Vestibular Rehabilitation

What is Vestibular Rehab?

Physical therapy is used to evaluate the cause of your symptoms, such as dizziness, vertigo, lightheadness, difficulty balancing, and headaches. Treatment then typically involves therapeutic exercise, visual training, habituation exercises, or manual therapy. Canalith Repositiong Maneuvers are performed when appropriate, often referred to as the Epley Maneuver. Some less common dysfunctions can benefit from lifestyle modifications such as addressing diet, stress, and sleep patterns.

Vestibular System

The Vestibular System is the sensory system that contributes to our understanding of movement, physical orientation, balance, and coordination. As many as 35% adults over 40 have had issues with vestibular function. Dysfunction can result in a myriad of symptoms such as nausea, vision disturbances, decreased balance, diminished spatial awareness, and most commonly dizziness/vertigo.

What to Expect on the first visit?

The first visit lasts between 30-60 minutes and focuses on diagnosing the origin of symptoms by assessing the neck, visual testing, balance, special tests and correlating these with the subjective information provided by the patient. Once the origin of symptoms is determined the remaining time is devoted to explaining the condition, plan for treatment, providing exercises, and treatment as appropriate.

Main Types of Vestibular Disorders

The two most common vestibular disorders, Benign paroxysmal positional vertigo (BPPV) and labyrinthitis/vestibular neuritis, and are highly treatable conditions. Studies have found 80-100% resolution of symptoms for BPPV in 1-5 visits, and the vast majority of those with unilateral vestibular hypofunction (e.g. neuritis, labyrinthitis) have significant improvement within 4-6 weeks with minimal functional limitations.


BBV is caused by displacement of otoconia (calcium carbonate crystals), that should be in the utricle, migrate into one of the semi-circular canals. Certain positions cause movement of the crystals and give you a false sense of movement or spinning.

Treatment of this condition typically involves progressing through a series of positions to allow the crystals to migrate back out of the effected canal. This is commonly referred to as the Epley Maneuver. Though the Epley is specifically for the posterior canal, the most commonly involved canal. The term Canalith Repositioning Maneuvers is now used, as it can refer to treatment of any of the three canals. Symptoms can resolve in a little as a single visit.

Vestibular Neuritis/Labyrinthitis

Usually caused by a viral infection of the inner ear or vestibular nerve resulting in dizziness, nausea, vomiting, unsteadiness, decreased balance, and vision changes. This is different that middle infections that occur often in children. For those who do no naturally recover (or what is termed compensate) can be addressed with vestibular rehabilitation.

Treatment typically focuses on therapeutic exercise addressing habituation, gaze stabilization, and balance. Symptoms typically significantly improve without 4-6 weeks.

Cervicogenic Dizziness

Cervicogenic Dizziness is disequilibrium cause by abnormal input from the cervical spine. This is often related to posture and/or muscular coordination. It can occur on its own or along with previously mentioned conditions.

Treatment involves manual therapy and exercise to address posture and muscle coordination.


Are there other causes of vertigo?

Yes, but they are less common. The ones that can be treated (at least in part) with physical therapy include: concussion/post-concussion syndrome, vestibular migraine, and persistent postural perceptual dizziness. Some examples of causes that require other forms of medical intervention: acoustic neuroma, Ménière’s disease, perilymph fistula, and superior semicircular canal dehiscence, orthostatic hypotension, and other cardiovascular issues.

How do the crystals get into the canals?

There have been theories as to the cause but there does not seem to be any hard evidence or consentience.

I was given exercises many years ago when I had vertigo. Should I do the same ones?

Treatment has greatly changed over the last 15-20 years, and you should be reassessed as to the cause of your symptoms either way.