Dizziness and Exercise Based Vestibular Rehab
By Sean Phillips PT, DPT, OCS

Millions of people suffer from dizziness every year, making even the simplest daily tasks difficult to perform. However, the word “dizzy” can accompany many different symptoms that someone can suffer from. Dizziness is a non-specific term used for the sense of imbalance, disorientation, vertigo, or light headedness. As we grow older our risk for encountering dizziness increases, and affects women at a higher rate than men. This is especially true when taking 3 or more forms of daily medication, as it is one of the most common side effects of combining medicine.

Feeling dizzy can lead to an increased risk of falls, heightened anxiety and fear levels, depression, and decreased activity levels. Due to this significant impact on daily activities, it is not surprising to learn that dizziness is one of the leading symptoms that would lead someone to seek care. But what can be done to help treat dizziness, especially if it has been going on for long periods of time?

Vestibular rehab has been attempting to treat patients with these complaints dating back to 1946, and today physical therapy is a leading provider for these services. These techniques have concentrated on identifying the causes of dizziness and correcting or reducing the impairments through specific exercises. In this article, we will briefly discuss several categories of dizziness and types of vestibular rehab that can treat specific disorders.

Categories of Dizziness

• True vertigo is a sense of rotation movement. This can feel like the room is spinning around you, or you are spinning around the room. It would be very similar to the sensation you get from someone suddenly stopping you from spinning in a chair, or a getting off a spinning theme park ride.
• Generally provoked by head movements, such as rolling over in bed or quickly looking upwards.
• BPPV = Benign Paroxysmal Positional Vertigo
• Tends to last less than 1 minute.

• Sense of poor balance or unsteadiness.
• Worse balance in dark rooms or when closing eyes, such as when washing your face in the shower.

• The sensation that someone is about to faint or pass out.
• Typically accompanied by nausea or sweating

• Sensation like rocking on a boat, floating, or rocking

Vestibular Rehab

– VR exercises include eye, head, and body movements that stimulate the vestibular system with a goal of gradually returning a patient to their normal state.
– These exercises include habituation, adaptive strategies, or substitution techniques.
– Habituation exercises uses repetitive movements or provoking stimuli until patients no longer respond adversely to the stimuli.
• For example, if turning head increases dizziness, performing this motion in a controlled environment can gradually resolve the issue.
– Adaptation exercises focus on head movements while keeping eyes focused on a stationary target.
– Substitution exercises utilize the remaining sensory inputs your body has to aid postural control and decrease dizziness.


In a systematic review of over 300 PT research articles, Kundakci et al. was able to conclude that vestibular rehab was beneficial in treating patients with chronic dizziness. These benefits included improvement in vertigo symptoms, fall risk, balance, confidence, and emotional status. However, they determined that it was not possible to identify the most effective vestibular rehab protocol, frequency, or intensity of exercises, attributing these changes to the high variability between patients.

Therefore, if you may be suffering from chronic dizziness then physical therapy and vestibular rehab may be of benefit to you. Since every patient’s symptoms may be slightly different, your physical therapist should be able to create a unique rehab program to return you to where you would like to be.

Kundakci B, Sultana A, Taylor AJ and Alshehri MA. How to cite this article: The effectiveness of exercise based vestibular rehabilitation in 2018, :276 (doi: adult patients with chronic dizziness: A systematic review [version 1; referees: 2 approved] F1000Research 7 )10.12688/f1000research.14089.1