Vertigo and Vestibular Rehabilitation in St. Catharines

Vertigo frightens people more than almost anything else we treat. The room spins when you roll over in bed, you grab the mattress, and your first thought is usually that something has gone badly wrong in your brain.

In most cases it has not. The commonest cause by a wide margin is benign paroxysmal positional vertigo, or BPPV, which is a mechanical problem in the inner ear. Tiny calcium crystals that normally sit in one part of the vestibular system have moved into a canal where they do not belong, and every time you change head position they slosh about and tell your brain you are spinning.

It is also one of the most rewarding things a physiotherapist treats, because the fix is quick. A properly performed repositioning manoeuvre resolves BPPV in a single session for a majority of patients.

What Vertigo Treatment in St. Catharines Covers

• BPPV (benign paroxysmal positional vertigo). Brief, intense spinning triggered by head position changes: rolling over in bed, looking up, bending down, lying back at the dentist. Episodes last seconds to a minute.
• Vestibular neuritis and labyrinthitis. Sudden severe vertigo lasting days, usually after a viral illness, followed by weeks of imbalance.
• Vestibular hypofunction. Reduced function in one or both inner ears, producing chronic unsteadiness and visual blurring with head movement.
• Post-concussion dizziness. Common after head injury, including after a motor vehicle collision.
• Cervicogenic dizziness. Dizziness arising from neck dysfunction rather than the inner ear.
• Age-related balance decline and falls risk.
• Ménière's disease, where physiotherapy manages the balance consequences alongside medical treatment.

How We Assess Dizziness

The first job is identifying which system is causing it, because "dizziness" describes at least four different sensations and patients often use the word for all of them.

We ask precisely what you feel. True spinning points toward the vestibular system. Lightheadedness suggests blood pressure or cardiac causes. Unsteadiness without spinning suggests balance system or neurological involvement. Fogginess points elsewhere again.

Then we test. The Dix-Hallpike manoeuvre is the standard test for posterior canal BPPV, and the specific pattern of eye movement (nystagmus) it produces tells us which ear and which canal is affected. We also test the roll manoeuvre for horizontal canal BPPV, head impulse testing for vestibular function, balance and gait, and cervical spine involvement.

We screen carefully for causes that need medical attention rather than physiotherapy: dizziness with double vision, difficulty speaking or swallowing, severe headache, weakness or numbness, or new hearing loss. These need urgent medical assessment and we will send you straight there.

Treatment

• Canalith repositioning (the Epley manoeuvre). For posterior canal BPPV, this is the treatment. A sequence of head and body positions guides the displaced crystals out of the canal and back where they belong. It takes a few minutes. Around 80% of patients resolve after one to three treatments. You may feel briefly worse during the manoeuvre, which is expected, and mildly off-balance for a day afterwards. We give you post-treatment instructions and follow up to confirm it has cleared.
• Barbecue roll (Lempert manoeuvre) for horizontal canal BPPV.
• Gaze stabilisation exercises for vestibular hypofunction. These retrain the vestibulo-ocular reflex so your vision stays steady when your head moves. They are simple, they must be done daily, and they work through habituation, which means they will make you feel dizzy while you do them. That is the mechanism, not a problem.
• Habituation exercises for motion-provoked dizziness. Controlled, repeated exposure to the movements that trigger symptoms, which gradually desensitises the system.
• Balance and gait retraining, progressing from stable to unstable surfaces, eyes open to eyes closed, static to dynamic.
• Cervical treatment where the neck is contributing.

BPPV, Dizziness and the Epley Manoeuvre

BPPV treatment in St. Catharines is the most satisfying thing we do, because it often resolves in one or two visits. The Epley manoeuvre in St. Catharines repositions displaced crystals in the inner ear and works in the large majority of confirmed BPPV cases.

Dizziness physiotherapy in Niagara covers the rest: vestibular hypofunction, post-concussion dizziness and balance loss, all of which need graded retraining rather than a single manoeuvre.

FAQs