Dizziness and balance disorders affect millions of people, significantly impacting quality of life. Vestibular rehabilitation is a specialized form of physiotherapy that effectively treats these conditions, often providing dramatic improvement where other treatments have failed.

Understanding the Vestibular System

Your vestibular system, located in your inner ear, works with your eyes and sensory receptors to maintain balance and spatial orientation. When this system malfunctions, you may experience dizziness, vertigo, imbalance, or other troubling symptoms.

Components

Inner Ear:

Semicircular canals (detect rotation)
Otolith organs (detect linear movement and gravity)
Filled with fluid and tiny crystals

Brain Integration:

Processes vestibular information
Combines with vision and proprioception
Maintains balance and coordination

Common Vestibular Disorders

BPPV (Benign Paroxysmal Positional Vertigo)

Most Common Cause of Vertigo:

Crystal displacement in inner ear
Brief spinning with head movements
Particularly rolling over in bed or looking up
Very treatable (90% success rate)

Symptoms:

Brief episodes (seconds to minute)
Triggered by specific head positions
Spinning sensation
Nausea
Usually one-sided

Vestibular Neuritis/Labyrinthitis

Inner Ear Inflammation:

Often viral origin
Sudden onset severe vertigo
Can last days
Gradual improvement
May leave residual dizziness

Chronic Dizziness

Persistent Unsteadiness:

Multiple potential causes
Often multifactorial
Impact on daily function
Requires comprehensive assessment

Post-Concussion Dizziness

After Head Injury:

May develop immediately or delayed
Can persist for months
Often complex presentation
Requires specialized treatment

Symptoms of Vestibular Dysfunction

Dizziness Types

Vertigo:

Spinning sensation
Room spinning or you spinning
Often with nausea
Triggered by movement

Light-headedness:

Feeling faint or woozy
About to pass out
Not true spinning
May have different cause

Disequilibrium:

Off-balance feeling
Unsteadiness walking
Like walking on a boat
Worse in dark or uneven surfaces

Associated Symptoms

Nausea and vomiting
Visual disturbances
Difficulty concentrating
Fatigue
Anxiety
Headaches
Motion sensitivity

Vestibular Assessment

What to Expect

Comprehensive Evaluation:

Detailed history
Observation of symptoms
Positional testing
Eye movement analysis
Balance testing
Gait assessment

Diagnostic Tests

Dix-Hallpike Test:

Identifies BPPV
Specific head positioning
Observes eye movements (nystagmus)
Determines affected canal

Head Impulse Test:

Tests vestibular reflexes
Quick head turns
Eye tracking observed
Identifies vestibular weakness

Balance Testing:

Standing with eyes closed
Foam surfaces
Head turns while standing
Gait observation

Treatment Approaches

For BPPV: Canalith Repositioning

Epley Maneuver (Posterior Canal):

Series of head positions
Moves crystals out of canal
Takes 5-10 minutes
Often resolves in one treatment

Semont Maneuver:

Alternative technique
Quick position changes
Similar effectiveness
Different movement pattern

BBQ Roll (Horizontal Canal):

Series of log rolls
For horizontal canal BPPV
Performed on treatment table
High success rate

Success Rates:

80-90% resolution in 1-3 treatments
May need home maneuvers
Recurrence possible but treatable
Most dramatic vestibular treatment

Vestibular Adaptation Exercises

For Vestibular Hypofunction:

Gaze Stabilization:

Focus on target while moving head
Horizontal and vertical movements
Gradually increase speed
Reduces dizziness with head movement

Habituation Exercises:

Repeated exposure to provoking movements
Reduces sensitivity over time
Individualized to symptoms
Gradual progression

Balance Retraining

Progressive Challenges:

Standing exercises
Walking programs
Uneven surfaces
Reduced visual input (eyes closed)
Dual-task training

Example Progression:

Standing on firm surface, eyes open
Standing on firm surface, eyes closed
Standing on foam, eyes open
Standing on foam, eyes closed
Add head movements to each level

Substitution Strategies

Using Other Systems:

Vision for balance
Proprioception enhancement
Central compensation
Movement strategies

Home Exercise Program

Daily Exercises (As Prescribed)

Gaze Stabilization:

Hold card with "X" at arm's length
Turn head side to side while keeping eyes on X
Target stays clear
1 minute, 3x daily

Balance Exercises:

Stand on one leg: 30 seconds each
Tandem stance: 30 seconds
Walking heel-to-toe: 10 steps
Progress as able

Head Movement Exercises:

Sitting:
- Look up and down (10x)
- Turn side to side (10x)
- Tilt ear to shoulder (10x)
Standing:
- Same movements
- More challenging

Progression

Make Harder By:

Closing eyes
Standing on foam
Adding head movements
Dual-tasking
Uneven surfaces

Lifestyle Management

Avoiding Triggers

Common Triggers:

Busy visual environments (grocery stores)
Crowded places
Heights
Escalators
Moving vehicles
Fluorescent lights

Management:

Gradual exposure
Sunglasses if light-sensitive
Support person initially
Time exposure carefully

Fall Prevention

Safety Measures:

Good lighting
Remove tripping hazards
Grab bars in bathroom
Non-slip mats
Proper footwear
Assistive device if needed

Activity Modifications

During Episodes:

Sit or lie down
Focus on stationary object
Slow, deep breaths
Stay calm
Wait for it to pass

Daily Life:

Move slowly
Turn body, not just head
Good lighting
Clear pathways
Plan activities

Recovery Timeline

BPPV

Often resolves immediately with treatment
May need 1-3 sessions
Some residual unsteadiness 1-2 weeks
Excellent prognosis

Vestibular Neuritis

Acute Phase (Days 1-7):

Severe symptoms
Medication management
Rest
Begin gentle exercises

Recovery Phase (Weeks 2-6):

Improving symptoms
Active rehabilitation
Gradual return to activities
Building tolerance

Compensation Phase (Months 2-6):

Residual symptoms improving
Near-normal function
Ongoing exercises
Full recovery common

Chronic Conditions

Varies by cause
May have fluctuations
Focus on management and function
Quality of life improvement possible

Medications

Acute Vertigo

Vestibular Suppressants:

Short-term use only (2-3 days)
Prevents central compensation if used long-term
Examples: meclizine, dimenhydrinate
Reduces nausea and vertigo

Chronic Management

Usually Avoid Medication:

Interferes with adaptation
Delays recovery
Side effects (drowsiness)
Physiotherapy more effective

Exceptions:

Meniere's disease
Migraines
Severe anxiety

When to See a Doctor

Medical Evaluation Needed

Red Flags:

Sudden severe dizziness
With headache or neurological symptoms
Hearing loss
Persistent vomiting
Chest pain
Difficulty speaking or swallowing
Weakness or numbness

Other Reasons:

New onset dizziness
Worsening symptoms
No improvement with therapy
Need for imaging or testing
Medication management

Special Considerations

Migraine-Associated Dizziness

Common:

May occur without headache
Triggered by diet, sleep, stress
Motion sensitivity
Responds to treatment and lifestyle changes

Meniere's Disease

Characteristics:

Fluctuating hearing loss
Tinnitus
Fullness in ear
Episodic vertigo
Requires medical management + rehabilitation

Aging and Dizziness

Multiple Factors:

Vestibular decline
Vision changes
Medication effects
Multiple medical conditions
Fall risk higher
Multifaceted approach needed

Prognosis and Success Rates

BPPV:

90% successful treatment
May recur (30% within 5 years)
Re-treatable
Excellent outcomes

Vestibular Compensation:

80-90% significant improvement
Requires consistent exercises
Time varies (weeks to months)
Most adapt well

Chronic Dizziness:

Management improves function
May not eliminate completely
Coping strategies effective
Quality of life improved

Preventing Vestibular Problems

General Health:

Control blood pressure
Manage diabetes
Avoid smoking
Limit alcohol
Treat infections promptly

Head Injury Prevention:

Seatbelt use
Helmet for sports
Fall prevention
Proper safety equipment

Living Well Despite Dizziness

Adaptation:

Most people compensate well
Brain remarkable at adaptation
Consistent exercises key
Patience required

Support:

Vestibular disorders support groups
Education reduces anxiety
Family understanding important
Professional counseling if needed

Success Story

Many patients report:

"Life-changing" improvement
Return to normal activities
Reduced anxiety
Better understanding of condition
Effective management strategies

Struggling with dizziness or balance problems? Our vestibular rehabilitation specialists at M.O. Therapy provide expert assessment and treatment for all types of dizziness and balance disorders. We'll identify the cause and create a personalized treatment plan.

Book your vestibular assessment today. Don't let dizziness control your life. Most vestibular conditions are highly treatable, and we're here to help you regain your balance and confidence.

Vestibular Rehabilitation: Treating Dizziness and Balance Disorders