Vestibular & Balance Therapy


Experts believe that more than four out of 10 Americans, sometime in their lives, will experience an episode of dizziness significant enough to send them to a doctor.

What is a balance disorder?

A balance disorder is a condition that makes you feel unsteady or dizzy. If you are standing, sitting, or lying down, you might feel as if you are moving, spinning, or floating. If you are walking, you might suddenly feel as if you are tipping over. For one person, dizziness might mean a fleeting feeling of faintness, while for another it could be an intense sensation of spinning (vertigo) that lasts a long time or is transient.

What are the symptoms of a balance disorder?

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up or with walking. Symptoms may come and go over short time periods or last for a long time and can lead to fatigue and depression.

You might experience other symptoms such as:

  • Dizziness or vertigo (a spinning sensation)
  • Falling or feeling as if you are going to fall
  • Lightheadedness, faintness, or a floating sensation
  • Blurred vision
  • Confusion or disorientation.
  • Nausea and vomiting
  • Changes in heart rate and blood pressure, and fear, anxiety, or panic.

What causes balance disorders and dizziness?

There are many causes of balance problems, such as medications, ear infections, a head injury, or anything else that affects the inner ear or brain. Low blood pressure can lead to dizziness when you stand up too quickly. Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders. Your risk of having balance problems increases as you get older. Many neurologic disorders cause balance issues and finally people have difficulty with balance as they age.

Unfortunately, many balance disorders start suddenly and with no obvious cause.

Common diagnoses include:

  • Central Nervous System Disorders
  • Neuropathy
  • Age-Related Balance Dysfunction
  • Oculomotor (Visual) Dysfunction
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Labyrinthitis
  • Ménière's Disease
  • Vestibular Neuritis
  • Muscle Atrophy
  • Nerve Injuries
  • Cervicogenic (arising from the cervical spine)

What is the Physical Therapist Role in Patients with Dizziness and/or Balance Disorders?

Physical therapists are experts in treatment of neuromusculoskelatal disorders. As such they evaluate and treat patients with dizziness and balance disorders to resolve or improve symptoms.

Treatment of balance & dizziness disorders can be very complex and that is why a thorough evaluation must be performed to determine the causation which then directs the treatment. Some of the diagnoses causing balance issues and dizziness that physical therapists treat are listed above. However, with some of these disorders physical therapy may be used in conjunction with medical intervention and medications from a physician with a physician’s care as part of a team approach. Other times it will be medical intervention and medication alone. Again, evaluating the cause is key to proper care which a physical therapist can help you determine.

Vestibular Therapy for Benign Paroxysmal Positional Vertigo (BPPV) - A Common Cause of Dizziness

For many patients, BPPV (benign paroxysmal positional vertigo), is the cause for vertigo. Inside your ear is the semicircular canals that contain fluid and fine, hair-like sensors that monitor the rotation of your head. Other structures (otolith organs) in your ear monitor movements of your head These otolith organs contain crystals that make you sensitive to gravity. For a variety of reasons, these crystals can become dislodged and they can move into one of the semicircular canals. This causes the semicircular canal to become sensitive to head position changes which makes you feel dizzy. Symptoms are usually brought on by a change in head position. Signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • A loss of balance or unsteadiness
  • Nausea
  • Vomiting

The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of vertigo due to BPPV can disappear for some time and then recur.

If you do have BPPV, our vestibular therapy experts can perform a series of tests to determine how best to restore the crystals to their proper position and then perform a series of simple movements to achieve this. In many cases, one session works; other people need the procedure several times to relieve their dizziness. In addition, we provide education as to how to best avoid recurrence as your condition is stabilizing and provide home exercises to allow complete recovery.

Cervicogenic Dizziness

When you are evaluated for dizziness, we look at all factors. Many times, patients develop dizziness from cervicogenic problems such as problems in the upper cervical joints either as a part of their dizziness presentation or as the cause in full. Therefore, comprehensive evaluation by one of our experts leads to resolution as all causative factors are addressed. In the case of cervicogenic dizziness, manual therapy, exercise, correction of postures and aggravating factors as well as a home program is often needed for complete recovery.

How Physical Therapy Can Help in Treatment for Other Balance Disorders

Physical therapist directed treatment can assist patients with balance disorders in several ways. As experts in the evaluation and treatment of movement, muscle, joint, and nervous system disorders, our physical therapists can prescribe and implement a variety of treatments including:

  • Coordination Exercises
  • Proprioception Exercises
  • Strengthening Exercises
  • Stretching and Range of Motion Exercises
  • Posture Exercises
  • Retraining of the Inner Ear
  • Visual Tracking Training
  • Patient Education in Diagnosis and Management of Problems Present
  • Education in Reducing Risk of Falls and Fear of Falling