Vestibular Physiotherapy

Vestibular rehabilitation is physiotherapy aimed at treating dizziness and balance concerns. Vestibular rehabilitation can help you resolve dizziness, regain balance, and improve your ability to participate in meaningful activities!

Vestibular rehabilitation can be helpful for people who experience any of these symptoms:

Dizziness or vertigo
Balance problems or unsteadiness
Visual changes with head movement
Prolonged symptoms post concussion

These symptoms are often caused by conditions such as:

Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular Neuritis
Ménière’s Disease
Concussions or other head injuries
Age-related balance changes
Neck pain, stiffness, and/or injury
Migraines

Your physiotherapist will direct you to the appropriate medical practitioner for continued assessment if the cause is outside of the physiotherapy scope of practice.

*Please note that we require that someone accompany you to your vestibular appointment(s), and pick you up from your appointment afterwards. Please see the FAQ below “Can I drive after my vestibular assessments and treatments?” for more information.

A typical assessment includes:

A thorough history-taking
Screening for red flags that would warrant referring you to your physician
An assessment of your head and eye movements
An assessment of your balance and gait
A manual therapy (hands-on) assessment of your upper quadrant (neck, shoulders and thoracic spine)
Cardiovascular screen if needed (blood pressure testing in different positions)
Specific tests to help differentiate the cause of your dizziness
Individualized home exercises
Education to help you understand your symptoms and develop the tools to manage your condition independently

A typical treatment plan includes:

Exercises and education to help with symptom management
Balance and coordination exercises
Gaze stability training (allowing your eyes to help with balance)
Motion sensitivity training (a form of desensitization training)
Physiotherapy for the neck including manual therapy (hands on joint mobilization and myofascial release), exercise, and needling
Specific repositioning techniques to safely move the loose crystals back where they belong, and help to re-normalize the vestibular-to-brain communication pathway
General strengthening and re-conditioning exercises

Frequently Asked Questions:

How long does it take to see improvements?

Some conditions, like BPPV, can be resolved in 1-3 sessions
Others may need weeks to months of consistent therapy

Who should consider seeking vestibular rehabilitation?

You might benefit from vestibular rehabilitation if:

Your experience room spinning dizziness, for any length of time (seconds, hours, days)
Your symptoms are worse with head movements such as turning your head, rolling in bed or looking up or down
You feel dizzy when changing positions
You frequently lose your balance or fall
You rely on hand support from furniture, or railings, for stability when walking
You experience dizziness or vertigo after an illness or injury
You have difficulty walking straight
You have ear symptoms such as fluctuating hearing loss, a sensation of ear fullness and/or ringing in your ears
Busy environments make you feel unsteady or “off”, you may prefer to avoid these environments all together
You experience visual changes such as blurred vision when turning your head or difficulty focusing while walking
Difficulty walking in the dark or uneven surfaces
You avoid activities or certain environments due to feeling unsteady or unwell

What is the difference between dizziness and vertigo?

The term dizziness is used to describe a broad variety of sensations (light headed, swaying, disorientated, etc.). Dizziness can be associated with a large number of causes and conditions.

Vertigo is a specific type of dizziness defined as the illusion of movement occurring in the environment, such as the room spinning. It is most associated with BPPV.

What are some of the causes of dizziness?

Dizziness has many possible causes including conditions that affect the inner ear, injury to the head and neck, and neck stiffness and motion sensitivity.

Dizziness can also result from a number of medical causes including medication side effects, infection, orthostatic hypotension, anemia, dehydration, among others. Vestibular physiotherapists are trained to screen your dizziness symptoms and identify if there is a vestibular, musculoskeletal or balance impairment.

What are common goals of vestibular rehabilitation?

The key goals of vestibular physiotherapy are to assess and treat the cause of your symptoms, and help you return to the activities you love with confidence!

Can I drive after my vestibular assessments and treatments?

No, we recommend that another person pick you up from your appointment to take you home. Unfortunately we cannot know before someone comes in what is the cause of their dizziness, or how they will react to the assessment and/or treatment, so it is safer to always have someone else take you home. It is also not recommended to use Uber or public transit to get home.

Can I expect the assessment to provoke my symptoms?

Yes, a vestibular assessment often intentionally provokes symptoms such as dizziness, vertigo, or nausea. This is a normal part of the diagnostic process, designed to activate the inner ear’s balance mechanisms to identify the cause of dysfunction. While uncomfortable, these symptoms are typically short-lived and subside shortly after the test concludes. The tests are safe, and your physiotherapist will adjust the process to ensure your safety and comfort.

Vestibular physiotherapy can help you resolve dizziness and regain your stability!

Common causes of dizziness that benefit from vestibular physiotherapy treatment:

BPPV (positional vertigo)
Post-concussion syndrome
Whiplash
Age-related balance changes
Ménière’s disease
Vestibular neuritis
Migraines

Vestibular physiotherapy assessments often include:

A thorough history
An assessment of your head and eye movements
An assessment of your gait and balance
Specific tests to help differentiate the cause of your dizziness
Hands-on treatment
Individualized home exercises
Education to help you understand your symptoms and develop the tools to manage your condition independently

The key goals of vestibular physiotherapy are to assess and treat the cause of your dizziness, and help you return to the activities you love with confidence!

What do you mean by the terms vertigo and dizziness?

Vertigo is characterized as the feeling of existing in a moving environment when the environment itself is stationary. Vertigo may be described as “rotational vertigo”, when you feel like the room is spinning, or it may be experienced as a “swaying” or “rocking” sensation.
Dizziness can be described as the feeling of being lightheaded, or off-balanced, and can be experienced differently by each person.

Can the neck and vestibular system, or inner ear dysfunction, cause vertigo and dizziness?

Yes! The vestibular system provides information to the brain about your body’s position in space, greatly helps with balance and your perception of movement. Deficits in the vestibular system can cause conditions like Benign Paroxysmal Positional Vertigo (BPPV), where little crystals (that we all are supposed to have) shift where they do not belong. This causes the information from the vestibular system to the brain to be altered, which is ultimately interpreted as faulty movement. This is one of the most common causes for brief rotational vertigo. There are other conditions like vestibular neuritis, or labyrinthitis, where the nerve that connects the vestibular system to the brain gets inflamed, or damaged (i.e. due to motor vehicle accidents, concussion, viral/bacterial infection, Ménière’s Disease)

Neck pain and stiffness and injury can also cause dizziness. This type of dizziness is called “cervicogenic dizziness.”

What are the best treatment options for dizziness and nausea?

This depends on the cause of the dizziness and nausea:

Exercises can often help with symptom management. Exercises may be dedicated to improve: balance, coordination, gaze stability training (allowing your eyes to help with balance), or motion sensitivity training (a form of desensitization training).
If your dizziness is due to neck dysfunction, there are a variety of treatment options that may include, but are not limited to, dry needling, joint mobilization/manipulation, myofascial release, and exercise.
If the condition is due to BPPV, then there are techniques that a physiotherapist can use to safely move the loose crystals back where they belong, and re-normalize the vestibular-to-brain communication pathway.

Will dizziness get better on its own?

Some conditions like labyrinthitis or neuritis can be time-base, but even in these cases, treatment can help you cope with the dizziness. BPPV may spontaneously resolve but it is better to see a vestibular therapist immediately.

How can a vestibular-trained physiotherapist help me?

Physiotherapists who have specialized training in vestibular physiotherapy are trained to appropriately screen what is causing your symptoms — i.e. neck, neurological, vestibular, other medical conditions — and direct you to the appropriate medical practitioner if the cause is out of their scope.

Vestibular Physiotherapy

Frequently Asked Questions:

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