» Blog
» How vestibular therapy can improve balance, vertigo and dizziness
How vestibular therapy can improve balance, vertigo and dizziness

By Aleisha Theisen, PTA and NBC-HWC

Do you need to bring balance back into your life? At FYZICAL-Forest Grove, that’s one of our specialties. A major way we help people regain their balance is by improving the way they use their vestibular system. 

What Is The Vestibular System? 

The vestibular system is a tiny but powerful apparatus located in the inner ear, past the eardrum. Though it’s next to the hearing mechanism of the ear, the vestibular system’s job isn’t hearing related; instead, it detects movement of the head and body and relays that information to the brain. The brain then interprets that data, combines it with the sensory input from the eyes and the somatosensory system (sense of touch and body position, or proprioception), and tells the body how it needs to move to maintain balance. 

The vestibular system can be irritated, weakened or damaged by numerous causes. These include: 

  • Benign paroxysmal positional vertigo, aka BPPV (this is covered in more detail below)
  • Viruses
  • Migraines
  • Concussions
  • Strokes and other neurological disorders
  • Changes in blood flow
  • Fluctuations of fluid inside the vestibular apparatus
  • Autoimmune disorders
  • Structural abnormalities

How Vestibular Therapy Works

Vestibular therapy is a specialized form of physical therapy that can help the body regain proper use of the vestibular system — or adapt the body to any permanent changes. Over several weeks or months, this process results in improved balance and decreased dizziness. 

If you are having dizziness or balance issues, our physical therapists will evaluate you using specialized balance testing and dizziness assessments, and then they’ll create a customized set of exercises to address your unique needs. The activities might include repeated head movements, turning, standing on an unsteady surface or closing your eyes. Each of these exercises activates the vestibular system and improves the way it communicates with your brain, as well as the way your brain communicates with your body. 

Your physical therapist will guide you through gradual progressions that help your system get stronger. The road to recovery from a vestibular disorder isn’t always perfectly linear, meaning you may have some good days and some not-as-good days along the way. But vestibular therapy is very effective, and over time you should notice big improvements in how you feel. You’ll probably feel your confidence in your balance increase as well. 

Additionally, your physical therapist may add lower body and core strengthening exercises to your home exercise program, as these can also make you more steady on your feet. Coordination and reaction exercises are two other components that can complement vestibular therapy and improve balance.


One very common cause of imbalance and vertigo is BPPV, benign paroxysmal positional vertigo. It occurs when tiny particles in the vestibular system come loose from the gel they live in and spill into the next-door semicircular canals, most commonly the posterior canal, which is the lower canal. This confuses the vestibular system and causes a room-spinning sensation. Your eyes might also move in a pattern known as nystagmus. If you have BPPV, you might experience vertigo when lying down in bed or rolling over. Other folks notice it when moving their head quickly or bending over. They might also notice they are generally more “off” or unsteady than usual.

Your physical therapist will evaluate you to determine which semicircular canal the particles are stuck in, and then they can treat the BPPV with specialized maneuvers, such as the Epley maneuver. The maneuvers guide the particles out of the canal. Some folks feel immediate relief after this, but some need several treatments. You might also need a few additional days to get back on track after the treatment. Your PT might give you additional vestibular exercises to help your system reset faster after the BPPV has been fixed. 

Visual Sensitivity

In addition to dizziness, some folks notice visual sensitivity. They may find themselves bothered by grocery stores or busy patterns. This is a common occurrence, as the brain tends to become hypervigilant visually when there is a dysfunction in the vestibular system. 

Vestibular therapy is very effective at addressing this issue as well. In addition to improving the use of the vestibular system, so the body no longer needs to over-rely on visual input, vestibular therapy can incorporate visually challenging exercises. These are added gradually, in a gentle manner, so as not to overstimulate the brain. The brain then becomes conditioned to processing visual input more smoothly and appropriately, and dizziness and sensitivity subside.  

Specialized Treatment is Key

Whether imbalance or dizziness is from BPPV or another cause, our uniquely trained physical therapy team at FYZICAL–Forest Grove is here to help. If you or someone you know is having balance difficulties or dizziness, call us for an evaluation at 503-357-1706.

Aleisha Theisen is a physical therapist assistant and a board-certified health and wellness coach.

Disclaimer: This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.

Photos courtesy of Pexels and Pixabay. 


Vestibular Disorders Association Fact Sheet on BPPV by Sheelah Woodhouse, BScPT, updated in 2022 by John Patrick Doriangricchia, DPT. Retrieved 1/15/2023.

Patient Education Fact Sheet from the Academy of Neurologic Physical Therapy and the Vestibular Rehabilitation Special Interest Group, 2019, retrieved 1/15/2024.

Why See a PT for Dizziness? Fact sheet from the Academy of Neurologic Physical Therapy and the Vestibular Rehabilitation Special Interest Group by Laura O. Morris, PT, NCS. Updated in 2019. Retrieved on 2/11/2024.