Treating Dizziness with Vestibular Physiotherapy: What You Need to Know

Treating Dizziness with Vestibular Physiotherapy: What You Need to Know

Dizziness, vertigo, and disequilibrium are common symptoms that can affect people of all ages. Dizziness refers to feelings of lightheadedness, faintness, or unsteadiness and can be caused by a vestibular disorder, but can also be a result of cardiovascular, neurologic, metabolic, vision or psychological problems. Vertigo has a rotational or spinning nature internally or of the surroundings. Disequilibrium can refer to unsteadiness or imbalance. While dizziness can be a temporary inconvenience, it can also be a debilitating condition that affects a person’s quality of life. An effective part of treatment for dizziness is vestibular physiotherapy. 

Vestibular physiotherapy is a specialized form of physical therapy that focuses on treating disorders of the vestibular system, which is responsible for maintaining balance and spatial orientation. The vestibular system includes the inner ear and the pathways that connect it to the brain.

The goal of vestibular physiotherapy is to reduce symptoms including dizziness, vertigo and disequilibrium, to improve balance, and to increase a person’s ability to perform daily activities without experiencing symptoms. This may be achieved through specific manoeuvres in certain conditions, or with specific exercises that are designed to retrain the brain and improve the function of the vestibular system.

The first step in treating dizziness with vestibular physiotherapy is to undergo a thorough evaluation by a trained physiotherapist. This evaluation will include a detailed description of symptoms and medical history and a physical examination including assessment of balance, eye movements, and vestibular system function.

Based on the results of the evaluation, the physiotherapist will develop an individualized treatment plan that addresses the specific needs of the patient. This treatment plan may include specific repositioning manoeuvres in cases of BPPV (Benign Paroxysmal Positional Vertigo), and in other disorders a combination of exercises that are designed to improve balance, improve gaze stability, and improve movement tolerance to increase a patient’s ability to perform daily activities without experiencing symptoms. 

One commonly known treatment that is used in vestibular physiotherapy is the Epley manoeuvre. This manoeuvre is used only in specific cases of BPPV and involves a series of head and body movements that are designed to reposition crystals in the inner ear that may be causing vertigo,  a false sensation of motion. Other manoeuvres may be more appropriate based on the assessment findings.  Your Physiotherapist may use infrared goggles to assist in determining the presence and direction of abnormal eye movements during the testing to assist in a more accurate diagnosis. BPPV is one of the most common causes of vertigo, and can be effectively treated, often in 1-3 visits, by appropriate mechanical manoeuvres performed by a qualified healthcare professional. 

The 3 main types of exercises for vestibular physiotherapy

There are three main types of exercises used in vestibular physiotherapy to address problems related to other types of vestibular disorders. They are gaze stability exercises, balance exercises and habituation exercises.

Gaze stabilization exercises aim to improve eye movement control during head movement. These exercises involve focusing on a stationary object during head movements back and forth or up and down in a variety of functional postures. They are designed to improve a patient’s ability to maintain visual focus while their head is moving, which can reduce symptoms of dizziness.

Balance exercises are also an important part of vestibular physiotherapy, and are aimed at improving a patient’s stability so they are able to perform daily tasks without falling. They need to be specific to a patient’s balance problem and must be moderately challenging while being performed in a safe environment.

Habituation exercises are helpful for patients that primarily experience dizziness when they are moving around and for patients that experience dizziness in visually stimulating environments.  This approach aims to gradually expose the patient to movements or stimuli that produce their dizziness while mildly provoking symptoms, in order for their brain to learn to ignore abnormal signals over time.

It is important to note that the effectiveness of vestibular physiotherapy may vary depending on the underlying cause of dizziness. Patients with conditions such as Meniere’s disease or Vestibular Migraine may require additional treatments, such as medication or dietary and lifestyle changes, to manage their symptoms. Patients with stable peripheral vestibular disorders on one side typically have the best ability to reduce their symptoms compared to those with both sides involved or with problems in the vestibular parts of the brain.

The role of a physiotherapist in managing vestibular disorders

A physiotherapist who specializes in vestibular rehabilitation can play an important role in the diagnosis and treatment of dizziness. They have a deep understanding of the vestibular system and can help patients manage the symptoms associated with vestibular disorders.

First, a physiotherapist can help with the accurate diagnosis of the underlying cause of dizziness. Dizziness can be caused by a variety of factors, including inner ear disorders, head injuries, medication side effects, and blood pressure changes. A vestibular physiotherapist will conduct a thorough examination to identify the root cause of the dizziness, which is the basis of an effective treatment plan.

Second, a physiotherapist can design a customized treatment or exercise program that is tailored to the specific needs of the patient. This exercise program can help to retrain the vestibular system, improve balance, and reduce symptoms. Dizziness can make it difficult to maintain balance, which can increase the risk of falls and injuries. A program of exercises that are specifically targeted to improve balance and reduce the risk of falls may include exercises that challenge balance, such as standing on one leg or walking on uneven surfaces. The physiotherapist will work with the patient to develop an exercise program that is appropriate for their level of function and considers their individual needs and goals. 

Third, a physiotherapist will provide education on symptom management and lifestyle modifications that may be helpful. Patients may be educated on strategies to minimize triggers that can exacerbate dizziness, such as sudden head movements or changes in lighting. They may also be advised to make changes to their diet or sleep habits to reduce symptoms.

Fourth, a physiotherapist can help patients manage the psychological impact of dizziness. Dizziness can be a frightening and isolating experience, and it can lead to anxiety, depression, and a decreased quality of life. A vestibular physiotherapist can provide education, resources, and support to help patients understand their condition, manage their symptoms, and improve their overall well-being.

Finally, a physiotherapist can provide ongoing support and monitoring to ensure that the treatment is effective. Dizziness can be a complex condition, and it may take time for patients to see improvements. A vestibular physiotherapist will work with the patient to monitor their progress and make any necessary adjustments to the treatment plan to ensure that it is effective.

In addition to these specific roles, a vestibular physiotherapist can also play a broader role in the management of dizziness. They can work closely with other healthcare professionals, such as audiologists, neurologists, and ENT specialists, to ensure that the patient is receiving comprehensive care. 

In conclusion, a physiotherapist who specializes in vestibular rehabilitation can play a crucial role in the diagnosis and treatment of dizziness. They can help patients manage the symptoms associated with vestibular disorders, improve their balance and reduce their risk of falls, and provide ongoing support and monitoring to ensure that the treatment is effective. If you are experiencing dizziness, it is important to seek the help of a trained vestibular physiotherapist who can provide you with the care and support you need to manage your condition.


This appointment is your opportunity to tell us what hurts and discover whether physiotherapy or chiropractic care is a good fit for you! During this session, you will talk with a physiotherapist or chiropractor on a phone call (or online) and create the right care plan specifically for your pain. There is no obligation on this session is to find out whether physiotherapy or chiropractic care can help you getting back to doing the things you love in life.

Frequently Asked Questions

It can take several weeks of vestibular therapy for improvement to be noticed. The length of time it takes for vestibular therapy to work will depend on the type of the condition and the individual’s response to treatment.

At first symptoms may seem to worsen, but with time and consistent effort in vestibular therapy, symptoms should steadily improve along with improved ability to function and perform daily activities.

There are several exercises that can be done at home to help with vestibular therapy. These exercises may include balance exercises, gaze stabilization exercises, and head and neck movements. It is important to speak with a healthcare professional for a correct diagnosis before attempting home exercises or self-treatment for vestibular conditions.

About Denise Vandermeulen

​Denise has extensive experience in sport and orthopaedic physiotherapy. She has worked and travelled with Wheelchair Basketball Canada’s National Teams and worked with a variety of sport teams at local, varsity, and provincial levels. Denise also has provided coverage for numerous sporting events including Skate Canada International, the Ontario Summer Games, and the World Synchronized Skating Championships.

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. The Clinic Accelerator Inc. and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

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