What to know about physical therapy and vertigo

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Vertigo refers to a sensation of motion that is unrelated to the person’s actions, and it typically presents as a spinning sensation. It may sometimes make a person feel as though their surroundings are spinning around them.

Vertigo is a symptom of other issues. However, it can also occur alongside or lead to other symptoms, such as balance issues, nausea, and motion sickness.

There are two types of vertigo: peripheral and central.

Peripheral vertigo accounts for about 80% of cases and is often the result of benign paroxysmal positional vertigo (BPPV).

The remaining 20% of cases are central vertigo, which results from lesions on the brain stem or another issue affecting the brain.

Both multiple sclerosis (MS) and migraine can cause central vertigo.

What is BPPV?

BPPV occurs when calcium carbonate crystals in the ear, known as canaliths, come loose and move into one of the fluid filled canals.

It is the most common cause of peripheral vertigo.

These crystals interfere with the normal movement of fluid in the canals. The purpose of the fluid is to sense movement, but disturbances can cause it to send false signals to the brain.

This tricks the brain into thinking that a person is moving, even if they are not. The false signal contradicts what the other ear senses and what the eyes are seeing. This conflicting information causes a spinning sensation, known as vertigo.

Physical therapy can help with vertigo. The most suitable exercises may vary depending on the type of vertigo. A person should make sure that they have the correct diagnosis before seeking physical therapy or trying exercises at home.

Healthcare professionals may use a form of physical therapy called vestibular rehabilitation therapy (VRT) to help with vertigo. VRT may help people with vertigo resulting from BPPV, head injuries, central nervous system lesions, and undefined causes.

However, this type of therapy might not work for all causes of vertigo. The aim of VRT is to help a person anticipate vertigo from known triggers and take action to prevent it from occurring. As a result, people who experience sporadic, unpredictable incidents may not benefit from VRT.

Can VRT make vertigo worse?

The symptoms of vertigo may either reduce or worsen during VRT exercises.

Sometimes, worsening symptoms may be due to unnecessary overuse of the exercises on a “good” day, which can cause fatigue, resulting in increased symptoms.

Even if the exercises seem to have resolved the symptoms of vertigo, a person can experience a relapse of symptoms at a later time.

Some exercises for vertigo may be easy for people to do at home. However, it is important to determine the cause of vertigo before beginning any therapy to treat the symptoms.

A person should also follow all exercise recommendations from a doctor or therapist. These professionals can explain each exercise in more detail and provide guidance on what to expect and when to stop.

This section explains how to perform two canalith repositioning exercises that may help alleviate vertigo.

Learn more about exercises for vertigo.

Epley maneuver

This common exercise is particularly effective in treating BPPV.

A person can perform the Epley maneuver by following these steps:

1. Sit upright on the edge of a bed.
2. Turn the head about 45 degrees to the right.
3. Lie back quickly.
4. Stay in this position for 30 seconds.
5. Turn the head so that it is now 45 degrees to the left.
6. Stay in this position for 30 seconds.
7. Turn the head and body another 90 degrees to the left, into the bed.
8. Maintain this position for 30 seconds.
9. Slowly sit up.

A person should then repeat the same movement on the opposite side — in other words, facing the right at the beginning. They can do this up to three times per day until they no longer experience vertigo for at least 24 hours.

Learn more about the Epley maneuver with a step-by-step video guide.

Brandt-Daroff exercises

This is a similar exercise that involves alternating between sitting and lying positions.

To perform Brandt-Daroff exercises, a person should:

1. Sit upright on the edge of a bed.
2. Turn the head about 45 degrees to the left.
3. Lie down on the right side of the body, keeping the head at the same angle.
4. Hold this position for 30 seconds or until the dizziness stops.
5. Slowly return to the starting position.
6. Turn the head back to the center.
7. Repeat the exercise on the other side.

Learn more about Brandt-Daroff exercises with a step-by-step video guide.

A person can ask a healthcare professional for their recommendations regarding physical therapists in the area. Not all therapists will have the same level of experience, and some may not know how to treat all causes of vertigo.

A person who needs help finding a physical therapist can use the Academy of Neurologic Physical Therapy’s website to find a local professional in their area.

The Vestibular Disorders Association also offers a resource that can help a person find physical therapists in their area.

The costs of physical therapy can vary, but health insurance may cover some or all of the costs. A person with a health insurance plan should contact their provider to determine how much of each session it will cover.

Those without insurance should talk with a healthcare professional, who may be able to provide information on local resources that can help cover the costs.

Learn more about Medicare and Medicaid.

Vertigo treatments can vary depending on the exact underlying cause. Once a person treats the underlying cause, the symptom of vertigo should resolve.

Other treatments that can help treat some causes of vertigo include:

• medications, such as antihistamines, diuretics, benzodiazepines, corticosteroids, or anti-emetics
• a combination of medications and VRT
• lifestyle changes, such as avoiding alcohol, caffeine, and salt
• surgery

Learn more about home remedies for vertigo.

With physical therapy and other effective treatments, most people should see their vertigo improve. A doctor can address any underlying conditions responsible for the vertigo.

However, a person may still experience some vertigo in the future. For example, about 50% of people will experience a relapse in BPPV within 5 years. In addition, about one-third of people experiencing vertigo from anxiety will still experience symptoms after 1 year.

Vertigo is a symptom associated with several different conditions. It occurs when a person experiences spinning and dizziness or feels as though their surroundings are moving around them.

Physical therapy can help improve a person’s vertigo. A person should speak with a doctor before starting any new program to make sure that they receive effective treatment for the underlying condition.