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What is Vertigo?

Vertigo is often described as the sensation of dizziness that can make you feel off balanced, like the room is spinning or yourself is spinning. But what actually causes this sensation?

In your inner ear you have a vestibular apparatus which controls your vestibular system. What is your vestibular system you may ask? Think of it like your balance organs, which helps maintain awareness of your body positioning, and works with the visual system to stop objects from blurring when your head moves.

This organ is made up of:

1. Three Semicircular Canals that are situated in different angular planes. There is fluid in these canals that move depending on your head movements, and continuously provide feedback to our brain via the vestibular nerve of where our head is angled in space.

2. A Utricle and Saccule that contains small crystals which move on receptor cells that are specialised in detecting linear motion. For example, if we are in an elevator with our eyes closed, it informs us if the elevator is going up or down, likewise if we are in a car with our eyes closed, we know if we are moving forwards or backwards.

The vestibular system is connected to the muscles that move the eyes (vestibule ocular reflex) and works with the visual system, to make our eyes move at the same speed as our head. This ensures our eyes are centred at the same moment the head stops moving. If there is an issue with this complex system, the vestibule ocular reflex will fail and cause our eyes to move out of sync with our head, giving the unpleasant sensation of vertigo.

What causes this?

There are multiple possible causes of vertigo, with the most common being Benign Paroxysmal Positional Vertigo (BPPV). This occurs when the small crystals within the utricle and saccule become dislodged and are free-floating in one of the semicircular canals. This causes increased pressure in the canals and disrupts the normal flow of the fluid, causing altered messages to be sent to the brain via the nerve receptors. Alternative and much rarer causes for the increased pressure can be due to the involvement of the vestibular nerve by a viral, bacterial, circulatory, tumour, toxic or autoimmune disease. Hence, an effective diagnosis is essential to treat the disease.

How can a physiotherapist help me with vertigo?

A trained physiotherapist can effectively diagnose and treat the most common type of vertigo involving the crystals within the inner ear, BPPV. This is treated with the Epley manoeuvre in which your physiotherapist will carefully move you through a series of specific positions that cause the small crystals to return to the utricle and saccule. Physiotherapists may also utilise home exercises that will improve the communication between the vestibular system and the visual system.

Alternatively, physiotherapists are also trained to identify when BPPV is not the cause of vertigo and know when to refer on for further investigations.

Lucy Creaser


Saltfleet Clinic


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