Can Physical Therapy Help Vertigo?
Clifton Physical Therapy
If the room seems to spin when you roll over in bed, look up, bend down, or turn your head, you may be dealing with vertigo. The sensation can be unsettling and may come with nausea, imbalance, or difficulty walking. For some people, the symptoms last only a few seconds. For others, dizziness and balance problems can continue for hours or even days.
The good news is that physical therapy can help many people with vertigo, particularly when the symptoms are related to problems with the vestibular system or benign paroxysmal positional vertigo (BPPV). A specialized approach called vestibular rehabilitation therapy (VRT) uses targeted exercises and, when appropriate, repositioning maneuvers to reduce symptoms and improve balance.
However, physical therapy is not the right first step for every type of vertigo. Vertigo is a symptom rather than a diagnosis, and the underlying cause needs to be identified before treatment begins. Some causes involve the inner ear, while others can involve the brain, blood vessels, migraine, infection, or other medical conditions. A proper evaluation helps determine whether physical therapy is appropriate and which treatment is most likely to help.
What Is Vertigo?
Vertigo is more specific than simply feeling dizzy. It describes a false sensation of movement when you are actually still. You may feel as though you are spinning, the room is moving around you, or your body is being pulled in a particular direction. Vertigo can also affect your ability to walk or maintain your balance. Other symptoms may occur at the same time, including:
Nausea or vomiting
Unsteadiness when standing or walking
A feeling that you are being pushed or pulled to one side
Abnormal or involuntary eye movements
Difficulty maintaining your balance
Motion sensitivity
Ringing in the ears or changes in hearing in some conditions
One important distinction is that dizziness and vertigo are not exactly the same thing. Dizziness is a broad term that can describe lightheadedness, unsteadiness, or a disturbed sense of orientation. Vertigo specifically involves an abnormal perception of movement.
What Causes Vertigo?
Vertigo can have many different causes. Broadly, healthcare professionals classify it as peripheral vertigo, which usually involves the inner ear, or central vertigo, which is related to the brain or central nervous system. Peripheral causes account for roughly 80% of vertigo cases, while central causes account for the remaining 20%, according to the information reviewed for this article.
BPPV
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of peripheral vertigo. It occurs when tiny calcium carbonate crystals in the inner ear become displaced and move into one of the fluid-filled canals responsible for detecting head movement.
Normally, these structures help your brain understand how your head is moving. When the crystals move into the wrong location, they can interfere with the normal movement of fluid in the canal. This sends confusing signals to the brain, creating the sensation that you are moving even when you are not. BPPV often causes brief episodes of spinning when you:
Roll over in bed
Sit up or lie down
Look upward
Bend over
Turn your head in a particular direction
Because BPPV has specific physical tests and treatments, it is one type of vertigo that can respond particularly well to physical therapy.
Other Causes
Vertigo may also occur because of:
Vestibular neuritis or inflammation affecting the inner-ear nerve
Labyrinthitis or other inner-ear problems
Ménière’s disease
Vestibular migraine
Head injury
Stroke
Certain brain or central nervous system disorders
Problems involving the cervical spine or blood vessels
The cause also influences how long symptoms last. Some episodes may last seconds, while other conditions can cause symptoms lasting hours or even days.
This is why trying a random vertigo exercise found online is not always a good idea. An exercise that is appropriate for BPPV may not address the cause of dizziness related to another condition.
Can Physical Therapy Help Vertigo?
Yes, physical therapy can help many people with vertigo, but the treatment needs to match the cause. Physical therapists with training in vestibular rehabilitation can evaluate your symptoms, screen for warning signs, assess balance and movement, and determine whether specialized therapy is appropriate.
For BPPV, treatment may involve a canalith repositioning maneuver, such as the Epley maneuver. The goal is to guide the displaced crystals out of the affected canal and back into an area of the inner ear where they no longer cause abnormal signals. BPPV generally has a very good response to appropriate repositioning treatment, and the source material reports that some patients improve within one to three treatment sessions.
Physical therapy can also help when vertigo leaves you with ongoing balance problems, visual sensitivity, or difficulty moving your head without triggering symptoms. A vestibular rehabilitation program may include:
Gaze stabilization
Balance training
Walking exercises
Habituation exercises
Strength and flexibility exercises
What Happens During Vestibular Physical Therapy?
Vestibular physical therapy starts with an evaluation rather than a standard set of exercises. Your therapist will ask about when the symptoms began, what movements trigger them, how long each episode lasts, whether you have hearing changes or ringing in your ears, and whether you have experienced falls or difficulty walking.
The therapist may then assess your eye movements, balance, walking, head and neck movements, and how your symptoms respond to different positions. If BPPV is suspected, specific positional tests can help identify the affected canal. Clinical guidelines recommend distinguishing BPPV from other causes of dizziness and vertigo before choosing treatment.
Once the cause and contributing problems are clearer, your treatment plan may include one or more of the following:
Canalith repositioning maneuvers
For BPPV, the therapist may use a repositioning maneuver such as the Epley maneuver. Rather than strengthening a muscle or stretching a joint, the purpose is to move displaced inner-ear particles into a position where they no longer trigger abnormal signals.
Gaze stabilization
If your vestibular system is not properly processing head movement, your vision may become blurry or uncomfortable when you move your head. Gaze-stabilization exercises train you to keep your eyes focused on a target while your head moves.
These exercises are an important part of vestibular rehabilitation for people with vestibular hypofunction. Current physical therapy guidelines report strong evidence that vestibular rehabilitation can reduce symptoms and improve gaze and postural stability in appropriate patients.
Balance and walking exercises
Vertigo can make ordinary activities feel unsafe. You may hesitate when getting out of bed, walking on uneven surfaces, turning quickly, or moving through a crowded store.
Balance training gradually challenges your ability to remain stable. Your therapist may progress from simple standing exercises to more demanding activities involving head movements, different surfaces, changes in direction, or walking while looking in different directions.
Habituation exercises
Some people continue to feel dizzy when exposed to particular movements or environments even after the original vestibular problem has improved. Habituation exercises use controlled, repeated exposure to specific triggers so that the brain can gradually become less sensitive to them.
The exercises should be selected according to your symptoms. More exercise is not necessarily better, and pushing through severe symptoms without guidance can make you feel worse.
How Long Does Physical Therapy for Vertigo Take?
There is no single treatment schedule that works for everyone.
Someone with straightforward BPPV may improve after one or a few treatment sessions, particularly when the correct repositioning maneuver is performed. The source material reviewed for this article reports that some cases of BPPV can resolve within one to three sessions.
Other vestibular conditions require a longer rehabilitation program. The duration depends on the underlying diagnosis, how long symptoms have been present, your balance and mobility, other health factors, and how your body responds to treatment.
For peripheral vestibular hypofunction, clinical practice guidelines support supervised vestibular rehabilitation and individualized home exercises. The recommended exercise dose can range from several weeks to longer periods depending on whether the problem is acute, chronic, unilateral, or bilateral.
This is why it is difficult to answer questions such as “How many physical therapy sessions will I need?” without first knowing what is causing the vertigo.
Can Vertigo Exercises Make You Feel Worse?
Sometimes, yes.
It is not unusual for certain vestibular exercises to temporarily bring on mild dizziness. In rehabilitation, controlled exposure to symptoms can be part of the treatment. However, severe, prolonged, or unusual symptoms should not simply be ignored.
The source material notes that symptoms can sometimes increase when exercises are overused, particularly when someone feels better and does too much on a “good” day.
Your therapist should explain what level of symptom increase is expected, how long it should last, and when you should stop an exercise. You should also report new symptoms rather than assuming they are part of normal recovery.
When Is Vertigo a Medical Emergency?
Not every episode of vertigo is an emergency, but some symptoms require prompt medical evaluation.
Vertigo can occasionally be associated with problems involving the brain or central nervous system. Warning signs include:
Double vision
Trouble speaking
Difficulty swallowing
Fainting
New facial numbness or impaired facial sensation
Significant or new difficulty walking
New neurological symptoms
Other sudden symptoms that are substantially different from your usual episodes
These symptoms should not be treated as ordinary BPPV without medical evaluation. A particularly important point is that physical therapy should not be used to self-diagnose unexplained vertigo. A physical therapist trained in vestibular rehabilitation can screen for concerning findings, but referral to a physician or other appropriate healthcare professional may be necessary when the symptoms suggest a medical condition outside the scope of physical therapy.
Should You Try the Epley Maneuver at Home?
The Epley maneuver is widely used for BPPV, but that does not mean it is appropriate for every person who feels dizzy.
The maneuver is designed for a specific type and location of BPPV. Correct diagnosis matters because different semicircular canals can require different positioning techniques. Clinical guidelines emphasize accurate diagnosis and appropriate repositioning rather than treating every case of dizziness as BPPV.
There are also practical reasons to have a professional guide you through the process. Neck problems, limited mobility, balance difficulties, and other factors may affect whether a particular maneuver is appropriate or safe.
If you repeatedly experience spinning when turning over in bed or changing head position, it is better to have the symptoms evaluated before repeatedly performing exercises from an online video.
What Are the Benefits of Vestibular Rehabilitation?
When vestibular rehabilitation is appropriate for the underlying condition, treatment may help you:
Reduce dizziness and vertigo symptoms
Improve balance and walking ability
Improve visual stability during head movement
Become more comfortable with everyday movements
Reduce the risk of falls
Return to work, exercise, driving, and other daily activities more confidently
Improve your ability to manage symptoms that remain after the initial vertigo episode
How to Find the Right Physical Therapist for Vertigo
If you are looking for physical therapy for vertigo, ask whether the therapist has specific experience with vestibular rehabilitation, BPPV, dizziness, and balance disorders.
Not every physical therapist treats vestibular conditions regularly. Some therapists have advanced training or clinical practices focused on neurological and vestibular rehabilitation. Before scheduling an appointment, you can ask:
Do you evaluate and treat BPPV?
Do you provide vestibular rehabilitation?
How often do you treat patients with vertigo or dizziness?
Can you perform positional testing and appropriate repositioning maneuvers?
Will you provide a home exercise program when appropriate?
Don’t let dizziness or vertigo keep you from your normal activities. Our physical therapists can evaluate your symptoms and create a personalized treatment plan to help improve your balance and confidence. Call Clifton Physical Therapy at (973) 241-1338 to schedule an evaluation today.
References
Clifton Physical Therapy
✆ Phone (appointments): (973)-241-1338
Address: 1059 Bloomfield Ave, Clifton, NJ 07012
