What's Happening

Vestibular Rehabilitation

by Sarah K. Terpin, PT, DPT

More than 5 million people in the U.S. visit the doctor every year with complaints of dizziness.

Dizziness is one of the most common complaints both children and adults have and can affect all aspects of life. Someone suffering from dizziness may describe symptoms in a variety of ways, such as spinning, rocking, light-headedness, or unsteadiness, and may experience associated issues that affect everything from their ability to get out of bed to driving a car.

Why Am I Dizzy?

While many medical conditions or medications may cause or contribute to dizziness, most patients’ complaints arise from a dysfunction of the vestibular system—the system responsible for helping our body understand how we are interacting with our surroundings, and providing us with our sense of stability. The vestibular system is composed of the inner ear, parts of the visual system, and nerves arising from the brainstem.  A thorough examination will look at each of these parts of the system to determine what is causing your symptoms. Identifying the cause of dizziness is integral to successful treatment.

How Does Physical Therapy Help?

Vestibular rehabilitation is a specialized form of physical therapy aimed at addressing the symptoms of vertigo, dizziness, visual disturbance, and imbalance associated with vestibular system dysfunction. Some issues may permanently change the way your vestibular system functions, while others are entirely reversible.  We always tailor treatment to your specific issues. Generally speaking, vestibular rehabilitation is an exercise-based program with the goal of decreasing sensitivity to movement by reducing abnormal or elevated vestibular response, or by teaching the brain to compensate for the vestibular loss. In either case, proper treatment is highly effective at decreasing symptoms and improving overall function.

One of the most common conditions is called Benign Paroxysmal Positional Vertigo (BPPV) and results from a mechanical issue of the inner ear. Dizziness in BPPV is described as spinning and is caused by head movements or positions such as rolling over in bed. Although the spinning sensation can be severe, it typically lasts only seconds to minutes before resolving. Many people may have heard of someone having “rocks in their ears” or “crystals in their ears;” this is what is causing dizziness in people with BPPV, and we can quickly treat the symptoms with just one or two sessions with the appropriate repositioning maneuver.

Other Common Conditions

Meniere’s Disease

A condition of the inner ear often associated with dizziness that is not provoked by head movement or position. Additional symptoms may include ringing in the ear(s), hearing loss, or a feeling of fullness in the ear.  Symptoms are episodic, but last many minutes to hours at a time.

Vestibular Neuritis

An inflammation of the nerve of the inner ear thought to result from a viral infection. Dizziness may be spontaneous or be affected by head movement and position. Primary dizziness may last a few days with more mild symptoms persisting much longer.

Labyrinthitis

Very similar in origin and presentation as Vestibular Neuritis, but symptoms may also be associated with sudden loss of hearing or ringing in the ears.

Mal De Debarquement

A feeling of rocking or imbalance following prolonged movements such as air or sea travel. Symptoms are continuous and may last up to a year or more but improve with movement rather than worsen.

Dizziness Is Not Just a Nuisance

For many, symptoms of dizziness or imbalance can be disorienting, alarming, or cause nausea or anxiety.  Dizziness can also affect concentration, balance, depth perception, and energy level. Because of these secondary effects, people with dizziness are at higher risk of becoming sedentary—a risk factor in a myriad of other health problems—and are also at much higher risk of falling. Particularly in the elderly population, a fall can be catastrophic.  If you or a loved one is suffering from dizziness, a physical therapist with vestibular training can conduct a thorough evaluation to rule out any non-vestibular causes of these symptoms, identify the source of vestibular dysfunction, and develop a specific plan to help you return to your healthy life.