Understanding Vestibular Physiotherapy

Vestibular physiotherapy is a specialized form of rehabilitation that addresses disorders of the vestibular system—the intricate network in your inner ear responsible for balance, spatial orientation, and coordinating eye movements with head motion. If you’ve experienced dizziness, vertigo, or balance problems, vestibular physiotherapy may be able to help.

Who Benefits from Vestibular Physiotherapy?

Vestibular therapy can help individuals experiencing a wide range of conditions:

Vertigo and Dizziness

• Benign Paroxysmal Positional Vertigo (BPPV): The most common vestibular disorder, causing brief episodes of spinning with head movements
• Vestibular neuritis: Inflammation of the vestibular nerve
• Labyrinthitis: Inner ear infection affecting both hearing and balance
• Ménière’s disease: A disorder causing vertigo, hearing loss, and tinnitus

Concussion Recovery

Post-concussion syndrome often includes vestibular symptoms such as dizziness, motion sensitivity, and balance difficulties. Vestibular rehabilitation is a key component of concussion management.

Fall Prevention

Older adults experiencing balance problems, unsteadiness, or fear of falling can benefit from vestibular exercises to improve stability and confidence.

Other Conditions

• Vestibular migraine
• Acoustic neuroma (post-surgery rehabilitation)
• Bilateral vestibular loss
• Persistent postural-perceptual dizziness (PPPD)

Understanding the Vestibular System

Your vestibular system works in concert with two other systems to maintain balance:

1. Vision: Your eyes provide information about your environment and movement
2. Proprioception: Position sensors in your neck, joints, and feet tell your brain where your body is in space
3. Vestibular organs: The semicircular canals and otolith organs in your inner ear detect head movement and gravity

When any of these systems are impaired, the brain receives conflicting information, leading to dizziness, vertigo, and balance problems.

The Assessment Process

A comprehensive vestibular assessment includes:

History Taking

Understanding when symptoms started, what triggers them, and how they affect daily life.

Oculomotor Testing

Examining eye movements to identify vestibular dysfunction, including:

• Smooth pursuit and saccades
• Gaze stability testing
• Head impulse test
• Positional testing for BPPV

Balance Assessment

Evaluating standing balance under various conditions (eyes open/closed, firm/foam surface) and during movement.

Functional Movement Analysis

Observing how symptoms affect walking, turning, and daily activities.

Treatment Components

Vestibular rehabilitation is tailored to your specific condition and symptoms. Treatment typically includes:

Manual Therapy

For BPPV, repositioning maneuvers (such as the Epley or Semont maneuver) can relocate displaced crystals in the inner ear. Many patients experience significant relief after just one or two treatments.

Cervicogenic dizziness may be addressed with manual therapy to the neck, including joint mobilization and soft tissue techniques.

Customized Exercises

Gaze Stabilization Exercises These exercises train your vestibular-ocular reflex to maintain clear vision during head movement. You’ll practice keeping your eyes focused on a target while moving your head at increasing speeds.

Balance and Postural Control Progressive balance exercises challenge your stability in various positions and conditions, gradually building confidence and reducing fall risk.

Walking and Mobility Training Practice walking with head turns, navigating obstacles, and moving in busy environments to improve real-world function.

Habituation

For motion sensitivity, habituation exercises involve repeated exposure to movements that provoke symptoms. Over time, the brain adapts and symptoms decrease.

Education

Understanding your condition is crucial for recovery. We provide education on:

• How the vestibular system works
• Why symptoms occur
• Lifestyle modifications
• Safety strategies
• Realistic expectations for recovery

Referral

When appropriate, we coordinate with other healthcare providers including:

• ENT specialists
• Neurologists
• Audiologists
• Primary care physicians

Some conditions require medical management alongside rehabilitation.

What to Expect from Treatment

Recovery time varies depending on the condition:

• BPPV: Often resolves within 1-3 sessions
• Acute vestibular loss: Significant improvement typically occurs over 6-12 weeks
• Chronic conditions: May require ongoing management strategies

Consistency with your home exercise program is essential for optimal outcomes. Most patients notice improvement within the first few weeks of starting treatment.

When to Seek Help

Consider vestibular physiotherapy if you experience:

• Spinning sensations (vertigo)
• Dizziness or lightheadedness
• Feeling off-balance or unsteady
• Difficulty focusing or reading during head movement
• Motion sickness or sensitivity
• Fear of falling
• Dizziness following a head injury

References

1. Herdman SJ, Clendaniel R. Vestibular Rehabilitation. 4th ed. F.A. Davis Company; 2014.
2. Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.
3. Hall CD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline. J Neurol Phys Ther. 2016;40(2):124-155.
4. Whitney SL, Alghwiri AA, Alghadir A. An overview of vestibular rehabilitation. Handb Clin Neurol. 2016;137:187-205.

Experiencing dizziness or balance problems? Contact us to book a vestibular assessment.