BPPV

Benign Paroxysmal Positional Vertigo is a disorder of the vestibular system in the inner ear. The condition is characterized by a sensation of dizziness and spinning with change in head positions. It occurs when calcium crystals called otoconia are dislodged from their normal location from the top of the utricle (sensory organ of inner ear). These free floating crystals travel in the fluid contained within the semicircular canals of the inner ear. It is the movement of these crystals that can trigger the sensory receptors within the inner ear resulting in disorientation and disequilibrium.

Causes

• Old age.
• Head trauma.
• Meniere’s disease.
• Vestibular migraines.
• Vestibular neuritis.
• Maintaining static positions of the head such as in a dentist chair and prolonged bed rest.
• Ototoxicity (inner ear infection).

Symptoms

• Vertigo
• Dizziness
• Lightheadedness
• Nausea/vomiting
• Imbalance
• Difficulty concentrating
• Nystagmus (involuntary eye movements)

Symptoms are triggered by the change in head position like getting up from the bed, tilting head in shower, reaching for upper shelf.

Diagnosis

BPPV is diagnosed by taking a medical history, a physical examination and vestibular and auditory tests. MRI may be recommended to rule out other conditions such as a stroke.

Dix Hallpike maneuver – This is a vestibular test: the physiotherapist or chiropractor will instruct you to sit on treatment table. You will be asked to lie back quickly while your head is held stationary in a certain position. These set of movements will usually trigger an episode of intense dizziness (vertigo) in patients with BPPV.

Treatment

• Epley maneuver- This treatment involves a series of movements.  First, while sitting up, the patients head is turned about 45 degrees to the side that normally provokes the vertigo. Then the patient is quickly laid down backwards with their head just over the edge of the examining table. This position usually provokes strong vertigo. The head is kept in this position for about 30 seconds and then turned 90 degrees to the opposite side. After another 30 seconds, the head and the body are turned together in the same direction so that the body is pointing towards the side, and the head is pointing down toward the ground at a 45 degree angle. After 30 seconds in this position, the patient is brought upright again. This is repeated as many as five or six times until neither vertigo or nystagmus are elicited when the head is brought into the previously aggravating position.
• A hand held vibrator is applied to the bone behind the affected ear to help dislodge the crystals that may have become stuck on the walls of the semicircular canal.
• Anti-nausea or antiemetic medicine is prescribed if vomiting sensation is severe.

If you are suffering from BPPV or have any questions regarding this condition don’t hesitate to contact us and book your free consultation. All the health professionals at P&C Rehabilitation Services have experience treating this condition. We have been providing chiropractic and physiotherapy to the Jane and Finch Community for 6 years. We take pride in providing excellent health care services to the North York community.

• Mal alignment of the patella as in knock knees, flat feet or unusual shaped patella.
• Over activities like running, jumping, climbing or descending stairs.
• Prolonged sitting with knees in a moderately bent position (the so-called “theater sign” of pain upon arising from a desk or theater seat).
• Quadriceps muscle imbalance or tight hamstring/weak quadriceps.
• Excess weight/obese.

Symptoms

• Knee pain; especially dull aching pain in the knee. Pain is mainly noticed while walking up and down stairs, squatting or getting up after prolong sitting.
• Crepitus on knee movements
• Knee buckling; the loss of quadriceps strength may cause the leg to “give out.”
• Stiffness in knee.
• Limited knee range of movement.
• Decreased quadriceps strength.

Diagnosis

• Physical examination – The physiotherapist or chiropractor will conduct a medical history with orthopaedic testing to make a diagnosis
• X ray – These are usually not helpful in diagnosing this condition but can be used to rule out other conditions
• Magnetic Resonance Imaging – MRI is a diagnostic tool which is used to see whether the pain is due to bone, cartilage or muscle problems.
• Arthroscopy – The internal structure and state of joint is visualized by inserting a camera through your knee joint.

Treatment

Around 80-90 percent of people suffering from patellofemoral pain recover fully and are able to resume their previous activities. Most active people respond to non-surgical treatments. Following is the line of management.

• Rice- Rest, Ice, Compression and elevation is the first line of treatment in acute and early stage of patellofemoral syndrome. RICE helps to alleviate pain and swelling.
• Physiotherapy or chiropractic care- Specific exercises for strengthening quadriceps, hamstrings and calf muscles. Stretching exercises for hamstrings and iliotibial band. Usually, six weeks to six months of supervised physical therapy and rehabilitation program is recommended depending on each case.
• Orthotics- If the underlining cause is flat feet then being fitted for orthotics can be beneficial in the management of this condition.
• Knee support- Wearing a patella tracking knee brace helps in proper knee mechanics and preventing further damage along with reducing pain by controlling knee movements. Patellofemoral taping techniques can help reduce pain by altering the track of the patella.
• Medications- Over the counter non-steroidal anti-inflammatory drugs like ibuprofen, naproxen help to reduce pain, swelling and stiffness.
• Surgery- In chronic and severe cases where conservative treatment fails to treat the symptoms, surgery is recommended. The Surgeon may have to perform reconstructive surgery depending on the cause.

If you are suffering from patellofemoral pain syndrome or have any questions don’t hesitate to contact us for your free consultation. The physiotherapist and chiropractor have vast experience in treating this condition. Lets end your knee pain today!