Physical therapy for vestibular disorders, Vestibular Rehabilitation Therapy, Vestibular Therapy, or VRT is one of the most impactful and effective treatments for people living with vestibular disorders. Just about all people with vestibular disorders, including Vestibular Migraine, Vestibular Neuritis & Labyrinthitis, Superior Semicircular Canal Dehiscence, Meniere’s Disease, Acoustic Neuroma (pre and post-surgical), and others, can benefit from Vestibular Therapy.
Vestibular Therapy is most common in the treatment of Benign Paroxysmal Positional Vertigo, BPPV. Treated with a Canalith Repositioning Maneuver, this kind of true-vertigo can usually be treated in 1-3 sessions of Vestibular Therapy.
In addition to treating BPPV, Vestibular Therapy aims to improve vestibular system strength. Symptoms of dizziness, lightheadedness, gaze instability, gait & balance abnormalities, and general fear of movement are just some of the symptoms Vestibular Therapy treats.
In general, we have a tendency to think of Physical Therapy as the treatment for musculoskeletal and neuromuscular disorders. While yes, physical therapy is incredibly effective for those with knee pain, who are post-stroke or need help returning to exercise postpartum, it is also incredibly effective in the treatment of Vestibular disorders.
Vestibular Rehabilitation Therapy Research
In clinical practice, I see Vestibular Rehabilitation Therapy change the lives of many people. Some people who haven’t been able to shower without a shower chair for more than 5 years can now comfortably stand in the shower and bathe. Others who have wanted to return to exercise but have been too nervous to move are now running long distances. Although there are many success stories similar to these, there is also research to back up these claims.
Vestibular Rehabilitation Therapy for Vestibular Migraine
Because of the lack of general research and criteria, there is no specific protocol to treat Vestibular Migraine, however, research does find that Vestibular Rehabilitation can improve Vestibular Migraine symptoms. Symptoms such as motion sensitivity, imbalance, spatial disorientation, and more are those we aim to treat. According to a 2009 study by Whitney, et.al., patients who have migraine attacks and migraine-related vestibulopathy benefitted from Vestibular rehabilitation Therapy, especially when combined with pharmaceutical management (1). Another article, a systematic review of articles, showed that Vestibular Rehabilitation Therapy was effective in treating subjective and objective complaints of vestibular symptoms.
Vestibular Rehabilitation Therapy is also found, in this 2017 article by Sugaya et.al., to improve headache symptoms, as well as symptoms of dizziness, and tension-type headache in those with vestibular migraine (3). All of this research, and more, can be found to show that vestibular symptoms of Vestibular Migraine can effectively be treated by Vestibular Rehabilitation Therapy.
Vestibular Rehabilitation Therapy for Unilateral Vestibular Hypofunction
A unilateral vestibular hypofunction is one of the most common causes of vestibular dysfunction and general disorientation and dizziness. This study sought to determine whether Habituation or Gaze Stability (AKA Adaptation), two common Vestibular Rehab protocols, was more effective (4). The research concluded that both were incredibly beneficial, and all treatment groups had positive outcomes. One treatment group used Gaze Stability exercises, and the other group used habituation exercises. After 6 weeks, both groups saw improvements in both habituation and adaptation outcome measures. This research shows, and otherwise cites, that the only ineffective treatment is to do nothing at all.
Vestibular Rehabilitation Therapy for Mal de Debarquement Syndrome
Mal de Debarquement Syndrome, or MdDs, is the sensation of rocking and swaying chronically, that gets better with passive movement and worse with being still. Classic Vestibular Rehabilitation Therapy is not very effective for the specific MdDS symptoms, but it does work to improve your balance and ability to walk. Your vestibular therapist could also help you with the Dai Protocol, which is the best possible treatment option for those with Mal de Debarquement syndrome.
What Else can your Vestibular Therapist Help you with?
A vestibular therapist cannot officially diagnose you with a vestibular disorder, however it’s really common that your vestibular therapist understands vestibular disorder diagnoses better than other healthcare professionals. Great vestibular therapists are typically vestibulo-holics (we LOVE treating dizziness). Not only will we help you return to gentle movement, but we can help empower you to talk with your doctor about a correct diagnosis, help you understand your vestibular disorder better, help you understand which supplements you may need to take, and more.
If you are a person who wants to return to the grocery store, driving, walking, cooking, and more without dizziness, Vestibular Rehabilitation Therapy with an excellent vestibular therapist can absolutely be of help to you!
When to Begin Vestibular Rehabilitation Therapy
Vestibular Rehabilitation Therapy is most effective when you are actually ready for it. But what does that even mean?
Vestibular Rehab is effective, the research shows that whether you have a unilateral vestibular hypofunction, Vestibular Migraine, or other vestibular pathology, Vestibular Rehabilitation Therapy should be a part of your recovery plan. However, starting before you are really ready for it can actually be discouraging and ineffective.
In my practice, I have found that VRT is most effective when my patients are in a sub-acute phase. This is mostly anecdotal, but you will find that better vestibular specialists don’t always refer patients to Vestibular Rehabilitation Therapy immediately after diagnosis.
There are of course exceptions, for instance, diagnoses like Vestibular Neuritis need immediate Vestibular Rehabilitation Therapy and should be referred to a PT quickly. Vestibular Neuritis is a form of unilateral vestibular hypofunction, and you can read more about it here. In this case, it’s important to get to VRT immediately to help your system recover. You will learn about why you’re feeling dizzy, what to do during a flare-up, and how to improve your vestibular system’s strength to increase gaze stability and habitation.
In Vestibular Migraine, however, it’s not always best to begin immediately. Vestibular Migraine patients can be incredibly delicate, and more movement in the acute phase can cause a worsening of symptoms. I evaluate many newly diagnosed Vestibular Migraine patients, and as much as I want to help them as quickly as possible, I send quite a few away for weeks to months at a time. It’s a hard line to walk because beginning to move more can be frightening at first, and you may never really feel ‘ready’. However, if you talk to a vestibular therapist, and your referring physician, there is usually an excellent plan of attack. It can’t hurt to get an initial evaluation from a vestibular physical therapist and then make a plan. Maybe you should start now, maybe you should start later – it’s always between you and your healthcare team!
Still not sure when or how to begin?
Start by finding a vestibular physical therapist here, ask for an evaluation, and see what the therapist has to say. If he or she feels like you are ready, and you are committed to starting, then I say go for it!
Or, if you reside in Maryland, Virginia, California, New York, or New Jersey contact me for a free 10-minute consult to see if we’d be a good fit!
(1) Whitney, S.L., Wrisley, D.M., Brown, K.E. and Furman, J.M. (2000), Physical Therapy for Migraine-Related Vestibulopathy and Vestibular Dysfunction With History of Migraine. The Laryngoscope, 110: 1528-1534. https://doi.org/10.1097/00005537-200009000-00022
(2) Alghadir AH, Anwer S. Effects of Vestibular Rehabilitation in the Management of a Vestibular Migraine: A Review. Front Neurol. 2018;9:440. Published 2018 Jun 12. doi:10.3389/fneur.2018.00440
(3) Sugaya, N., Arai, M., & Goto, F. (2017, April 3). Is The Headache in Patients With Vestibular Migraine Attenuated By Vestibular Rehabilitation? Frontiers in Neurology. https://www.frontiersin.org/articles/10.3389/fneur.2017.00124/full.
(4) Clendaniel RA. The effects of habituation and gaze stability exercises in the treatment of unilateral vestibular hypofunction: a preliminary results. J Neurol Phys Ther. 2010;34(2):111-116. doi:10.1097/NPT.0b013e3181deca01