Vestibular physiotherapy is a specialized approach that treats vertigo, dizziness, and balance disorders. This rehabilitation uses targeted exercises to help your brain compensate for inner ear problems. The good news? Success rates reach 80 to 95% for several conditions, including benign paroxysmal positional vertigo (BPPV).

You may have been experiencing dizziness since a car accident, an ear infection, or for no apparent reason. Regardless of the cause, these symptoms can be very disturbing. Simply turning your head can trigger a spinning sensation. It's frustrating and sometimes frightening.

This guide explains what vestibular physical therapy is, what conditions it treats, and what to expect. You will discover why this approach is the first-line treatment for balance disorders. To understand the causes of neck pain that sometimes accompanies these symptoms, see our comprehensive guide to neck pain.

What exactly is vestibular physical therapy?

Vestibular physical therapy is a specialized rehabilitation program that targets the vestibular system (the structures in the inner ear responsible for balance). It uses exercises to retrain your brain to correctly interpret movement signals.

Your vestibular system functions like an internal gyroscope. It detects the movements of your head and sends signals to your brain to maintain your balance. When this system is disrupted, you may experience dizziness, a floating sensation, or balance problems.

Vestibular rehabilitation is based on three mechanisms:

What is the difference between this and regular physical therapy?

Vestibular physiotherapy requires additional specialized training. A physiotherapist trained in vestibular rehabilitation can perform repositioning maneuvers for BPPV, prescribe gaze stabilization exercises, and design balance training programs tailored to your condition.

What conditions does vestibular physical therapy treat?

Vestibular physiotherapy treats several conditions: BPPV, vestibular neuritis, Ménière's disease, cervicogenic dizziness, and post-concussion or post-whiplash balance disorders.^1,3^

Benign paroxysmal positional vertigo (BPPV)

BPPV is the most common cause of vertigo. It occurs when small calcium crystals move into the canals of the inner ear. The result is intense episodes of rotational vertigo triggered by certain head movements.

The good news? BPPV responds remarkably well to treatment. The Epley maneuver is successful in 80 to 92% of cases after the first session. It is one of the most effective treatments in medicine.

| Condition | Cause | Success rate |

|-----------|-------|----------------|

| VPPB | Crystals displaced in the inner ear | 80-92% after 1-2 sessions |

| Vestibular neuritis | Inflammation of the vestibular nerve | 75-85% with exercises |

| Cervicogenic dizziness | Neck problems | 75% with combined treatment |

| Post-whiplash | Following a car accident | Significant improvement |

Cervicogenic dizziness

Cervicogenic dizziness is a feeling of imbalance caused by problems in the neck. This type often occurs after a cervical injury such as whiplash. Position receptors in the neck muscles send confusing signals to the brain, creating a feeling of imbalance.

Treatment combines cervical physical therapy and vestibular rehabilitation. Studies show that approximately 75% of patients improve with this combined approach. For more information, see our comprehensive guide to whiplash.

Post-concussion syndrome

After a concussion, many people develop persistent dizziness. Vestibular physical therapy helps the brain recover and reintegrate sensory information correctly.

How is the evaluation conducted?

The assessment begins with a questionnaire about your symptoms, followed by specific tests to identify the cause of your dizziness. The physical therapist examines your eye movements and balance, and replicates the positions that trigger your symptoms.

What happens during the first visit

Expect the evaluation to take about 60 minutes. Your physical therapist will ask you questions about:

• When your symptoms began
• What triggers your dizziness (head movements, positions)
• The length of each episode
• Your other symptoms (nausea, headaches)
• Your medical history

The tests performed

| Test | What it evaluates | How it works |

|------|-----------------|---------------------|

| Dix-Hallpike test | Posterior canal BPPV | You are quickly laid down with your head turned |

| Roll test | Horizontal canal VPPB | We turn your head from side to side |

| Eye movement examination | Vestibular function | Your eyes are observed during various movements |

| Balance tests | Overall function | Standing with eyes closed on an unstable surface |

These tests may cause temporary dizziness. This is normal and necessary to identify the cause. Your physical therapist will guide you safely through the process.

What are the main treatment techniques?

Techniques vary depending on your condition: repositioning maneuvers for BPPV, gaze stabilization exercises, balance training, and habituation exercises.

Repositioning maneuvers

For BPPV, the main treatment is repositioning maneuvers. The Epley maneuver guides the displaced crystals out of the problematic canal.

The procedure takes 5 to 10 minutes. Your physical therapist will position you in a series of specific positions. You may feel dizzy during the procedure, but this is temporary.

The results are often spectacular. Many patients experience immediate relief.

Eye stabilization exercises

These exercises train your brain to maintain stable vision during head movements. You stare at a target while moving your head from left to right or up and down.

Studies show up to a 75% improvement in 4 to 6 weeks of regular practice.

Balance training

These progressive exercises challenge your balance system:

• Stand with your feet together, then on one leg.
• Eyes open, then eyes closed
• On stable, then unstable surfaces
• Walking in a straight line, then turning your head

The goal is to retrain your brain to maintain balance even when sensory information is reduced.

Habituation exercises

If certain movements trigger your symptoms, habituation exercises gradually expose you to these triggers. Over time, your nervous system adapts.

It's like desensitizing an allergy: gradual exposure reduces the reaction.

What is the connection between the neck and dizziness?

The neck contains position receptors that inform the brain of the position of your head. When these receptors are disrupted by injury, they can send confusing signals that create a feeling of imbalance.

This link explains why dizziness is so common after whiplash. Between 40 and 85 percent of people who have suffered whiplash report symptoms of dizziness. It's not in their head. It's a real consequence of disruption to the cervical receptors.

Vestibular physical therapy for cervicogenic dizziness combines:

• Neck treatment (mobilization, stabilization exercises)
• Vestibular rehabilitation (eye movement and balance exercises)
• Education on the condition and prognosis

This combined approach is more effective than treating only the neck or only the vestibular system. To understand how physical therapy treats neck problems, see our guide to physical therapy for neck pain.

What does a typical treatment program look like?

A typical program includes weekly sessions for 4 to 8 weeks, combined with daily exercises at home. BPPV can be resolved in 1 to 3 sessions. Other conditions require longer follow-up.

Structure of a care episode

The importance of home exercises

Home exercises are essential. Allow 10 to 20 minutes per day. Consistency is more important than duration. Doing 10 minutes every day is better than 70 minutes once a week.

What results can I expect?

The majority of patients experience significant improvement. For BPPV, 80 to 95% of cases are resolved. For other vestibular conditions, 70 to 85% of patients improve. Results depend on the condition and your commitment to the exercises.

| Condition | Typical time to improvement |

|-----------|------------------------------|

| VPPB | Immediate to a few days |

| Vestibular neuritis | 4-8 weeks |

| Cervicogenic dizziness | 4-12 weeks |

| Post-concussion dizziness | 6-12 weeks |

Factors influencing results

• Commitment to exercises: Patients who do their exercises regularly have better results.
• Duration of symptoms: The sooner you seek treatment, the better the results
• Related conditions: Anxiety and migraines can slow down progress
• Age: Older people sometimes take longer, but still improve.

Possible side effects

It is normal to experience a temporary increase in symptoms after exercising. This is a sign that your vestibular system is being stimulated. These effects subside within a few hours.

When should you seek medical advice for dizziness?

Consult your doctor if your dizziness persists for more than a week, affects your daily activities, or is accompanied by worrying symptoms.

Signs that you should seek medical attention

• Dizziness lasting more than a few days
• Dizziness that affects your work or activities
• Feeling of imbalance when walking
• Dizziness after head or neck trauma

When to seek emergency care

Go to the emergency room if your dizziness is accompanied by:

• Severe and sudden headaches
• Double vision or loss of vision
• Difficulty speaking or understanding
• Weakness on one side of the body
• Facial numbness
• Loss of consciousness

These symptoms may indicate a neurological problem requiring immediate attention.

Frequently asked questions

Will the exercises make me feel more dizzy?

At first, yes, slightly. This is normal and even desirable. The exercises must cause some symptoms to be effective. The discomfort should remain tolerable and subside within 15-20 minutes after the exercise.

How long before I see an improvement?

It depends on your condition. BPPV can be resolved in a single session. Other conditions generally take 4 to 8 weeks. Patience and consistency are important.

Do I need a doctor's referral?

In Quebec, you can consult a physical therapist directly without a referral. However, it may be helpful to see your doctor first to rule out certain causes of dizziness.

Is vestibular physical therapy covered by insurance?

The same rules apply as for regular physical therapy. Most group insurance plans cover physical therapy. Check your contract for amounts and limits.

Can I do the exercises myself?

For BPPV, the Epley maneuver can be performed at home, but it is best to do it first with a professional to ensure the correct diagnosis. Stabilization and balance exercises can be done alone after learning them in the clinic.

If you suffer from dizziness or balance problems, vestibular physiotherapy can help. Make an appointment with our team for a comprehensive assessment.