Physical Therapy Exercises and Treatments for Vertigo Relief

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Physical Therapy Exercises and Treatments for Vertigo Relief

Understanding Vertigo and Its Causes

Vertigo is a sensation of spinning dizziness that can be debilitating and disrupt daily life. It is often described as feeling like the room is spinning around you, even when you are completely still. Vertigo can come on suddenly and disappear just as quickly, although it may linger for hours or even days in some cases. What causes vertigo? There are a few possible underlying reasons:

Benign Paroxysmal Positional Vertigo (BPPV)

One of the most common causes of vertigo is benign paroxysmal positional vertigo (BPPV), accounting for nearly half of all dizziness cases. BPPV occurs when calcium carbonate crystals become displaced and build up in the inner ear canals. Specific head movements, like looking up, down, or turning over in bed, can trigger short bursts of vertigo with BPPV. The good news is that BPPV often responds very well to treatment.

Vestibular Neuronitis

Vestibular neuronitis is an inflammation of the vestibular nerve, which is responsible for sending balance information from the inner ear to the brain. When this nerve becomes inflamed, likely due to a virus, vertigo symptoms arise. Vestibular neuronitis may only cause one vertigo episode before it resolves or could cause recurring bouts.

Vestibular Migraine

People who experience migraines sometimes have vertigo before or during migraine headaches. However, vertigo can also occur independently as the main symptom of a vestibular migraine. During a migraine-related vertigo attack, people often describe feeling the room spin, lose their balance, and experience nausea and sound/motion sensitivity.

Meniere’s Disease

Meniere’s disease leads to abnormal fluid buildup in the inner ear, causing pressure and damage over time. This chronic condition causes vertigo along with other symptoms like tinnitus, muffled hearing, and a feeling of ear fullness. Meniere’s vertigo attacks can be severe and long-lasting from hours to days.

Vestibular Neuritis

Sometimes vertigo stems from a problem in the central nervous system rather than the inner ear. Conditions like tumors, strokes, or multiple sclerosis can disrupt the pathways that coordinate balance, resulting in vertigo. Depending on the underlying cause, these vertigo symptoms may eventually resolve or could be recurring.

Physical Therapy Treatments for Vertigo

For many vertigo sufferers, physical therapy provides significant symptom relief. Physical therapists have specialized training in evaluating and treating balance disorders. Some of the common physical therapy interventions used for vertigo include:

Canalith Repositioning Maneuvers

Canalith repositioning maneuvers are usually the first line treatment for BPPV. These involve a series of controlled head and body movements designed to relocate the calcium crystals trapped in the inner ear. Several maneuvers exist, including the Epley maneuver and Semont maneuver, which a physical therapist can perform during office visits.

Balance and Gaze Stabilization Exercises

Custom exercise programs are often prescribed to help improve balance and gaze stability, which can reduce vertigo episodes. These begin seated or with support, then progress to standing positions with more challenge to the vestibular system. Exercises include targeting head movements in different directions, standing on unstable surfaces like foam, walking obstacles courses, and more.

Vestibular Adaptation Exercises

Sometimes vertigo arises because the vestibular system in the inner ear has impaired function. Vestibular adaptation exercises train the brain to become less sensitive to mismatches of input coming from the inner ear, eyes, and body. This relies on repetitive, controlled head and eye movements to trigger symptoms and encourage adaptation.

Balance Retraining Therapy

For chronic vertigo, balance retraining therapy aims to rebuild proper vestibular function over time. This intensive therapy helps people maintain balance with vision blocked, practice normal head motions, develop effective stability strategies for daily activities, and improve vision tracking. The customized exercises are progressed as abilities improve.

Other Treatments That May Be Recommended

In addition to physical therapy, people with vertigo often benefit from other medical treatments recommended by their doctor. Some possibilities include:


Medications that can minimize vertigo episodes include anticholinergics, antihistamines, anticonvulsants, tranquilizers, and corticosteroids, depending on the cause. Antinausea drugs may also help control nausea associated with vertigo.

Vestibular Rehabilitation Therapy

If physical therapy alone isn't effective, vestibular rehabilitation may be prescribed. This combines physical therapy with other strategies to promote vestibular system compensation and central nervous system adaptation to vertigo triggers.


For severe Meniere’s disease that doesn’t respond to other interventions, surgery may be an option. Procedures can include drainage tubes in the inner ear or cutting the balance nerve to prevent vertigo signals from reaching the brain.

Prevention and Home Exercises

While medications and rehabilitation can help manage vertigo, these prevention and home exercise tips also improve symptoms between treatment sessions:

Avoid Triggers

For conditions like BPPV, avoid movements that are known to trigger vertigo spells, like abrupt head motions and looking straight up or down. Take it slow when getting up from lying down.

Stay Hydrated

Dehydration can exacerbate vertigo, so drink plenty of water. Caffeine and alcohol can promote fluid loss, so limit intake.

Use a Night Light

Keep a night light on to avoid making sudden position changes from lying down to sitting up or walking in a dark room.

Practice Balance Exercises

Simple gaze stabilization and balance exercises can be continued at home, like standing with your feet together and eyes closed for 30 seconds, walking heel to toe, or working on a balance board.

Try Ginger

Ginger root capsules may minimize nausea and vomiting related to vertigo. Check with your doctor on suggested dosing.

Consider Vestibular Supplements

Discuss supplement options with your doctor that support inner ear health, like vitamin D, magnesium, calcium, potassium, and quercetin.

When to Seek Emergency Care

Severe vertigo accompanied by these red flag symptoms requires urgent medical attention. Seek emergency care if you experience:

  • Sudden, intense vertigo
  • Difficulty walking or standing
  • Vertigo along with slurred speech
  • Vision changes or loss of vision
  • Hearing loss
  • Dizziness with fever, headache, numbness, or ringing in the ears
  • Unexplained falls or injury due to vertigo

These signs can indicate a serious underlying problem like stroke, brain inflammation, or nerve damage requiring immediate treatment.

Know When to Contact Your Doctor

Be sure to follow up with your doctor if vertigo:

  • Occurs frequently with disruptive daily symptoms
  • Lasts for hours or days at a time
  • Doesn’t improve with initial treatment efforts
  • Significantly impacts your ability to complete normal daily activities
  • Is accompanied by hearing changes or ear fullness

Ongoing communication with your doctor helps determine if medication adjustments, further testing, or specialty referrals could help better control vertigo episodes.

The Takeaway

Vertigo is a common medical condition with several potential underlying causes. For many patients, physical therapy and vestibular rehabilitation exercises provide significant symptom relief. While vertigo can't always be cured, the right treatment approach helps minimize spinning episodes and related impairment. Stay in close contact with your doctor throughout management and bring any new or worsening symptoms to their attention.


What tests help diagnose the cause of vertigo?

Doctors use tests like videonystagmography, vestibular-evoked myogenic potential, computerized dynamic posturography and head thrust testing to evaluate the vestibular system and pinpoint the reason for vertigo.

Can physical therapy cure vertigo?

While physical therapy cannot cure every underlying cause of vertigo, it is very effective at significantly reducing symptoms and frequency of spinning spells. However, vertigo may return if PT is discontinued.

How long does vestibular therapy take to work?

Most people see some improvement after 1-2 weeks of PT, but it often takes 4-6 weeks of regular vestibular therapy to experience the full effects on vertigo reduction.

What are BPPV exercises?

For benign paroxysmal positional vertigo, exercises like the Epley and Semont maneuvers are often used to reposition particles in the inner ear to stop vertigo.

Can you do vestibular exercises at home?

Yes, your physical therapist will recommend home exercises to continue improving your balance and gaze stability in between therapy visits.