vertigo, it is not the only cause. Talk to your doctor or physiotherapist certified in vestibular rehabilitation if you have these symptoms, or think you may have BPPV.

Iliopsoas Bursitis

Iliopsoas Bursitis

Physiotherapy » Posts by Robina Palmer, B.Sc.PT, CAFCI, Vestibular Therapist

Iliopsoas Bursitis

It’s a pain that no one wants to experience. It lives in the front of your hip and groin, and can radiate down the inside of the thigh to the knee. The hip and groin pain is noticeable with certain hip motions and activities. It’s called Iliopsoas bursitis, and you might have it.

Iliopspas bursitis is an inflammatory condition that involves the muscle and busra in the hip/groin region. It is often the result of repetitive hip flexion (bending) in activities such as running, dancing, track and field and gymnastics. People report having pain in the front of the hip and groin region that often radiates down the front or inner thigh all the way to the knee. Occasionally, a snapping or clicking is heard that may or may not be painful. The pain is made worse with extending the hip back, crossing the leg in front of the body, and twisting the leg inwards. Bringing the knee up to the chest can often produce a pinching sensation in the hip or groin.

The Iliopsoas bursa is the largest bursa of the 160 bursae found in the human body. A bursa is a fluid-filled sac that lies between a muscle and bony prominence. It is designed to reduce the friction and provide cushioning for the muscle as it glides over the bony prominence. Inflammation of the Iliopsoas bursa results when the overlying hip flexor muscle produces excessive pressure or friction on the bursa during movement. This increase in friction is often a result of tight hip flexors combined with repeated hip flexion, poor mechanics, or even direct trauma.

The amount of repeated hip flexion during running, dancing, gymnastics, and field events makes this a familiar condition for these athletes but it is also common among the recreational athlete too. What I tend to see, clinically with the recreational athlete who presents with Iliopsoas bursitis, is someone who typically has a seated job (desk job, driver, etc.) They spend the majority of their day in a seated position, which is the ideal position to promote hip flexor tightness (not to mention hamstring and calf tightness). Then, with their tight hip flexors, they go for a run or a long hike. The whole time the tight hip flexor is gliding over the underlying Iliopsoas bursa, creating excessive friction and inflammation. The end result in both cases is the same. Pain, decreased hip motion, decreased activity tolerance, and often tenderness to touch.

Treatment for Iliopsoas bursitis includes stopping the irritating activity, decreasing the inflammation with ice, using anti-inflammatory medication as directed, and seeing your Physiotherapist for assessment and treatment. Your Physiotherapist will determine the cause of the irritation to the bursa, rule out other possible diagnosis, and administer additional inflammatory reduction therapy (ultrasound and electrical stimulation). They will begin stretching exercises as soon as possible, and then appropriate strengthening exercises to minimize reoccurrence. If your injury was a result of improper mechanics, your Physiotherapist will also be able to help you identify and correct those factors.