What Is Vestibular Physical Therapy?

If you have dizziness or vertigo, you may benefit from a specific type of rehabilitation called vestibular physical therapy. Vestibular physical therapy is a special type of treatment designed to help you recover from dizziness, unsteadiness, or vertigo. It can help you recover quickly and return to your previous level of functioning with no dizzy spells.

Symptoms of Vestibular Problems

Your vestibular organ is a special structure in your inner ear. You have two of them: one on the left side and one on the right. Your vestibular organs are responsible for telling your brain the position of your head and then coordinating your eye movements based on your head position.

Symptoms of vestibular problems may include:

• Dizziness
• Whooshing sensations
• Difficulty maintaining upright balance
• Difficulty stabilizing your eyes on objects
• Fogginess in your head
• Headache
• Nausea

If you have any symptoms of vestibular problems, see your physician right away. A doctor will assess you and make a diagnosis of your condition. Sometimes these symptoms may be a sign of something serious like a stroke. In that case, time is of the essence, so checking in with your physician is a must.

After assessing your condition, the doctor may recommend treatment that includes vestibular physical therapy.

Conditions Treated

People with a variety of conditions who are symptomatic may benefit from vestibular physical therapy. Conditions often treated include:

• Benign paroxysmal positional vertigo (BPPV): BPPV causes mild to intense dizziness and is one of the most common causes of vertigo.
• Vestibular hypofunction: This condition decreases the balance in the inner ear, triggering dizziness and disorientation.
• Meniere's syndrome: An inner-ear disorder that can cause hearing loss and dizzy spells.
• Concussion: A traumatic brain injury usually caused by a blow to the head or a strong hit to the body that causes the head to rapidly shake.
• Vestibular migraine: A neurological condition that causes pounding or throbbing headaches.
• Multiple sclerosis: A disease of the brain and spinal cord that causes the immune system to attack the protective sheath that lines the nerve fibers.
• Chronic and stable stroke: A stroke occurs when blood supply to part of the brain is reduced, which keeps the brain tissue from getting the oxygen and nutrients it needs.
  

Who Administers Vestibular Rehab?

Vestibular physical therapy is performed by a physical therapist who has had extensive training in problems affecting balance and vestibular systems. Many vestibular therapists are certified as a vestibular specialist through the American Institute of Balance.

Physical therapists who are not certified in vestibular therapy may still perform assessments and treatments related to vertigo and dizzy symptoms. But your overall outcome will likely be improved by seeing someone with certification as a vestibular specialist.

Some vestibular rehab specialists may be occupational therapists or ear, nose, and throat physicians (otolaryngologists).

Procedures

Vestibular physical therapy usually begins with an initial evaluation. During this appointment, your therapist will assess your condition and determine the best procedures to help you recover. Treatments often vary depending on your diagnosis and your specific needs.

Procedures often include:

• Otolith repositioning maneuvers (for those with BPPV): This procedure uses head maneuvers that shift the canalith particles (otoconia) in the inner ear. If canalith particles are in a place in your ear causing dizziness, shifting them may improve symptoms.
• Postural exercises: These exercises can help improve posture and align the neck and spine.
• Neck range of motion: Stretching the neck can help reduce pain and muscle tension, helping to keep your muscles moving freely.
• Gaze stabilization exercises: These are exercises that help improve vision while the head is moving, ultimately reducing dizziness and improving balance.
• Balance exercises: Practicing balance exercises can help improve fall risk while standing or walking in the event vertigo occurs.

Not every person with vertigo will need every procedure or treatment. Your treatment should be tailored to your specific diagnosis and needs. For example, if you have BPPV, your dizziness is likely caused by displacement of otolith crystals in the semicircular canals of your vestibular organ.

The Epley maneuver may be performed to reposition the crystals. Performing this maneuver for someone with dizziness caused by a concussion would likely not be helpful.

Sometimes, vestibular physical therapists use specialized tools to diagnose and treat vertigo or vestibular-related problems. For example, Frenzel goggles may be used to diagnose your condition. These specialized goggles take a video picture of your eyes as you move your head in various directions. They help your therapist detect subtle eye motions that may be a sign of a vestibular problem.

Occasionally, virtual reality goggles and optokinetic videos are used to create situations that cause mild dizziness. This therapy allows your central nervous system to slowly adapt to changing visual fields, lessening the symptoms of vertigo.

Outcomes

If you have a vestibular condition causing vertigo, dizziness, or a loss of balance, vestibular physical therapy may help since it has been proven to be an effective treatment. A 2019 study examined the effects of early vestibular physical therapy after a sports-related concussion.

The results showed that vestibular rehab was helpful in getting athletes back to sports quicker than those who did not do vestibular physical therapy for concussion.

A 2020 study showed that vestibular rehab is an effective method to reduce falls in elderly people who have symptoms of vertigo. Positive outcomes were maintained up to 12 months following therapy.

How Long Should Vestibular Physical Therapy Take?

Most series of vestibular physical therapy last for four to eight weeks. Some patients attend therapy twice weekly, while others attend less frequently. Some patients do daily exercises at home for their vestibular system and check in with their physical therapist at regular intervals.

Keep in mind that everyone is different. Your series of sessions of care may be longer or shorter depending on your specific condition and needs. Be sure to speak with your physical therapist and physician to understand your course of vestibular rehab.

Summary

Vestibular physical therapy can help people with dizziness or vertigo. It is often performed by a physical therapist, occupational therapist, or ear, nose, and throat doctor (ENT) with experience in balance and vestibular systems.

Vestibular rehab consists of many exercises that vary based on patient needs, including otolith repositioning maneuvers, postural exercises, neck range of motion, gaze stabilization exercises, and balance exercises. It has been shown to be effective for a range of patient types, including athletes and the elderly.

A Word From Verywell

Feeling dizzy can make everyday tasks difficult and affect your quality of life. Thankfully, there are many different exercises that may help you feel your best again.

A physical therapist who specializes in balance and vestibular systems can work with you to improve posture, mobility, and gaze stabilization. That way, you can quickly reduce or eliminate your dizzy symptoms and return to your previous level of function.

Frequently Asked Questions

What is vestibular physical therapy?

Vestibular physical therapy is a specialized form of rehab to help people with vertigo, loss of balance, or dizziness.

What types of exercises should you expect from vestibular physical therapy?

Various exercises may be used to help improve symptoms of vertigo. These exercises are specific to your condition and may include the Epley maneuver, balance and postural exercises, and gaze stabilization exercises.

How long after a concussion should I wait to do vestibular physical therapy?

Research shows that early access to vestibular physical therapy is best for concussion. Once acute symptoms subside, about one to two weeks after injury, you can begin rehab.

How much does insurance pay for vestibular physical therapy?

Vestibular physical therapy is often a covered service by most insurance plans. Most plans pay $75–$150 per session for vestibular physical therapy, depending on your location and for what specific procedures your physical therapist bills. You may have a co-payment or out-of-pocket expense as well, depending on your particular insurance plan.