Vertigo Therapy

How Vestibular Rehabilitation Therapy Gets You (Literally) Back on Your Feet

From Shift­ing Inner Ear Crys­tals to Sta­bi­liz­ing Your Eye Movements

You feel like you’re sea­sick. You’re nau­se­at­ed and dizzy, and you’re hav­ing trou­ble keep­ing your bal­ance. But there’s one major prob­lem with this: You’re not actu­al­ly at sea!

That feel­ing of imbal­ance, even when you’re just stand­ing still or walk­ing down the side­walk, could be a sign of a vestibu­lar dis­or­der. And you might be sur­prised to know that your inner ears are very much to blame for the dizziness.

The Vestibu­lar Sys­tem: The Con­nec­tion Between Ears and Balance

Your ears do more than help you hear. A lot more.

The parts in your inner ear work with your brain to help main­tain bal­ance and con­trol eye move­ment. This is your vestibu­lar sys­tem.

Source: Vestibu­lar Dis­or­ders Asso­ci­a­tion (VeDA)

If the vestibu­lar sys­tem is weak or dam­aged, it can lead to a vestibu­lar dis­or­der. Dam­age could come from an injury or struc­tur­al prob­lems in the ear. For exam­ple, there are small crys­tals (oto­co­nia) with­in your inner ear that are sen­si­tive to grav­i­ty and accel­er­a­tion. They usu­al­ly rest in the part called the utri­cle. Some­times, these inner ear crys­tals shift into your ear’s semi­cir­cu­lar canals. When the crys­tals are out of place, they can make you sen­si­tive to changes in your body posi­tion or move­ments that you wouldn’t usu­al­ly be sen­si­tive to, caus­ing a spin­ning sen­sa­tion (ver­ti­go). This ver­ti­go is often asso­ci­at­ed with get­ting in/​out of your bed.

For­tu­nate­ly, vestibu­lar reha­bil­i­ta­tion ther­a­py (VRT) can make a dif­fer­ence if you are expe­ri­enc­ing these symptoms.

Where Vestibu­lar Reha­bil­i­ta­tion Ther­a­py Comes In

Vestibu­lar reha­bil­i­ta­tion ther­a­py is a spe­cial­ized, exer­cise-based treat­ment plan that aims to help you man­age and cope with symp­toms, such as:

  • Dizzi­ness
  • Ver­ti­go (Feel­ing like you are spin­ning or mov­ing when you’re not actu­al­ly doing so, or feel­ing like your sur­round­ings are spinning)
  • Dis­e­qui­lib­ri­um (Feel­ing unsteady, imbal­anced, or disoriented)
  • Falling
  • Nau­sea
  • Headaches
  • Visu­al prob­lems, like blurred vision
  • Motion sick­ness
  • Dif­fi­cul­ty mov­ing and walk­ing around

VRT is par­tic­u­lar­ly ben­e­fi­cial if you have:

  • Benign parox­ys­mal posi­tion­al ver­ti­go (BPPV), which caus­es tem­po­rary, intense episodes of ver­ti­go that are typ­i­cal­ly trig­gered by your head chang­ing posi­tion. It occurs when your inner ear crys­tals shift out of their nor­mal posi­tion with­in the ear.
  • Vestibu­lar neuritis/​labyrinthitis, which is inflam­ma­tion of the nerve that car­ries sig­nals from your vestibu­lar organs to the brain. It caus­es sud­den and severe episodes of ver­ti­go, as well as nau­sea and vomiting.
  • Post-con­cus­sion syn­drome, which occurs when your vestibu­lar sys­tem is dam­aged due to a trau­mat­ic brain injury. This dam­age can cause your sys­tem to send inac­cu­rate infor­ma­tion to your brain, result­ing in imbal­ance, dizzi­ness, head or neck pain, dif­fi­cul­ty con­cen­trat­ing, or whiplash.

VRT can also be used to treat imbal­ance or dizzi­ness caused by oth­er con­di­tions, such as stroke.

If you are hav­ing imbal­ance, dizzi­ness, or ver­ti­go, vestibu­lar reha­bil­i­ta­tion ther­a­py may be right for you. Con­tact a Duly vestibu­lar phys­i­cal ther­a­pist to learn how you could ben­e­fit from VRT.

What to Expect Dur­ing VRT

The first step is meet­ing with a phys­i­cal ther­a­pist who spe­cial­izes in vestibu­lar reha­bil­i­ta­tion to dis­cuss your symp­toms and have your vestibu­lar sys­tem eval­u­at­ed. Dur­ing this ini­tial eval­u­a­tion, your ther­a­pist may per­form mus­cle strength or bal­ance screen­ings (like hav­ing you stand in cer­tain posi­tions and main­tain them with­out los­ing your bal­ance), and will observe your eye movements.

Next, your ther­a­pist will pre­scribe how often you should go to phys­i­cal ther­a­py and which types of exer­cise to focus on.

Depend­ing on your symp­toms and the spe­cif­ic dis­or­der caus­ing your imbal­ance, you may be pre­scribed exer­cis­es such as:

  • Canalith repo­si­tion­ing pro­ce­dure: This is used to treat benign parox­ys­mal posi­tion­al ver­ti­go (BPPV). It involves clear­ing the inner ear crys­tals (small pieces of cal­ci­um bicar­bon­ate) that have bro­ken off and are float­ing in your inner ear canal with spe­cif­ic head and body movements.
  • The Epley maneu­ver: This is a spe­cif­ic type of canalith repo­si­tion­ing pro­ce­dure to treat the pos­te­ri­or canal (the most com­mon­ly affect­ed canal).
  • Gaze sta­bi­liza­tion: This improves your eye move­ments so that your vision can remain clear when you move your head. Your eyes coor­di­nate with your inner ear to main­tain your equi­lib­ri­um. You may need to do gaze sta­bi­liza­tion exer­cis­es if you can’t see clear­ly because things seem to jump about or bounce, espe­cial­ly as you’re moving.
  • Bal­ance train­ing: This type of train­ing aims to improve unsteadi­ness, sharp­en reflex­es and keep you on your feet.
  • Strength­en­ing and pos­tur­al exer­cis­es: These are designed to improve body strength, flex­i­bil­i­ty, and pos­ture — all of which can be impact­ed if you don’t move very often in an effort to avoid get­ting dizzy.

Also, read 4 Sur­pris­ing Things You Didn’t Know You Could Go to Phys­i­cal Ther­a­py For

As for how long and how often you will need to attend VRT? There isn’t a clear-cut answer. Depend­ing on the root cause of your symp­toms, you could notice improve­ment after a few days or sev­er­al weeks.

Even if it seems like it’s tak­ing a long time to notice any improve­ment, stick with it. It might be frus­trat­ing and time-con­sum­ing at the moment, but your body and inner ears will thank you in the long run.

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  • I have an outgoing, energetic personality and love to share laughs in the gym. I enjoy motivating patients to reach their personal goals. I have been practicing physical therapy for 15 years in the outpatient clinic setting. I have a hands on approach to improving joint mechanics and motion patterns. My passion for PT began while playing collegiate soccer and experiencing rehab first hand as an athlete.