Vestibular rehabilitation: How does it work?

Vestibular rehabilitation is a specialised therapy designed to help people suffering symptoms such as dizziness and lack of balance. We spoke to Matthew Long, Clinical Lead Physiotherapist at BMI The Manor Hospital, to find out who can benefit from this treatment.

What is a vestibular disorder?

‘Vestibular’ refers to the inner ear system. This contains fluid-filled canals that help with balance and spatial awareness. Vestibular disorders occur due to damage to the inner ear system, which can be either temporary or permanent.

Sometimes disorders will affect both ears but sometimes only one. Common symptoms include dizziness and a reduced sense of balance.

What is vestibular rehabilitation?

Vestibular rehabilitation, also known as vestibular rehabilitation therapy or VRT, is a safe way of helping improve problems of dizziness and unsteadiness. Balance disorders are frequently associated with inner ear conditions.

VRT involves a programme of exercises designed to gradually improve the inner ear function and recalibrate your balance system.

What causes inner ear problems?

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There are various conditions that can affect the vestibular system. Dizziness can affect people of all ages, but it becomes more common as we get older.

Vestibular disorders are often due to infection or loose inner ear crystals. People often don’t know what’s causing their symptoms so it’s important to get a medical opinion. You could speak to a specialist physical therapist or have an assessment with your GP.

Common vestibular disorders include:

Benign paroxysmal positional vertigo (BPPV)

This is the most common inner ear disorder. It is caused by loose crystals in the ear.

BPPV causes spinning sensations and/or unsteadiness when changing positions. Symptoms often occur when standing up or rising from bending down, or when turning over in bed. These side effects are very unpleasant but tend to be short lived – a minute or under.

The problems associated with benign paroxysmal positional vertigo can normally be resolved with VRT sessions using specific manoeuvres to clear the crystals.

Labyrinthitis (also known as vestibular neuritis)

Some people experience spinning sensations, dizziness and vertigo after an ear infection. This is a condition known as labyrinthitis or vestibular neuritis, caused by inflammation of the inner ear.

Normally the spinning sensation will occur in the first few days of the condition and after this you will feel a less specific sense of imbalance. Labyrinthitis commonly causes nausea and vomiting in the early stages, too.

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Vestibular rehabilitation for this involves head and eye co-ordination and balance exercises.

Ménière's disease

This disorder can cause vertigo, tinnitus (ringing in the ear), hearing loss and a feeling of fulness in the ear.

Ménière's disease tends to occur in people in their 40s and 50s. There is no cure but some people find that vestibular therapy helps. Other treatments include counselling, injections and even surgery.

If you are experiencing any of these conditions and their side effects, vestibular rehabilitation may be able to help you manage them.

Can dizziness and imbalance be caused by something more serious?

Sometimes feelings of dizziness and balance problems can be caused by other conditions.

These are less common, but include neurological problems (e.g. Stroke or Multiple Sclerosis), or an acoustic neuroma (benign growth on the brain).

If your vestibular symptoms are a result of such a condition, but this is an existing issue which is well-controlled from a medical perspective, there’s a chance vestibular rehabilitation can still be helpful.

There are some circumstances where vestibular rehabilitation is not recommended, for example if you’re having blackouts or becoming very faint.

If you are experiencing acute symptoms, you should absolutely seek medical opinion. There are underlying problems (including low blood pressure and heart conditions) that can cause these symptoms so don’t hesitate to speak to your doctor.

What does vestibular rehabilitation involve?

VRT is a type of physical therapy specifically targeted at the symptoms of vestibular disorders. Your physiotherapist will work with you to develop a tailored exercise programme that hopes to reduce your symptoms and improve your quality of life.

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For every individual person, there will be a different approach that works best for them. It’s important that you speak to a specialist physiotherapist and follow their advice carefully.

We work with each person to create a bespoke therapy programme, tailored just to them. This might include a variety of different approaches.

Exercises we might recommend for people with vestibular issues include:

Vestibular compensation

This method aims to allow your brain to regain balance control, and to minimise dizziness in cases where you have an imbalance between the balance organs in your left and right inner ears.

Head and eye movements

Your physiotherapist may encourage you to practise eye or head movements that normally make you dizzy in order to become used to them.

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Gradually, your ability to move your eyes independently of your head should improve, and you may find that your head, neck and shoulder muscles relax too.

This can be a long process and it’s important that you don’t try to do too much too soon. That’s why it’s crucial to follow a personalised exercise programme put together by a vestibular specialist.

Balance training

If you have issues with balance, your physiotherapist can help you to identify special balancing exercises. When successful, they can significantly improve your balance and in turn your quality of life.

Again, you will most likely start small and gradually build up the variety and intensity of your exercises.

Gaze stabilisation exercises

Vestibular issues can affect your vision and your ability to focus, especially while moving. Gaze stabilisation exercises are designed to help with this.

How long will vestibular rehabilitation last?

The length of your rehabilitation will depend on factors personal to you, such as your age, the extent of your vestibular dysfunction, and what you want to get from therapy.

At BMI Healthcare, you can refer yourself for an initial physiotherapy session (prices starting from just £40) with one of our experienced specialists. You don't need a referral from your GP. 

They’ll help you gauge the extent of your issue and start building a recovery programme tailored to you, which will include a realistic timeline.

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