I believe that every single movement and rehabilitation professional should be assessing the Vestibular system.
They should be assessing it along with the other sensory systems when helping a client get out of pain or trying to improve balance, posture, pain or coordination.
What is the Vestibular System
The Vestibular system is one of the most important areas in our brain and nervous system in that it communicates to our brain about 3 major inputs.
Where is my head in space? Where is my body in relation to my head? Which way is up?
To me, those things seem pretty important when it comes to coordinating our movement and posture, don't you reckon? The Vestibular system system is one of the most phylogentically ancient areas of the brain. It's already working when we are bobbing around in our mum's belly, essentially weightless. As soon as we come out of the womb and hit the forces of gravity though, that's when the Inner Ear system, as it is commonly known, starts to play a major role.
The primary function of the vestibular system is to inform the brain of the position and angulation of the head in relation to gravity so as to keep the body upright and the visual field towards any potential dangers.
The stimulation of tiny hair’s within the inner ear along with recruitment of postural muscles becomes our sense of balance.
The vestibular system is comprised of the Otolith organs which monitor the position of the head and 6 semi-circular canals which monitor change in the angulation of the head.
Motor and posture control is sensory driven
The Vestibular system is also part of the sensory apparatus that coordinates with our other major sensory centres to establish posture and movement. These areas are:
The Visual systemThe Vestibular systemThe Proprioceptive system embedded in the muscles, fascia, skin and jointsThe Feet
The communication and integration between these systems is paramount in order to gain an accurate picture of all the sensory stimulus flying into our brain. The integration of this stimulus will determine the quality of the motor output after everything is integrated. As motor control is an output of the brain and is primarily sensory driven, then considering the vestibular system as a way of affecting motor output is not a bad idea.
Vestibular system and posture
The vestibular system is intrinsically connected the reflexive posture system of the body. The particular pathway is called the Vestibulo-spinal system and the Vestbilo-cerebellum. These pathways have reflexive connections into the posterior chain to support upright posture and provide a platform for movement. It also has reflexive connections into the glands of the endocrine system, so any hormonal imbalances can effect posture and visa versa.
I believe that every single movement & rehabilitation professional should be assessing the Vestibular system.
Vestibular system and para-sympathetic activity
The Vestibular system is also intrinsically linked to the para-sympathetic nervous system via the vagus nerve. It explains why sometimes when we have dysfunctional vestibular integration we feel nauseas and ill. Also why after performing vestibular drills a person can feel more calm and relaxed.
Vestibular Occular Reflex (VOR)
An extremely powerful reflex associated to this system is called the Vestibular Occular Reflex which is the ability of the eye to remain fixed on a target while the head is moving. This requires a massive amount of coordination between the vestibular system and midbrain to coordinate the head and eye movements.
Without this reflex our visual field would slip all over the place when we moved our head. This is also a reflex that is vital to the human gait cycle and helps to map different segments of the visual field while walking.
It can be used clinically to address balance and coordination issues and anyone trained in functional neurology will be able to assist you with this.
We will discuss more on this reflex and how to use it in therapy at the bottom of this article.
This reflex aims to stabilise the body. The VSR consists of static and dynamic reflexes that change muscular activity below the head, relative to the position of the head. The function of these motor commands is to alter muscle tone, extend, and change the position of the limbs and head with the goal of supporting posture and maintaining balance of the body and head.
Connections to the Cerebellum
Cranial Nerve VIII, the Vestibulo-Cochlear Nerve carries impulses from the inner ear to the vestibular nuclei that live within the cerebellum.
The vestibular system is tonic, meaning it fires continuously into the cerebellum. This way the brain always knows where our heads and can reflexively fire our extensor muscles to keep us upright, balanced and as much as possible out of harms way.
Sensory Threat Matrix
The eyes, the vestibular system, the tongue, the spine the jaw and the neck muscles are well connected. All those areas of the body are highly integrated and co-dependant of one another, so imbalances in any, can affect all. These areas are intrinsically wired together via the cranial nerves and a particular pathway called the Medial Longitudinal Fasciculus.
These are linked to our head righting reflexes, that react when any one the special senses perceives a threat in our environment. So over time we may get really tight upper traps due to overactive sensory input into the vestibulo-occulo-spino-mandibular pathway.
Who can and should assess the Vestibular system
Basically any health professional that deals with helping people who are in pain or with performance should have an understanding and ability to assess the vestibular system.
Don't get me wrong, leave the medical diagnosis of serious neurological conditions to the medically trained Neurologists. Anything else that is not a medical issue are called sub-clinical findings and can be assessed with functional neurological assessments from a trained professional.
Up until recently only chiropractors trained in Functional Neurology were able to learn these skills, but over the last few years with a more integrative focus, this has been opened up other professionals such as physiotherapists, manual therapists, acupuncturists, strength and conditioning coaches and personal trainers.
The vestibulo-spinal system also has reflexive connections into the glands of the endocrine system, so any hormonal imbalances can effect posture and visa versa.
The future of fitness and holistic health
Education companies such as Applied Movement Neurology have opened up learning these skill sets to members of the fitness community such as personal trainers and other movement therapists. There are others such as Z Health, the Carrick Institute and the Functional Neuro-Orthopeadic Rehab group that train professional to assess and drive the vestibular system.
A qualified AMN practitioner is trained in functional neurological assessments can assist in finding sub-clinical vestibular asymmetries.
A client does not have to have a vestibular condition or history of one, although many do to benefit from this approach. Often asymmetries in the vestibular system can give major clues as to why the same injury keeps popping up time and again. Also if manual therapy and conservative exercise therapy approaches do not resolve the problem then it may an idea to look to the brain and the vestibular apparatus or any of the associated pathways and structures.
Training the Vestibular System
The vestibular system loves complex movement in general. It loves changes in elevation, rolling around on the floor, spinning, going vertical and just being challenged.
Below are some videos courtesy of Z Health Performance Solutions, one of the world's leading authorities on brain based fitness education that I have studied with. The founder Dr Eric Cobb shows some simple yet effective way to train the vestibular system.
Spin training is very beneficial for developing connections between the vestibular system and cerebellum.
VOR Integration Drills
Vestibular Occular Reflex drills aim to develop integrity of the occular system and the inner ear. These drills can used to integrate this reflex. The VOR drills can be used to improve balance, coordination, flexibility and even help with pain relief.
Exercise caution if you have a history of balance, visual and vestibular issues. You may want to start in a seated position before progressing to standing.
The Vestibular apparatus is a highly critical structure to assess in anyone with postural issues, movement disorders or musculoskeletal pain.
Training this system is also highly critical if you are working with athletes and can bring rapid results and help those nagging injuries.
In the following articles we will discuss the other sensory systems that impact how your brain controls posture and movement.
Those areas are:
The visual system
The Basal Ganglia
The Limbic system
The proprioceptive system
The interoceptive system
The fascial system
- Neuroscience: Foundations for Rehabilitation
- Anatomy and Physiology of the normal Vestibular system
- Z Health Performance Solutions, Youtube Channel
- Vogue magazine, Dancer Image