Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy is a specialised form of physiotherapy for selected problems involving dizziness, vertigo, unsteadiness and balance. Treatment is based on a detailed assessment and a personalised programme rather than a standard set of exercises given to everyone.

At Core Physio, your physiotherapist will take time to understand your symptoms, how they began and the effect they have on your daily life. They can then assess your balance, movement and response to different head, eye and body positions before recommending an appropriate management plan.

Depending on the findings, treatment may include specific eye and head exercises, balance work, walking exercises, movement practice, education and advice for managing symptoms safely.

Vestibular Rehabilitation Therapy is available through our London Bridge clinic and our East Dulwich clinic.

What Is Vestibular Rehabilitation Therapy?

Vestibular Rehabilitation Therapy, often shortened to VRT, is an exercise-based approach used to help manage selected dizziness and balance disorders.

The programme aims to help your brain make more effective use of information from the inner ears, eyes, muscles and joints. These systems normally work together to help you remain balanced, keep your vision steady and understand the position of your head and body.

When the information from these systems does not match or is not processed effectively, you may experience symptoms such as dizziness, vertigo, blurred or unstable vision and unsteadiness.

Vestibular rehabilitation exercises are selected according to your symptoms and assessment findings. They are then reviewed and progressed as your abilities and confidence improve.

What Is the Vestibular System?

The vestibular system is part of the inner ear and provides the brain with information about head movement, position and spatial orientation.

Your balance also depends on information from:

• Your eyes and visual surroundings
• The balance organs within the inner ears
• Sensors in your muscles and joints
• The parts of the brain that process and coordinate this information

When these sources provide consistent information, your brain can help stabilise your vision and control your posture while you stand, walk and move your head.

A disturbance within the vestibular system can make normal movements feel disorientating. For example, turning your head, rolling over in bed, walking through a busy environment or looking between moving objects may provoke dizziness or imbalance.

What Is the Difference Between Dizziness and Vertigo?

Dizziness is a broad term that people use to describe several different sensations. These can include feeling light-headed, unsteady, disorientated, faint or as though the surroundings are moving.

Vertigo describes a false sensation of movement. You may feel that you are spinning, tilting or moving even though you are still, or that the environment is moving around you.

Vertigo is a symptom rather than a diagnosis. Therefore, an assessment is important before beginning treatment because different causes may require different forms of management.

Symptoms That May Be Assessed

A vestibular physiotherapy assessment may be considered when you experience ongoing or recurring symptoms such as:

• Dizziness during head or body movement
• A spinning or moving sensation
• Unsteadiness while standing or walking
• Difficulty walking in the dark or on uneven surfaces
• Blurred or unstable vision during movement
• Discomfort in busy visual environments
• Dizziness when turning in bed
• Reduced confidence walking outside
• Difficulty looking up, bending or turning quickly
• Fear of falling
• Nausea associated with movement
• Symptoms that limit work, travel, exercise or everyday activities

These symptoms can have many possible causes. Vestibular Rehabilitation Therapy will only be recommended when the assessment indicates that it is appropriate.

Conditions That May Benefit from Vestibular Rehabilitation

Vestibular rehabilitation may form part of the management of several balance and dizziness conditions.

These can include:

• Vestibular neuritis
• Labyrinthitis after the acute stage
• Unilateral vestibular loss
• Bilateral vestibular loss
• Benign Paroxysmal Positional Vertigo, commonly called BPPV
• Persistent Postural-Perceptual Dizziness, or PPPD
• Vestibular migraine, as part of wider management
• Age-related balance decline
• Persistent imbalance following an inner-ear problem
• Selected neurological or central balance disorders where appropriate
• Ongoing symptoms following treatment or surgery for a vestibular condition

This list does not mean that everyone with one of these conditions will require the same exercises. Some people may also need assessment or treatment from a GP, audiologist, ear, nose and throat specialist, neurologist or another healthcare professional.

Your Initial Vestibular Assessment

Your first appointment begins with a detailed discussion about your dizziness or balance symptoms.

Your physiotherapist may ask:

• When the symptoms began
• Whether they started suddenly or gradually
• How you would describe the sensation
• How long each episode lasts
• Which movements or environments provoke symptoms
• Whether you experience nausea, headaches or visual disturbance
• Whether you have noticed changes in hearing or tinnitus
• Whether you have fallen or feel at risk of falling
• What medical investigations or specialist assessments you have received
• Which medication you currently take
• How the symptoms affect work, travel and everyday activity

It can be helpful to bring relevant medical letters, vestibular test results, scan reports and a current medication list to the appointment.

Physical and Balance Assessment

The practical assessment will depend on your symptoms and medical history.

Your physiotherapist may examine:

• Eye movements
• Head movements and their effect on symptoms
• Standing balance in different positions
• Walking and turning
• Balance with reduced visual information
• Movement on different surfaces
• Your ability to complete more than one task while walking
• Neck movement where relevant
• Strength and general mobility
• Positional movements when BPPV is suspected

The assessment may temporarily reproduce familiar dizziness. However, each test should be explained beforehand and conducted in a controlled environment.

Your physiotherapist will use the findings to decide whether vestibular rehabilitation is suitable and whether further medical or specialist investigation should be recommended.

Your Vestibular Rehabilitation Programme

No single exercise programme is appropriate for every dizziness or balance problem.

Your personalised plan may include:

• Gaze-stability exercises
• Controlled head and eye movements
• Habituation exercises
• Standing balance exercises
• Walking and turning practice
• Movement in visually busy surroundings
• Exercises on different surfaces
• Functional tasks linked to everyday activity
• Falls-risk reduction and safety advice
• A home exercise programme

The exercises will be selected according to your current abilities. They can then be progressed by changing the speed, duration, position, visual background or level of balance required.

Gaze-Stability Exercises

The vestibular system helps keep your vision steady when your head moves. When this function is affected, objects may appear blurred, unstable or as though they are moving during activity.

Gaze-stability exercises commonly involve focusing on a visual target while moving your head in a controlled way.

The starting position, speed and duration will be adapted to you. Exercises may begin while sitting before progressing to standing or walking when this can be completed safely.

These exercises should be prescribed following an assessment rather than copied from a generic online programme. The correct exercise depends on the nature of the vestibular problem and your individual response.

Habituation Exercises

Habituation exercises involve carefully repeating selected movements or activities that provoke manageable dizziness.

The purpose is to help the brain become less sensitive to movements that are safe but currently trigger symptoms. These exercises may involve actions such as turning the head, bending, changing position or moving between sitting and standing.

Some temporary dizziness may occur during habituation work. However, symptoms should be provoked in a planned and controlled way rather than pushed to an excessive level.

Your physiotherapist will explain how long symptoms should reasonably take to settle and when the exercise should be reduced, modified or stopped.

Balance and Walking Exercises

Vestibular problems can reduce confidence with standing, walking and moving through different environments.

Balance rehabilitation may include:

• Standing with the feet in different positions
• Moving the head while standing
• Walking while turning the head
• Changing walking speed
• Turning and changing direction
• Stepping over or around obstacles
• Practising on different surfaces
• Reducing reliance on vision where appropriate
• Completing simple additional tasks while walking

Exercises should be completed in a safe environment. Support, supervision or a stable surface may be required during the early stages.

Vestibular Rehabilitation for BPPV

Benign Paroxysmal Positional Vertigo is a common cause of brief episodes of spinning dizziness triggered by changes in head position.

Symptoms may occur when:

• Rolling over in bed
• Lying down or sitting up
• Looking upwards
• Bending forwards
• Turning the head quickly

BPPV occurs when tiny particles within the inner ear move into a part of the balance system where they should not be.

Assessment commonly involves moving the head and body into specific positions while the clinician observes your eye movements and response.

When BPPV is identified, treatment may involve a repositioning manoeuvre designed to guide the particles back towards the correct part of the inner ear. The appropriate manoeuvre depends on which canal and side are affected.

General vestibular exercises are not a substitute for correctly identifying and treating BPPV. Avoid attempting repeated repositioning manoeuvres without suitable guidance when the cause of your dizziness has not been established.

Will Vestibular Exercises Make Me Feel Dizzy?

Some prescribed exercises are expected to provoke a mild or moderate amount of your familiar dizziness. This controlled exposure can form part of the rehabilitation process.

However, the purpose is not to make you as dizzy as possible. Exercises should remain safe, manageable and appropriate for your diagnosis.

Your physiotherapist will explain:

• How strongly symptoms should be provoked
• How long they should take to settle
• How frequently to complete the exercise
• When to progress the exercise
• When to reduce or stop it
• Which symptoms require medical advice

Contact the clinic when an exercise causes a major change in your symptoms, prolonged worsening or a response that differs from what was discussed.

The Importance of a Home Exercise Programme

Vestibular rehabilitation commonly requires regular practice between appointments.

Your home programme should contain a manageable number of exercises with clear instructions about frequency, duration and progression.

Completing exercises consistently is generally more helpful than performing a long or intense session occasionally. Nevertheless, the programme must fit safely around your symptoms and normal routine.

At follow-up appointments, your physiotherapist can review your response and alter exercises that have become too easy, too difficult or no longer relevant.

Avoiding Movement and Dizziness

It is understandable to avoid movements that bring on dizziness. However, prolonged avoidance can sometimes reduce confidence and limit the brain’s opportunity to adapt to safe movement.

Vestibular rehabilitation introduces movement gradually rather than expecting you to confront every difficult activity immediately.

The programme may begin with controlled exercises at home before progressing towards more challenging tasks such as busy shops, public transport, outdoor walking or exercise.

Safety remains the priority. Movements should not be practised without suitable support when dizziness places you at risk of falling.

Managing Visually Induced Dizziness

Some people experience symptoms in environments containing significant visual movement or detail.

Examples can include:

• Supermarkets
• Busy streets
• Scrolling on a screen
• Watching moving traffic
• Travelling on public transport
• Crowded rooms
• Patterns, bright lighting or fast-moving images

Rehabilitation may include gradually increasing exposure to relevant visual environments while working on balance, head movement and confidence.

The progression should remain individual. Moving too quickly into an overwhelming environment may cause an unnecessary increase in symptoms.

Vestibular Migraine and Rehabilitation

Vestibular migraine can involve dizziness, vertigo, imbalance and sensitivity to movement or visual surroundings. Headache may or may not occur during every episode.

Vestibular Rehabilitation Therapy may help selected people manage ongoing movement and balance problems. However, it is usually only one part of a broader management plan.

Medical review may also be required to consider diagnosis, medication and factors such as sleep, stress, hydration and migraine triggers.

Persistent Postural-Perceptual Dizziness

Persistent Postural-Perceptual Dizziness, commonly shortened to PPPD, can cause ongoing dizziness or unsteadiness that is often aggravated by standing, movement and visually complex surroundings.

A management plan may include vestibular exercises, gradual exposure to movement, education and strategies for rebuilding confidence with everyday activities.

Some people may also require support from other healthcare professionals. The recommended approach should reflect the individual presentation rather than relying on exercises alone.

Falls, Confidence and Everyday Activity

Dizziness and imbalance can lead people to reduce walking, exercise and social activity because they are worried about falling or triggering symptoms.

Your rehabilitation may therefore focus on practical goals such as:

• Walking outside safely
• Using stairs
• Turning and changing direction
• Getting in and out of bed
• Using public transport
• Shopping in busy environments
• Returning to work
• Resuming exercise or leisure activities

Where falls risk is identified, your physiotherapist may recommend environmental changes, walking support or further medical assessment alongside the exercise programme.

How Long Does Vestibular Rehabilitation Take?

There is no single timescale that applies to everyone.

Progress can be influenced by:

• The cause of the symptoms
• How long they have been present
• Whether one or both vestibular systems are affected
• Your general health and mobility
• Other neurological, visual or musculoskeletal problems
• Medication
• Confidence and fear of movement
• How consistently the exercises are completed
• Whether the diagnosis or medical condition is stable

Some people respond after a small number of appointments, while others require a longer period of rehabilitation and progression.

Your response should be reviewed regularly rather than assuming that one programme or timescale will suit every vestibular condition.

Vestibular Rehabilitation and General Physiotherapy

Vestibular Rehabilitation Therapy is a specialist area within physiotherapy.

A person may require both approaches when dizziness is accompanied by reduced mobility, neck stiffness, weakness or loss of general physical confidence.

When Is Medical Assessment Required?

Dizziness and balance problems are not always caused by a vestibular disorder. They may also be related to medication, blood pressure, migraine, neurological conditions, cardiovascular problems, blood glucose or other medical issues.

Contact your GP or NHS 111 when dizziness is new, unexplained, worsening, repeatedly returning or accompanied by symptoms that require medical assessment.

A medical or specialist review may be required before rehabilitation when you have:

• New or unexplained dizziness without an established cause
• Sudden or worsening hearing loss
• Persistent vomiting
• Blackouts, fainting or collapse
• Chest pain, breathlessness or an unusual heartbeat
• A severe or unusual headache
• New neurological symptoms
• Recent head or neck trauma
• A major unexplained change in walking or coordination

When Should I Seek Emergency Help?

Call 999 immediately when sudden dizziness or vertigo occurs with possible signs of a stroke or another medical emergency.

Emergency symptoms can include:

• Facial weakness or drooping
• Weakness or numbness affecting an arm or leg
• Slurred speech or difficulty speaking
• Sudden double vision or loss of vision
• A sudden severe headache
• Sudden confusion
• Loss of consciousness
• Severe difficulty standing or walking

Seek emergency help even when these symptoms begin to improve or disappear.

Vestibular Rehabilitation Therapy at Core Physio

Core Physio provides personalised Vestibular Rehabilitation Therapy for selected dizziness and balance problems through our London Bridge and East Dulwich clinics.

Your physiotherapist will assess your symptoms before developing an appropriate programme. Where necessary, they may also recommend medical, audiology, ear, nose and throat or neurological review.

Visit our London Bridge clinic or our East Dulwich clinic to view local information and appointment availability.

Frequently Asked Questions About Vestibular Rehabilitation

Do I need a confirmed diagnosis before booking?

Bring any diagnosis, test results or specialist letters you have received. When the cause of your dizziness has not been established, medical, audiology or specialist assessment may be recommended before or alongside rehabilitation.

Is Vestibular Rehabilitation Therapy suitable for every type of dizziness?

No. Dizziness has many possible causes, and vestibular exercises are not appropriate for every condition. Your symptoms and medical history must be assessed before a treatment plan is recommended.

Will the assessment make me feel dizzy?

Some tests may briefly reproduce your familiar symptoms because they involve head, eye or positional movements. Each test should be explained and completed in a controlled environment.

Will my exercises make me dizzy?

Some exercises are designed to provoke a manageable amount of familiar dizziness. Your physiotherapist will explain the expected response and how quickly symptoms should settle.

Can Vestibular Rehabilitation Therapy treat BPPV?

A trained clinician can assess for BPPV and, when it is identified, may perform an appropriate repositioning manoeuvre. The treatment depends on the side and part of the inner ear involved.

Can I perform an Epley manoeuvre myself?

Home manoeuvres may be appropriate after BPPV has been correctly identified and suitable instructions have been provided. Avoid assuming that all positional dizziness is BPPV or repeatedly performing manoeuvres without appropriate assessment.

How frequently should I complete the exercises?

The recommended frequency depends on the exercise, diagnosis and your response. Follow the individual instructions provided rather than using a generic schedule.

Can I drive after my assessment?

The assessment may temporarily provoke dizziness. Discuss driving with the clinic beforehand and consider arranging for someone to accompany you when your symptoms could make travelling or driving unsafe.

What should I wear?

Wear comfortable clothing and secure footwear that allow you to stand, walk and move safely. Bring any walking aid, glasses or hearing device you normally use.

How many appointments will I need?

This varies according to the cause and duration of your symptoms, the complexity of the balance problem and how you respond to the home programme. Your physiotherapist will discuss follow-up after completing the initial assessment.

Can vestibular rehabilitation help me return to exercise?

Where appropriate, the programme can progress towards walking, gym activity, running or other forms of exercise. The progression will depend on your symptoms, balance and general physical ability.

Book Vestibular Rehabilitation Therapy

Persistent dizziness, vertigo and imbalance can affect your confidence, independence and ability to complete normal everyday activities.

Book a Vestibular Rehabilitation Therapy assessment at Core Physio to receive a personalised evaluation, practical advice and an exercise programme based on your symptoms and goals.