Vestibular Rehabilitation

Disorders of the vestibular system (inner ear) can cause dizziness, vertigo and problems with balance and walking.  Dizziness and balance problems affect approximately 50% of all adults at some time.  They are especially common after whiplash  or concussion injury sustained in car accidents,sports injuries and falls.  Secondary problems often arise in the body due to the inactivity and increased muscle tension that result from the discomfort and fear of moving that the dizziness brings about.

Vestibular rehabilitation is focused on assessing the vestibular system and musculoskeletal system to determine what the cause of the dizziness, vertigo, or balance issue is.  The findings from this assessment will direct the correct form of treatment for the problem.

Common causes of dizziness are:

  • Cardiovascular problems
  • Vestibular- specific system disorders
  • Neurological dysfunctions such as MS or stroke
  • Visual deficits
  • Anxiety/depression

It is important to see your doctor to rule out the more serious causes of dizziness prior to starting vestibular rehabilitation.

Vestibular disorders can be caused by:

  • Head injuries such as whiplash or concussion
  • Vestibular system degeneration
  • Ear infections
  • Acoustic neuroma
  • Barotrauma
  • Vascular insufficiency
  • Ototoxicity (high dosage or long term use of certain antibiotics)

Common symptoms include:

  • Dizziness
  • Vertigo: the illusion of movement of your self or the environment.
  • Disequilibrium
  • Light-headedness
  • As sense of rocking or swaying
  • Motion sickness
  • Nausea and vomiting
  • Ossillopsia or the feeling of visual motion that happens when your eyes are open
  • Vertical diplopia or the sensation of seeing double with the 2 images lined up vertically

The vestibular system:

What can be treated?

  • Problems with balance
  • BPPV (Benign Paroxysymal Positional Vertigo)
  • Vestibular loss which can give the sensation of:
    • Dizziness that comes on with head motion
    • Movement of the visual world with head motion
    • Vertigo or dizziness with position changes
    • Poor visual acuity with head motion.
  • The secondary symptoms that arise due to the vestibular dysfunction such as decreased strength, decreased mobility, headaches and increased muscle tension.


To assess the vestibular system, the physiotherapist will take a thorough history to determine what the client’s symptoms are.   The therapist will do a physical examination beginning with examining the client’s neck.  A series of tests looking at the movement of the client’s eyes and then looking at the ability to keep one’s eyes stable while the head is moving will be performed.  The Dix-Hallpike test for Benign Paroxysmal Positional Vertigo (BPPV) is also performed.  This involves the tester holding the client’s head in rotation while quickly lying the client down on his/her side and observing the eyes for a movement called nystagmus.  This test will bring on the vertigo if the client has BPPV.

Dizziness and vertigo can cause problems with balance so after these initial tests have been performed the client’s balance and gait will be assessed.


If testing is positive for BPPV then a treatment called the Epley Manoeuvre is performed.  This involves taking the client through a series of head positions that will move the debris that is stuck in the canal through the canal and back into the sack where it is supposed to be.

Exercises that help retrain the vestibular system to function more normally are prescribed.  The goals of these exercises are to help decrease dizziness and vertigo and to improve balance and walking.   These exercises will bring on some of the dizziness and this is necessary in order to progress.

What to expect after the treatment:

The assessment and treatment of dizziness and vertigo can increase the symptoms in the short term so it is a good idea to have someone pick you up from the appointment because it can be unsafe to drive and you might not feel well enough to do so.  It is common to feel dizzy or nauseous for the rest of the day so it is good to plan your appointment when you have time to rest after.

What to bring to your appointment:

  • A towel and safety pin
  • Any test results that are relevant
  • A list of your medications
  • A friend or family member who can take you home

Video: Epley Maneuver to Treat BPPV Vertigo