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1st Oct


October 2015

Positional Vertigo: Diagnosis and Treatment

Vertigo, the feeling that you are moving even though you aren’t, is an unpleasant yet common experience caused by a variety of conditions. It may surprise you to learn that in some cases your physiotherapist is actually able to treat vertigo.

Our brain’s ability to tell if we are moving or still is a complex process involving many different parts of the nervous system. The inner ear plays a very important role, with 3 semi-circular canals being responsible for gathering information about head movement. The vestibulocochlear nerve (remember that for quiz nights!) relays that information back to the brain where it is processed. Certain conditions can interrupt the smooth transition of that message, causing the brain to perceive movement when there is none. Physiotherapists may be able to help with a certain kind of vertigo called Benign Paroxysmal Positional Vertigo.

Commonly referred to as BPPV or positional vertigo, sufferers will only feel dizzy when their head moves in certain positions or directions. Most people complain of dizziness and nausea when rolling over in bed or when looking upwards. Other symptoms may include disturbance of balance and lightheadedness. BPPV can occur for no reason, however it has been noticed more commonly following a recent head trauma, previous bouts of vertigo, recent respiratory infections or recent travel on an airplane. All of these conditions have the ability to disrupt the inner ear’s normal function.

The odd symptom pattern of BPPV can be explained by a disruption in the signal sent by the semicircular canals off the inner ear to the brain.

Each of the three canals is positioned in a different direction and filled with fluid. As your head moves, the fluid in each of the canals moves slightly differently depending on the orientation of your head. Receptors are able to pick up that movement direction and speed, sending that message to the brain.

Sometimes, small calcium crystals, which typically form and reside in the space where all three semi-circular canals meet, called the utricle, escape and become lodged within the semi-circular canals. This causes disruption to the free-flowing fluid, and obscures the messages being sent to the brain.

If your doctor has diagnosed you with BPPV, they or your physiotherapist will be able to show you a series of movements, which can be done to assist in dislodging and moving the calcium crystals away from the semi-circular canal. You may be asked to perform exercises to keep the crystals from returning as well. In most instances, only one or two treatments are required for resolution of symptoms, however some cases require more.

If you think you have vertigo, it is necessary to be assessed by a medical professional, as your symptoms may be caused by any number of conditions and require correct diagnosis prior to treatment.

Balance and stability are important skills that can help to prevent injury. Can you stand on one leg for 30 seconds without falling or wavering?

Thoracic Outlet Syndrome

What is Thoracic Outlet Syndrome?

The thoracic outlet is a small opening between the neck and shoulder that allows a variety of nerves and blood vessels to pass safely from the neck and supply the arm, chest and shoulder blade. As this can be quite a small space, any narrowing can cause these structures to become compressed and irritated. This phenomenon is commonly referred to as “Thoracic Outlet Syndrome”. This space can become compromised through trauma to the neck, overuse or repetitive stresses to the arm or the presence of an extra rib in the neck.

What are the signs and symptoms of Thoracic Outlet Syndrome?

Signs and symptoms of Thoracic Outlet Syndrome may depend on whether nervous tissue or blood vessels are involved. In most cases, symptoms will be caused by compression of nerve tissue rather than veins or arteries.
When neural tissue compression is the cause of the Thoracic Outlet Syndrome, reported symptoms may include pins and needles, tingling or numbness of the affected arm. Other symptoms include pain and weakness or tiredness of the arm that increases with work done overhead. Some people may experience neck pain or headaches in the base of their head.
If the vein is affected, there will be swelling and discoloration of the affected arm, as well as pain. When the artery is affected, cramping of the arm or hand during use may occur. Due to decreased blood flow, the arm or hand may feel cold and even change colour.

Who is usually affected?

It is common for people who work with their arms in an above-shoulder position to develop Thoracic Outlet Syndrome. For example, a teacher who writes frequently on a chalkboard, a construction worker hammering nails overhead, or a hairdresser.

How can physio help?

Your physiotherapist will assess a range of things including your posture, the flexibility of your spine, and length of your neck muscles. It is also important to assess the way you move your neck, back and arms.

Depending on the findings of the physical assessment, your physio will help you stretch appropriate muscles, assist with movement modification, and correct your posture. This may involve manual therapy techniques such as joint mobilizations, strapping techniques and soft tissue massage.

Treatment times may vary depending on symptom presentation and response, Thoracic Outlet Syndrome typically can take just a few treatments or several weeks to resolve as well as continuation of a home exercise program in order to resolve the issue.

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition.

Halloween Fun Facts

  1. Which country claims Jack-o-lanterns as a tradition?
  2. Why do we wear masks for Halloween?
  3. How much did the world’s largest pumpkin weigh?

Did You Know?

Building upper body strength can actually help to improve your running fitness. Balanced body fitness is vital and will help you improve your running technique and ability in the long term. Add upper body strength training, such as weights or swimming to your training regime to be pleasantly surprised at your improvement in running ability.

Kids Spy Network

Check out this new concept that uses personalized Spy Missions to encourage kids to explore and learn about the world around them.
Have a look at…

Baby Carrot and Almond Salad


1 bunch baby carrots (any colour)

1 tbsp white wine vinegar

1 tsp honey

1 tbsp soy sauce

1 tbsp peanut oil

2 tbsp almonds, roughly chopped

  1. Trim carrot tops, wash. Soak leaves in cold water for 30 minutes, dry, and store in moist towel in the crisper of the fridge.
  2. Whisk together white wine vinegar, soy, honey and peanut oil.
  3. Place the carrots in saucepan of cold water and bring to boil. Simmer for 5 minutes, drain and cut in half if desired. Toss with dressing.
  4. Add 3 tbsp of the chopped leaves and almonds and mix with carrots.
    Ready to serve straight away.
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