From Wobbly to Steady: A Quick Guide to Dizziness and Balance Troubles 

When the vestibular system isn’t functioning properly, it can lead to dizziness, vertigo, unsteadiness, and falls—all of which affect your daily activities and independence. Luckily, physical therapy has proven, evidence-based methods to help retrain and restore function to this vital system.  

So, what Is the Vestibular System? 

The vestibular system is your body’s balance center, located deep within your inner ear. It works alongside your eyes, muscles, nerves, and joints to help you maintain balance, stabilize your gaze, and orient yourself in space. 

 Quick Facts: 

• Your vestibular system sits in the inner ear and includes semicircular canals, otolith organs, and the vestibular nerve. 
• It constantly sends signals to your brain about head movement and spatial orientation. 
• Issues in this system are a leading cause of dizziness, especially in older adults. 
• Vestibular dysfunction is often misdiagnosed or overlooked, but PT can help. 

 Types and causes of common dizziness issues:  

1. Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. It occurs when tiny crystals (called otoconia) become dislodged and move into the semicircular canals, where they shouldn’t be. 

• Sudden spinning sensation when rolling over in bed, looking up/down, or turning the head. 
• Episodes are brief but intense and often recurring. 

You may be at greater risk if you: 

• Are over age 50 
• Have suffered a head injury or concussion
• Have been on prolonged bed rest 
• Have a history of inner ear infections or Meniere’s disease 
• Recently had a viral illness 
• Are prone to migraines 
• Do not perform resistance training exercises 

2. Vestibular Neuritis/Labyrinthitis 

• Caused by viral infection of the vestibular nerve (neuritis) or the inner ear (labyrinthitis). 
• This leads to severe dizziness, nausea, imbalance, and sometimes hearing loss. 

 3. Meniere’s Disease 

• Chronic condition involving fluid imbalance in the inner ear. 
• Characterized by episodes of vertigo, tinnitus, ear fullness, and hearing loss. 

 4. Vestibular Hypofunction (Unilateral or Bilateral) 

• Reduced function in one or both inner ear systems. 
• Leads to unsteadiness, motion sensitivity, and difficulty with head movements or busy environments. 

5. Cervicogenic Dizziness 

• Neck-related dizziness: stems from issues in the cervical spine (neck), often triggered by poor posture, stiff joints, or past injuries like whiplash/concussions. 
• Symptoms flare with movement: People may feel lightheaded, off-balance, or disoriented—especially during or after neck movements or when holding certain positions too long. 

 

How Physical Therapy Helps: 

Vestibular Physical Therapy is a specialized form of rehab targeting balance, dizziness, and vertigo. It includes: 

1. Canalith Repositioning Techniques (CRTs) 

• For BPPV, we use techniques like the Epley maneuver or Semont maneuver to guide the dislodged crystals back to their proper place. These techniques are safe, fast, and often effective in just 1–2 sessions. 

2. Gaze Stabilization Exercises 

For vestibular hypofunction, we retrain the brain and eyes to compensate for lost inner ear function. One common exercise is: 

• VOR x1 Exercise: 
  • Hold a letter or target at arm’s length. 
  • Keep your eyes on the target and turn your head side to side or up/down for 30 seconds. 
  • Keep the target in focus the whole time.
  • This improves the vestibulo-ocular reflex (VOR)—your system’s ability to keep vision clear during movement. 

3. Manual therapy 

• Hands on techniques performed by your PT to decrease tension in the cervical spine joints and muscles as well as upper back and shoulders 
• Potentially even down into your lower back, hips and even your feet and ankles!  

4. Postural muscle strengthening 

• Enhances your body’s ability to stay upright and steady, especially during movement or when visual input is overwhelming. 
• Targeted exercises for postural control (e.g., heel-to-toe walking, single-leg stance) help retrain balance systems and reduce reliance on vision 

 

Simple Balance Training You Can Do at Home  

Try these safe home exercises to help improve balance and vestibular function: 

1. Bilateral Static standing 

• Stand with feet touching, eyes open. 
• Progress to closing your eyes for 10–30 seconds. 
• Stand near a counter for support and keep a chair behind you. 

2. Single leg standing 

• Single-Leg stance. 
• Try to hold for 15–30 seconds each side. 
• Stand near a counter for support and keep a chair behind you. 

3. Dynamic balance 

• Marching in place with head turns, can either scan room or focus on items. 
• March in place while slowly turning your head side to side. 
• Builds dual-task balance control. 
• Stand near a counter for support and keep a chair behind you. 

4. Walking balance 

• Tandem Walking. 
• Walk heel-to-toe in a straight line. 
• Perform near a wall for safety. 
• Try forwards and backwards. 

Consistency is key—practice daily and often to build neural connections and improve safety. 

When to See a PT or Doctor 

You should seek professional evaluation if you experience: 

• Recurrent or unexplained dizziness 
• Vertigo lasting more than a few days 
• Unsteadiness or frequent falls 
• Difficulty walking in the dark or on uneven surfaces 

 A tailored physical therapy program can restore your confidence, reduce symptoms, and improve your independence. 

Final Thoughts  

The vestibular system is often taken for granted—until it starts causing problems. But the good news is that vestibular rehab is highly effective and often leads to significant improvements in a short amount of time. If you or someone you love is feeling dizzy or off-balance, don’t wait—reach out to a vestibular-certified physical therapist. Lucky for you, we have three of them!