Vestibular Therapy FAQ

Your vestibular system includes structures in the inner ear and brain that help control balance, spatial awareness, and stability. When part of this system is not working properly, symptoms can look different from person to person. Some people experience spinning vertigo, while others may feel unsteady, “off,” lightheaded, motion-sensitive, or visually overwhelmed. Vestibular problems can also cause blurred vision, nausea, difficulty walking, trouble concentrating, or ringing in the ears.

Although the words are often used interchangeably, dizziness and vertigo are not quite the same. Dizziness is a broad term that can describe feeling lightheaded, unsteady, woozy, off-balance, or simply “not right.” Vertigo is more specific and refers to the sensation that you or your surroundings are moving or spinning. With true vertigo, this spinning sensation can be very intense and powerful. You can, however, still have a vestibular disorder without ever experiencing the classic room-spinning feeling many people associate with vertigo.

Vestibular symptoms often show up with movement. You may notice dizziness when turning your head, rolling over in bed, looking up or down, walking in the dark, or navigating uneven surfaces. Busy visual environments such as grocery stores, traffic, crowds, or large screens may also make symptoms worse. Some people notice blurred or unstable vision when moving their head, nausea, motion sensitivity, or unexplained balance problems. Because dizziness can have many different causes, a specialized vestibular evaluation can help determine what may be contributing to your symptoms.

Our vestibular specialists evaluate and treat a wide range of conditions, including Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, vestibular labyrinthitis, vestibular migraine, Persistent Postural-Perceptual Dizziness (PPPD), cervicogenic dizziness, acoustic neuroma-related vestibular problems, uncompensated Ménière’s disease, cerebellar degeneration, and age-related balance and sensory changes. We also provide specialized vestibular rehabilitation for dizziness, balance problems, visual symptoms, and motion sensitivity that may occur after a concussion.

This is often called visually induced dizziness or visual motion sensitivity. Your brain normally combines information from your inner ear, eyes, and body to help you understand where you are in space. After a vestibular problem, the brain may begin relying too heavily on vision for balance. Environments with lots of movement or visual information, such as grocery store aisles, traffic, crowds, patterned floors, or screens, can then become overwhelming and cause dizziness,
nausea, disorientation, or unsteadiness. Vestibular rehabilitation can gradually help your brain become more comfortable processing these environments again.

Not necessarily. Many patients come to us because they know they are dizzy or off-balance but do not yet know why. A vestibular evaluation looks closely at your symptoms, their timing and triggers, your eye movements, balance, walking, and other findings that can help us better understand what may be contributing to the problem. In many cases, beginning with a specialized vestibular assessment can help identify a treatable problem without putting you through an unnecessarily long diagnostic process. If your findings suggest that additional medical testing or another specialist is needed, our team can help guide you in the right direction.

Your evaluation starts with a detailed conversation about what you are feeling, when your symptoms began, what makes them better or worse, and how they are affecting your daily life. From there, your therapist may assess your eye movements, balance, walking, response to head movement, and positional changes depending on your symptoms. Our vestibular specialists also use infrared video nystagmography to visualize small eye movements that can provide important information about the vestibular system. Because every presentation is different, the evaluation is tailored to your individual symptoms and history.

Your eyes and inner ear work closely together to keep your vision clear and stable while your head is moving. Because of that connection, certain eye movements can provide valuable clues about how the vestibular system is functioning. Your therapist may look at how well your eyes track a target, respond to head movement, or move when you are placed in different positions. In conditions such as BPPV, the direction and pattern of involuntary eye movements, called nystagmus, can even help identify which ear and semicircular canal may be involved.

Infrared video goggles allow your therapist to closely observe and record eye movements during a vestibular examination. Certain eye movements related to the vestibular system can be difficult to see with the naked eye and may become more noticeable when visual fixation is removed. At Equilibrium, we use infrared video technology to gain a clearer picture of what may be contributing to dizziness or vertigo. In BPPV, for example, the pattern of eye movement can help identify the affected ear and canal and guide treatment. We can also identify a unilateral vestibular weakness and identify the involved ear with a skilled infrared video exam.

Vestibular rehabilitation is a specialized area of physical therapy that requires additional training in dizziness, vertigo, balance, eye movements, and the way the brain, inner ear, and vision work together. A vestibular therapist is trained to look for patterns that may not be part of a typical orthopedic evaluation and to use specialized testing and treatment techniques based on those findings. Equilibrium’s vestibular clinicians have advanced vestibular training and experience and can also coordinate with other medical specialists when additional care is needed.

Vestibular rehabilitation is a specialized form of physical therapy designed to reduce dizziness and imbalance, improve visual stability, and help you move more confidently through everyday life. Treatment is based on what is causing your symptoms rather than using the same exercises for everyone. Depending on your condition, therapy may include gaze stabilization exercises, balance training, gradual exposure to movements or environments that trigger symptoms, or repositioning maneuvers for conditions such as BPPV. The goal is to help your brain and balance system adapt and respond more effectively to movement and sensory information.

Sometimes. Certain vestibular exercises intentionally introduce a manageable amount of movement or visual stimulation so your brain can gradually become less sensitive to it. You may notice a temporary increase in symptoms during or shortly after some exercises, but treatment should be carefully controlled rather than simply pushing through severe dizziness. Your therapist will adjust the difficulty based on how you respond and gradually progress the exercises as your tolerance improves.

There is no single timeline because recovery depends on the condition being treated, how long symptoms have been present, and how your body responds to treatment. Some problems, such as certain cases of BPPV, can improve very quickly and may require only a small number of visits. Other vestibular conditions may require treatment over several weeks or months while the brain and balance system gradually adapt. Your therapist will continually reassess your progress and adjust your treatment plan along the way.

Benign Paroxysmal Positional Vertigo, or BPPV, is one of the most common causes of positional vertigo. It occurs when tiny calcium crystals that normally sit in one part of the inner ear become displaced and enter one of the semicircular canals. This can cause brief episodes of spinning when you lie down, roll over in bed, look up, or move your head into certain positions. A vestibular therapist can use your symptoms and eye movements to identify the affected canal and then perform a canalith repositioning maneuver designed to guide the crystals back toward where they belong.

Absolutely. Vestibular rehabilitation can be helpful for many people with vestibular migraine, particularly when symptoms include imbalance, motion sensitivity, visual sensitivity, or difficulty tolerating head movement. Vestibular migraine can cause dizziness or vertigo with or without a headache, which is one reason it can sometimes be difficult to recognize. Because migraine can involve several different systems, vestibular rehabilitation may be one part of a broader treatment plan based on your individual symptoms. Your vestibular specialize may also recommend supplements, a dietary plan, and referrals when pharmacological intervention may be helpful.

Persistent Postural-Perceptual Dizziness, or PPPD, is a condition in which dizziness or unsteadiness becomes persistent, sometimes after an initial vestibular illness, injury, or other triggering event. People with PPPD often feel worse while standing, moving, or spending time in visually busy environments, even after the original problem has improved. Vestibular rehabilitation can help gradually retrain how the brain processes movement and sensory information while reducing sensitivity to the activities and environments that trigger symptoms.

Absolutely, this is a key element of what we do! Each of these conditions can affect the vestibular system differently, but vestibular rehabilitation may help when dizziness, imbalance, motion sensitivity, or visual problems continue afterward. Vestibular neuritis and labyrinthitis can disrupt signals coming from the inner ear and cause VOR dysfunction. Your VOR is the Vestibular Ocular Reflex, and this is how your eyes focus on targets while your head and body are moving. Concussion for examples can affect how the vestibular, visual, and balance systems work together. Depending on your findings, treatment may include VOR gaze stabilization, balance training, habituation, visual-vestibular exercises, and gradual exposure to motion or busy environments.

If dizziness, vertigo, imbalance, motion sensitivity, or visual symptoms are interfering with your daily life, you do not necessarily need to wait for multiple tests or specialist appointments before having your vestibular system evaluated. Many common causes of dizziness can be identified through a detailed vestibular examination, and some conditions, such as BPPV, may respond to treatment very quickly once the problem is identified.

Our goal is to evaluate you as early as possible, determine whether your symptoms appear appropriate for vestibular rehabilitation, and begin treatment when we can. If something during your evaluation suggests that another medical provider or additional testing is needed, we can help make that recommendation rather than leaving you to navigate the process on your own.

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