Times of Oman
Nov 28, 2015 LAST UPDATED AT 07:10 PM GMT
It is just dizziness or is it underlying equilibrium issues?
July 11, 2013 | 12:00 AM
Photo - Marco via Flickr under the Creative Commons License

As a physiotherapist practicing vestibular therapy, I often attend to patients with fractures. However, upon detailed history checking, the underlying issue often turns out to be loss of balance leading to falls , hence causing fractures.

What is vestibular therapy? It is a branch of physiotherapy that deals with correcting balance problems in individuals. We have three balance mechanisms or sensory systems in the body. First are our feet, which sense the texture of the surface we are walking on, such as grass, sand, marble or snow. Second are our eyes. Hence, when we walk onto a wet floor, we immediately look at the ground to secure our balance. Third, and most important, is our inner ear. This is the part of the ear which is located beyond the ear drum. This entire sensory system is formed in the third week of the fetus's development. This system is very well developed in cats, helping them always land on their feet.

For sake of simplification, each inner ear houses three fluid filled canals or loops and crystals which are gravity sensitive, embedded in a jelly like substance. They have near equal density in both left and right ear. Every time we turn our heads, the fluid moves, distorting the jelly along with the crystals. So if we turn our heads to the left, the left ear mechanism gets activated, deactivating nerves of the right ear, and achieving balance of the entire body. A similar process occurs for up and down or diagonal movements.

In the event of a head injury, which might be anything ranging from bumping your head during a fall, a road accident or a ball hitting your head during sports, these crystals get dislodged from the jelly and enter the canals. Now every time the head moves one way, there is additional stimulus to the nerves in the inner ear. No different than hair stuck in your clothing. There is mismatch of activation and deactivation between the two ears and it results in the feeling that you are continuing to move in the direction of your head, making you lose your balance and fall. 

Other reasons contributing to crystals entering the canals may be dehydration, which reduces the adhesiveness of the jelly, kidney disorders, recent cardiac surgeries, or calcium sodium disorders. The list is extensive.  

As a part of our body's repair mechanism, it adapts to this imbalance. A person learns to avoid certain movements. In vestibular therapy, precise evaluation determines the exact canal which is compromised. Then through series of head movements the crystals are removed from that specific canal (or canals). This in turn disturbs the compensation our body has achieved over a period of time. Hence, to provide the patient with a "new" equilibrium, specific exercises are given for all three components: feet, eyes and ears.

So if an individual is losing balance often, more in one direction or movement than in another, it is highly advisable to seek the opinion of an ENT and also pay a visit to a physiotherapist trained in vestibular therapy, as untreated this may result in other injuries. 

For those individuals who are in their thirties and above, do note that as a part of the iGeneration, we are subconsciously limiting our head movements.  What you won't use, you will lose. In order to exercise your inner ears, turn your head several times during the day in any direction you choose to keep those sensory nerves stimulated.

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