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JNPT Perspectives for Patients

Treatment for Vestibular Disorders

How Does Your Physical Therapist Treat Dizziness Related to Vestibular Problems?

Hall, Courtney D. PT, PhD; Herdman, Susan J. PT, PhD, FAPTA; Whitney, Susan L. PT, PhD, NCS, ATC, FAPTA; Cass, Stephen P. MD, MPH; Clendaniel, Richard A. PT, PhD; Fife, Terry D. MD, FAAN, FANS; Furman, Joseph M. MD, PhD; Getchius, Thomas S. D. BA; Goebel, Joel A. MD; Shepard, Neil T. PhD; Woodhouse, Sheelah N. PT, BScPT

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Journal of Neurologic Physical Therapy: April 2016 - Volume 40 - Issue 2 - p 156
doi: 10.1097/01.NPT.0000481898.55592.6e
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Dizziness is very common, but it is never normal. Dizziness can make performing daily activities, work, and walking difficult. Many people get dizzy when they turn their head, which can cause problems with walking and makes people more likely to fall. Most of the time dizziness is not from a life-threatening disease. Often dizziness is because of a disorder of the vestibular (or inner ear balance) system. People can get vestibular disorders from infections in the ear, problems with the immune system, medications that harm the inner ear, and rarely from diabetes or stroke because of a lack of blood flow to the inner ear. Stress, poor sleep, migraines, overdoing some activities, and feeling sad can increase symptoms. New guidelines for the treatment of vestibular disorders were published in the April 2016 issue of the Journal of Neurologic Physical Therapy. The guideline describes which exercises are best to treat the dizziness and balance problems commonly seen with an inner ear disorder.


Early treatment may help people to get better faster. Treatments focus on eye and head exercises plus balance exercises to help relieve dizziness and improve the ability to walk without losing balance. A physical therapist will tailor these treatments to your specific problems on the basis of a complete examination.


For people with inner ear dizziness, their dizziness may get better even without treatment. For some people, their dizziness does not get better unless they are given exercises for their dizziness and balance problems. Staying active is very important and moving your head, even if it makes you dizzy, is one of the best ways to recover from your inner ear problem. Medicine is not usually needed; however, if your dizziness is very bad, your physical therapist may work with your doctor to try to make your symptoms better with medicine so you can continue doing the exercises. On the basis of your diagnosis, your best treatment may include eye and head exercises, walking exercises, balance exercises, and education about your dizziness problem. Exercises are progressed as you improve so that you are less dizzy when you sit still and also when you move around. Physical therapists are trained to customize your exercises for best recovery. For more information about the treatment of inner ear dizziness, contact a physical therapist who specializes in inner ear problems.


Evidence suggests that early treatment of inner ear problems is helpful in decreasing dizziness. Not all inner ear problems are the same and so not everyone will do every exercise. Your physical therapist will determine which exercises will help you the most on the basis of your dizziness and/or balance concerns. Figure 1 shows an example of a common exercise that might be prescribed for dizziness and imbalance as a result of your inner ear disorder.

If you lose your balance in the dark or on uneven surfaces then you might do exercises that involve standing on a foam pad with your feet in different positions.

This JNPT Perspectives for Patients is based on an article by Hall CD et al, titled “Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline” (J Neurol Phys Ther 2016) and was written by Courtney Hall, Susan Herdman, and Susan Whitney and illustrated by Maverick Dunavan.

© 2016 Neurology Section, APTA