If the room spins when you roll over in bed, or you feel unsteady in a busy store, vestibular therapy may help. It’s a specialized, exercise-based form of physical therapy, sometimes called vertigo physical therapy, that retrains the balance system in your inner ear and brain. PMR has two offices, in Danbury, CT and Brewster, NY.
When to get urgent care
Some dizziness is a warning sign of a stroke or heart problem. Call 911 or go to the nearest emergency room if dizziness comes with:
- Stroke warning signs: a drooping face, weakness or numbness in an arm or leg, slurred speech, or sudden trouble seeing or walking
- A sudden, severe headache or neck pain, double vision or trouble swallowing
- Chest pain, a racing or pounding heartbeat, shortness of breath or fainting
- A recent blow to the head, especially with vomiting or confusion
- Sudden hearing loss in one ear
Please don’t drive while you feel dizzy. If you’re not sure whether your symptoms are an emergency, get checked right away.
Who vestibular therapy can help
Your vestibular system tells your brain how your head is moving. When part of it is damaged or sends mixed signals, your eyes, inner ears and body stop agreeing, and you feel dizzy or off balance. Targeted exercises and maneuvers help your brain recalibrate.
This kind of rehab may help if you have:
- Benign paroxysmal positional vertigo (BPPV), with brief spins set off by changes in head position
- Vestibular neuritis or labyrinthitis, once the first intense phase has passed
- Lingering imbalance from Meniere’s disease, between attacks
- Vestibular migraine, alongside care from your physician
- Dizziness linked to neck pain or stiffness
- Dizziness or balance trouble after a concussion
- Unsteadiness or repeated falls
Our vertigo and dizziness page explains these causes. If symptoms began after a head injury, see our concussion care page.
Your vestibular assessment
Dizziness has many possible causes, and the right dizziness treatment depends on which one you have. Your clinician will ask what the dizziness feels like, what sets it off, how long it lasts and which medicines you take. The exam may include:
- Eye movement checks for nystagmus (jumpy, involuntary eye movements)
- Positional tests, such as the Dix-Hallpike test, to look for BPPV
- Gaze stability, or whether your vision stays clear as your head moves
- Balance, walking, leg strength and fall-risk tests
- Neck motion and strength
Positional testing can briefly bring on your vertigo, which is expected. If the findings suggest a problem outside our scope, such as a heart rhythm or neurological issue, PMR will refer you to the right physician.
How vestibular rehabilitation works
Canalith repositioning for BPPV
In BPPV, tiny calcium crystals in the inner ear drift into one of its fluid-filled canals. Repositioning maneuvers, such as the Epley maneuver, are the standard BPPV treatment: they move your head through a series of positions to guide the crystals back where they belong. You may feel a short spin during the maneuver. Many people improve after one or a few treatments, although BPPV can come back.
Gaze stabilization exercises
These exercises train your eyes to stay locked on a target while your head moves. For example, you might keep a letter on the wall in focus as you turn your head side to side. They’re often used when one inner ear is weaker than the other, such as after vestibular neuritis.
Balance and habituation exercises
Balance training challenges your stability on firm and soft surfaces, with eyes open and closed, and while walking and turning. Habituation exercises repeat the movements or busy visual settings that make you dizzy, in small doses, so your brain gradually reacts less. Your therapist sets the dose so symptoms stay mild and settle soon after.
Your home program
Daily home exercises are a core part of vestibular therapy. You’ll learn a short routine to do between visits, and your therapist updates it as you improve. Plans may also add walking, posture and neck mobility work.
How long vestibular rehab takes
Some people with BPPV need only one or two sessions, while those with long-standing imbalance often need a longer program. Many patients are seen once or twice a week for six to eight weeks. Progress depends on the cause, how long you’ve had symptoms and how often you practice, so results vary.
Your plan can also include other care at PMR, such as physical therapy for strength and walking. You can browse all of our chiropractic and physical therapy services in one place.
Frequently asked questions
Will vestibular therapy make my dizziness worse?
Some exercises are meant to bring on mild, short-lived symptoms, because that’s how the brain relearns. Your therapist picks a starting level, watches how you respond and adjusts the plan so symptoms settle soon after each set. You shouldn’t leave feeling much worse than when you arrived, so speak up if symptoms build from day to day.
Do I need a referral for vestibular rehab?
You can contact PMR directly or come with a referral from a physician, ENT or neurologist. State law limits physical therapy without a referral, and some insurance plans require one before paying for therapy, so check your plan. PMR submits claims to most insurance companies, and your benefits are explained at your first appointment.
Can I do the Epley maneuver at home?
Sometimes, but get a diagnosis first. The Epley maneuver treats only one type of BPPV, and it must be done toward the affected ear. Without testing, you might treat the wrong side or miss another cause of dizziness. Once your therapist knows which ear and canal are involved, they may teach you a safe home version.
Further Reading
Book a vestibular therapy evaluation
Call the office nearest you to set up an assessment, or request an appointment online.
- PMR of Danbury, CT: (203) 744-8013
- PMR of Brewster, NY: (845) 279-1135
Plan your visit to PMR
Choose the PMR office that is convenient for you: Danbury, Connecticut or Brewster, New York. Visit the office page for directions, hours, and team information. Contact the team to discuss the care you need and appointment availability.