Common FAQs

Vertigo & Dizziness

Common Causes

Due to the complex diagnostic skills required to accurately diagnose the cause of your vertigo or dizziness, we highly recommend seeking the professional opinion of a healthcare practitioner with a special interest in, or expertise in the assessment and management of vestibular disorders.

Vertigo or Dizziness?

Vertigo or dizziness, are symptoms rather than a disease. Vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in your balance (vestibular) system. Vertigo may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo, and the perception of motion in surrounding objects is called objective vertigo. Vertigo usually occurs as a result of a disorder in the vestibular system (structures of the inner ear, the vestibular nerve, brainstem, and cerebellum). Your vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves. When your head moves, signals transmit to the labyrinth, which is an apparatus in the inner ear made up of three semi-circular canals surrounded by fluid. The labyrinth then transmits movement information to the vestibular nerve and the vestibular nerve carries the information to the brainstem and cerebellum (areas of the brain that control balance, posture, and motor coordination). The most common cause of dizziness is BPPV. Others include Inflammation in the inner ear, Meniere's disease, neck joint dysfunction, vestibular migraine and acoustic neuroma. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke or brain haemorrhage.

BPPV Symptoms

The symptoms of BPPV can include:
  • Sudden episodes of violent vertigo.
  • Dizziness and/or nausea.
  • Movements of your head trigger vertigo.
  • Your vertigo may last half a minute or more.
  • Your eyes may drift and flick uncontrollably (nystagmus).

What Causes BPPV?

Inside your inner ear, there is a series of canals filled with fluid. These vestibular canals are at different angles. When your head is moved, the rolling of the fluid inside these vestibular canals tells the brain exactly how far, how fast and in what direction your head is moving. BPPV is caused by little ‘ear rocks’ or otoconia (calcium carbonate crystals) within the vestibular canals. Usually, these crystals are held in special reservoirs within other structures of the inner ear (saccule and utricle). It is thought that injury or degeneration of the utricle may allow the ‘ear rocks’ to dislodge and escape into the balance organ and interfere with your vestibular system.

What Causes Your ‘Ear Rocks’ to Dislodge?

Factors that may cause or allow ‘ear rocks’ to migrate into your vestibular canals include:
  • Head or ear injury.
  • Ear surgery or ear infection, such as otitis media.
  • Degeneration of the inner ear structures.
  • Vestibular neuritis (viral infection of the inner ear).
  • Meniere’s disease (a disorder of the inner ear).
  • Some types of minor strokes.
In around half of BPPV cases, the cause of your BPPV can’t be found. This is known as idiopathic BPPV.

How is BPPV Diagnosed?

Dizziness and vertigo are common to a wide range of medical conditions, so careful differential diagnosis is important. Your physiotherapist or doctor may use several tests to diagnose BPPV.

What is the Treatment for BPPV?

‘Ear Rock’ Relocation Techniques

After assessing, you and confirming BPPV, your BPPV trained physiotherapist will apply specific techniques to relocate the "ear rocks" to an area in the inner ear that doesn't stimulate your feelings of dizziness or vertigo.

How Successful is BPPV Treatment?

When BPPV techniques are performed correctly, reduction of your vertigo, dizziness and other symptoms of BPPV is immediate in 80% or more of cases. Quality BPPV practitioners have a 90%+ success rate within three applications of the techniques.

Other BPPV Treatment Options?

Due to BPPV being caused by the physical presence of ear rocks within your vestibular canal, only the relocation of these ear rocks will clear your symptoms. You may find some drugs can help you mask your BPPV symptoms by diminishing your sensitivity your vestibular symptoms. They work in a similar fashion to sea sickness medications. Please discuss this medicated option with your doctor.

BPPV Surgery

Occasionally conservative BPPV treatments fails. If the symptoms continue for more than 12 months, an operation may be needed. Generally, the nerve that services part of the balance organ (posterior semicircular canal) is cut. The risks of this type of operation include hearing loss. Your ENT (Ear Nose Throat) surgeon is the best person to discuss this option.

Who Performs BPPV Treatment?

Some vestibular physiotherapists and doctors are trained in the assessment and treatment of BPPV.  BPPV-trained physiotherapists undertake specific training to diagnose and successfully treat BPPV. PhysioWorks has several BPPV trained physiotherapists. Please call them to book your appointment with a BPPV physiotherapist.

Why Do Physiotherapists Prescribe You Exercises?

The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose. Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.

What Exercises Should You Do?

Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person. You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage. It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs. The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescription Drugs?

Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not! Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional. So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.

Olympic Injuries

The Olympic games are the pinnacle of an athlete's career, where the fastest, strongest and elite compete for the podium finish. But just like you and me, they too suffer injuries, both career-ending and career limiting. How do they recover? In the 2008 Beijing Olympic games, out of the 9572 athletes, 1055 injuries were reported with the most common place of injury at the knee. The table below shows a grasp of the injuries sustained by athletes at the 2008 Olympic games and 2010 Winter Olympic games. Let's focus on the summer sports for the purpose of this article. If you guessed soccer, taekwondo, field hockey, handball and weightlifting as your top 5, you win the GOLD! Source: Scientific American, 2012

What're the Safest Olympics Sports?

For the risk adverse, you top 5 sports to get you to and from the Olympics are Sailing, Canoeing/Kayaking, Rowing, Synchronised swimming and diving. Having said that, I've seen all of those sportsmen and women with injuries at PhysioWorks! But the injury is not necessarily the end of your Olympic aspirations. You can see from the chart above that most athletes were able to recover and compete.

How Do Olympians Recover So Quickly?

When you’re at the elite level, you generally have an overabundance of medical assistance. You are closely monitored in terms of your daily health and any “niggles” are seen to immediately - not to mention the multiple physiotherapy sessions they can have in one day! Furthermore, they have access to state of the art medical technology which can assist diagnosis and speed up recovery. So what would be a 6-week injury for the local athlete (“Elite”) could potentially be under 4 weeks for the Olympian. They are also well in-sync with their bodies and consistently perform the recovery tasks mentioned below to ensure they are ready for their events and speed up their recovery.

What Do Olympians Do to Recover Quicker?

As mentioned earlier, a considerable portion of the Olympic athlete's recovery can be attributed to their access to medical assistance. The athlete does the training, has a natural talent, but there is also a proactive and readily available medical team behind them ensuring they stay at the top. We cannot undermine the athlete’s proactivity in performing their own recovery - regular stretching, not ignoring “niggles”, performing rehabilitation and “prehab” as prescribed. These are done so consistently but also with technical precision - not accepting poor quality.

How Do Olympians Prevent Injuries Between Events?

Competing at the Olympics isn’t a one-off event. More often than not, each sport has heats followed by a final series - sometimes even on the same day! To ensure the athletes are in their finest form to compete, they implement all the tricks of the trade - most of which we have access to! Compression gear, physiotherapy, massages, stretching, foam rollers, adequate nutrition and active recovery. Active recovery is often overlooked by the local sporting athlete but can so easily be the difference between being 80% and 100% recovered for your event. This can be done by a simple warm down jog/walk, stretching, pool recovery (water walking, light swimming) and nutrition. As the name suggests, the warm down is the opposite to the warm-up, we aim to gradually lower the heart rate and body temperature following physical activity. Simultaneously, it removes waste products created during exercise, including the dreaded Lactic Acid - which can cause cramping and tightness in muscles if it is not effectively removed. Inevitably, the tightness and soreness in muscles restricts movement and can limit the athlete's ability to perform at their top level.

What Does PhysioWorks offer that the Olympic Athletes have access to?

At Physioworks, we believe that every athlete whether competing in 5th-grade rugby or premier grade netball should have access to the same medical team services that elite athletes do. A team approach, with you at the centre, ensures your recovery from injury or event is undertaken effectively and efficiently. By offering access to physiotherapists, dietitians, massage therapists, exercise physiologists, hand therapists, acupuncturists etc as well as supplying products to potentially speed your recovery (protective equipment, compression garments, Tens machines and many other products), we are giving our patients every opportunity to ensure their quick and safe recovery. Of course, there is the body’s natural healing ability but, if we can place it in the optimal healing environment, you too can heal like an Olympian. GO AUSTRALIA!!

What Causes Muscular Pain?

You know the feeling… dreaded “stiff and sore muscles” a day or two after you’ve done a little more exercise than usual. Shortly after exercise begins, a mix of lactic and carbonic acids builds up in muscle tissue. These acids are waste products of muscle contractions. Don’t worry these acids are normal. To produce “energy”, muscles burn stored glycogen. Lactic and carbonic acids are by-products of this metabolic process. The good news is that most of these acids convert back into glycogen and are restored in preparation for your next bout of exercise. Pain and muscle fatigue can exist until the acid levels in your muscles return to normal.

How Does Massage Help?

Massage helps to eliminate the irritation caused by these acidic wastes. Research shows that massage can increase muscle recovery much quicker than rest alone.

Why is Massage So Useful When You Exercise?

Regular exercise causes many body changes. To meet the demand for more oxygen and nutrients, one improvement is the increase in blood vessels to the muscles. This circulation increase helps to eliminate the waste products and toxins that build up with exercise. Importantly, it can take several weeks to develop improved muscular circulation. Until the blood supply increases, you will have trouble with oxygen and nutrients supply. This allows toxic wastes to back up and stagnate. You will experience soreness, pain and stiffness. Many exercise enthusiasts regard aches and pains as the inevitable price to be paid. This is usually not true.

What about Muscle & Joint Stiffness?

Massage eases muscle and joint stiffness. Using massage strokes to reduce muscle tension and passive movement to stretch the connective tissue found around joints, massage will improve your performance. Massage also lengthens muscle and tendon units to help prevent injuries from occurring in the first place.

What about Soft Tissue Injuries and Massage?

Massage aids recovery from soft tissue injuries such as sprains and strains. Tissue repair accelerates by increasing circulation in the injured area. Massage therapy can help speed, improve recovery, and reduce discomfort from soft tissue injuries.

Massage is Drug-Free Treatment

Massage is a drugless therapy. Headaches, insomnia, neck and back pain, digestive disorders including constipation and spastic colon, arthritis, asthma, carpal tunnel syndrome and muscular aches and pains are just some of the problems that can respond to massage therapy.

What is the Correct Swiss Ball Size for You?

Which Exercise Ball Size is Best for You?

Exercise Balls come in a range of sizes depending on your height, leg length and whether you wish to use it primarily for exercising or as a posture seat. The right size exercise ball is vital to avoid causing pain or injury.

For example, when sitting on your exercise ball it is important that your hips are above your knees to allow the normal lower back curve to exist.

Recommended Exercise Ball Size

Exercise ball diameter Person's height
45 cm 5' and under
55 cm 5'1"– 5'8"
65 cm 5'9"– 6'2"
75 cm 6'3"– 6'7"
85 cm 6'8" and taller


Is Sitting on a Swiss Ball Good for You?

You may not realise it, but most of us have poor posture. Unfortunately, this causes long term wear and tear on the spine.  When used as a chair, the Swiss Exercise Ball encourages you to adjust your pelvis while sitting consistently. In addition to creating better circulation in your spine, gentle bouncing and balance reactions will improve your vital postural muscles' strength in your back. A better seat for the best back!

How Do You Use an Exercise Ball as a Chair?

The key to safe sitting upon an exercise ball is to have the appropriate height for you. You'll need one that lifts your seat bones just above your knee so that your thigh angle slopes slightly down from your groin to your knees. Otherwise, your lower back will curve in the wrong direction, which is high-risk of developing lower back pain.

But, once you have this ball height issue sorted, a Swiss exercise ball can successfully be used as an office chair to stimulate your postural sitting muscles as you work. This automatic muscle activation saves you time exercising those important back stability muscles, plus provides a pain-free office chair.

Beware of Cheap Swiss Exercise Balls. Are They Anti-Burst?

Exercise balls that come with an Anti-Burst Rating are strongly recommended for maximum safety. Staples, pins or other sharp items may unexpectedly pierce your ball if you roll over them. Anti-Burst rated balls will deflate slowly and safely when punctured, rather than bursting suddenly like a balloon with you landing on your back as occurs with cheap, non Anti-Burst exercise balls. PhysioWorks recommends only authentic, high-quality Anti-Burst exercise balls for your maximum safety and optimal comfort.

What Anti-burst Rating do we Recommend?

A 500kg anti-burst rating ball is the minimum that we recommend for safety purposes. Most exercise balls available that do not stipulate an anti-burst rating would have an anti-burst rating of between 100 and 200kg. They usually don't stipulate their anti-burst rating because it is low. A high anti-burst rating is a crucial issue if you consider exercises that involve bouncing or doing weights. Please take a look at our new Physiomed Pro Plus Exercise Ball, with a high anti-burst rating of 550 kg!

Consider Your Safety

As physiotherapists, we strongly suggest you avoid exercise balls that do not have an anti-burst rating. It's just not worth a few dollars to be potentially injured and out of action for months.

Anti-Burst Balls keep their shape better.

You'll also find that the higher the AntiBurst rating, the thicker the ball casing. This thickness reduces your likelihood of puncture in the first place from simple objects such as staples.  You should consider this if your intended use is as an office chair. A higher anti-burst rated ball will also keep it's shape better in the longer term.  Cheaper, thinner-walled exercise balls have the potential to stretch and become overinflated easier.  Please read our page on ball inflation tips before inflating your ball.
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