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Dizziness, lightheadedness, vertigo? Here is how a physical therapist can help.

Molly Gries, PT, DPT
Board-Certified Orthopaedic Clinical Specialist
Certificate in Vestibular and Balance Rehabilitation Therapy

When you are experiencing dizziness, lightheadedness, or vertigo, a physical therapist might not be the first practitioner you consider consulting.  You might not have known that a physical therapist is someone who can provide a differential diagnosis and treatment of an array of conditions that can cause dizziness. The treatment performed by a physical therapist can often provide significant, and in some cases immediate, relief.

The role of the inner ear

Most dizziness is caused by dysfunction or disorders of the inner ear called the vestibular system. This is the part of the inner ear that helps control balance, gaze stabilization and orientation. When the vestibular system is not working well, it can cause dizziness, nausea and vomiting, fatigue, brain fog, unsteadiness, and general decreased confidence in movement. This can lead to decreased physical activity levels, limited quality of life, and sometimes, anxiety and depression.1 Fortunately, a physical therapy who has specialized in vestibular therapy can assist with compensation of the inner ear and return to normal daily activities with improved confidence.

What is Vestibular and Balance Rehabilitation Therapy (VBRT) and how does it work?

Vestibular rehabilitation is a specialty that physical therapists can choose to develop. A physicl therapist who specializes in VBRT helps relieve dizziness that results from primary and secondary vestibular disorders. This form of treatment uses exercises and maneuvers to help improve balance, gaze stability, dizziness, and vertigo. The goals behind VBRT are to promote vestibular adaptation and substitution to help people return to full function. Repair of vestibular function after developing a disorder can be limited, however return to full function can be accomplished via compensation, substitution by other visual or sensory pathways, and habituation.

VBRT uses a few key principles of treatment to achieve the goal of adaptation and habituation of the vestibular system. Exercises are focused on head-eye movements with challenges to balance and postural orientation pathways to allow for compensation and adaptation. The main pathway that is used during these exercises is the Vestibular-Ocular Reflex (VOR) which is the connection between the vestibular system and the eyes that helps stabilize your gaze and tell you where you are in space. During vestibular dysfunction, the VOR can often be slightly offset which causes a mismatch of information from both sides of your inner ear. 3

Oftentimes, the vestibular system naturally compensates for the dysfunction and people can return to normal with no symptoms. However, there are times when the system does not compensate by itself and this requires additional specific exercises to help. VBRT uses a problem orientated approach to help address specific problems for each person. There are few key principles in treatment: Habituation, Gaze stabilization and/or Balance training. 1,3

Habituation exercises are used to treat symptoms of dizziness that occur when you move around or have symptoms with increased visual distraction. These may include watching TV, being in busy environments, like grocery stores, walking or quick movements. The two main goals of these exercises are to help desensitize the vestibular system to misfiring during relatively normal daily activities, and help improve overall daily functioning by provoking mild, not lasting symptoms, that lessen overtime. 2

Gaze stabilization exercises help to improve control of head-eye movement. Theses are commonly used when you find it difficult to maintain a steady visual field while moving, or identifying objects when moving or during quick head movements. The goal of these exercises is to help retrain the eyes and inner ear to work together to maintain a steady view of the environment when moving your body or your head. 1,2

Balance training works to improve steadiness and confidence in movement during daily activities. Exercises are designed to address individual deficits with the goal of being moderately challenging, but not unsafe. Usually balance training is done by manipulating variables of balance including, visual or balance cues, static or dynamic movements, dual task training and/or coordinating movements patterns. The goal of balance exercises is to return to normal daily and recreational activities with full confidence 1

But I was told I just needed a maneuver to fix my dizziness.

Yes, there is one vestibular condition that is treated with repositioning maneuvers to help move the crystals in your inner ear (Otoliths) back to the correct position. This is called Benign Paroxysmal Position Vertigo (BPPV) and is a common cause of dizziness, especially acute onset room spinning dizziness that lasts for a few seconds to minutes and usually occurs with positional changes. This is identified by a clinical exam and treated by the physical therapist via specific repositioning maneuvers.1,3

Dizziness is not something you need to live with and accept

Overall, dizziness is a multi-factorial problem that requires a skilled clinician to carefully examine your movement system to help identify the underlying root causes and determine the best treatment to help you return to your full life activities and goals. Seeing a physical therapist that specializes in VBRT can be life changing and get you back to doing the things you love!

  1. Farrell, L. (2021, May 21). Vestibular rehabilitation TherapyLis. VeDA.
  2. Han, B. I., Song, H. S., & Kim, J. S. (2011). Vestibular rehabilitation therapy: Review of indications, mechanisms, and key exercises. Journal of Clinical Neurology, 7(4), 184.
  3. Herdman, S., & Clendaniel, R. A. (2014). Vestibular rehabilitation (4th ed.). F.A. Davis Company.