Vestibular Rehabilitation

Dizziness and balance problems can affect people in many different ways. You may experience spinning, rocking or swaying, unsteadiness, motion sensitivity, blurred vision with head movement or difficulty walking in busy environments.

Vestibular rehabilitation is a specialised form of physiotherapy that assesses and treats problems affecting the balance system.

Your balance depends on information from three main systems: your inner ears, your eyes and your muscles and joints. Your brain constantly combines this information to help you stay upright, move safely and keep your vision stable as you move. When one of these systems is not working properly, the information reaching your brain can become altered or conflicting. This can lead to symptoms such as dizziness, vertigo, unsteadiness and difficulty with movement.

A thorough assessment helps us understand your symptoms, identify what may be contributing to them and determine the most appropriate treatment. Your rehabilitation programme is then tailored to your individual needs and may include specific exercises, balance retraining, movement strategies or repositioning manoeuvres.

Frequently Asked Questions

Why do I feel dizzy?

Dizziness is a symptom rather than a condition itself and can have many different causes.

Your balance relies on information from three main systems: your vestibular system (inner ears), vision, and proprioception (information from your muscles and joints). Your brain constantly combines information from these systems to help you stay balanced and orient yourself in your surroundings.

If one of these systems is not working properly, the information reaching your brain can become altered or conflicting. This can result in symptoms such as dizziness, vertigo, unsteadiness or blurred vision during head movement.

A thorough assessment can help identify what may be contributing to your symptoms and whether vestibular rehabilitation is appropriate for you.

What symptoms can vestibular rehabilitation help with?

People experience dizziness and balance problems in many different ways.

You may experience:

  • Spinning or vertigo: Feeling like the room is revolving or moving around you.
  • Rocking or swaying: Experiencing a sensation of back-and-forth or side-to-side motion.
  • Feeling unsteady or off balance: Struggling to maintain stability while standing still.
  • Floating or moving surface sensations: Feeling as though you are ungrounded or walking on an unstable surface.
  • Difficulty walking or veering: Overcompensating or drifting to one side when moving forward.
  • Motion sensitivity: Discomfort triggered by quick movements or watching moving objects.
  • Blurred or bouncing vision: Visual disturbances occurring specifically when turning your head.
  • Difficulty in busy environments: Sensory overload in crowded places like supermarkets.
  • Nausea: A feeling of sickness or stomach unease linked to movement.
  • Fatigue: Exhaustion caused by the extra brain effort required to stay balanced.
  • Difficulty concentrating or "brain fog": Mental fatigue and a lack of mental clarity.
  • Head movement triggers: Feeling noticeably worse when turning or shifting your head.

You don't need to describe your symptoms as “dizziness” for vestibular rehabilitation to be relevant. If you feel that your balance or movement isn't quite right, a comprehensive assessment can help establish what may be contributing to your symptoms.

What conditions do you treat?

We assess and treat a range of vestibular and balance disorders, including:

We can also assess people who have not yet received a specific diagnosis but are experiencing ongoing dizziness, unsteadiness or difficulty with balance.

Where symptoms suggest that further medical investigation is required, we will discuss this with you and recommend appropriate onward referral where necessary.

What happens during my appointment?

Your initial vestibular assessment lasts approximately 90 minutes, giving us time to properly understand your symptoms and complete a comprehensive assessment.

We will begin by discussing your symptoms and medical history, including when your symptoms started, what triggers them and how they affect your everyday life.

Depending on your symptoms, your assessment may include:

  • Eye movement assessment
  • Positional testing
  • Head impulse testing
  • Dynamic visual acuity
  • Balance assessment
  • Walking assessment
  • Vestibular and neurological screening
  • Falls assessment
  • Validated outcome questionnaires

We will explain what we are doing throughout the assessment and discuss our findings with you.

Where appropriate, treatment can begin during your first appointment.

How should I prepare for my appointment?

Please wear comfortable clothing and supportive, flat footwear that allows you to move freely. You may be asked to walk, stand, turn your head or lie down and roll from side to side during some assessments.

It is helpful to bring a list of any medications you take and any relevant medical or hospital letters if you have them.

If possible, consider arranging someone to drive you home after your first appointment. Some assessments and treatments can temporarily increase dizziness.

There is no need to avoid your normal activities beforehand. In fact, it can be helpful to arrive having followed your usual routine so that we can understand how your symptoms behave in everyday life.

What does treatment involve?

Treatment is individualised and depends on the cause of your symptoms.

Depending on your assessment, treatment may include:

  • Canalith repositioning manoeuvres for conditions such as BPPV
  • Gaze stabilisation exercises
  • Habituation exercises
  • Balance retraining
  • Walking and movement exercises
  • Functional movement retraining
  • Visual dependence training
  • Fall prevention advice
  • A personalised home exercise programme

Your exercises may temporarily bring on some of your symptoms. This is often an important part of rehabilitation, as controlled exposure to movement can help your brain adapt to altered balance information.

Your programme will be progressed according to your symptoms, goals and response to treatment.

How many appointments will I need?

This depends on your diagnosis, symptoms and individual goals.

Some conditions, such as BPPV, can often be successfully treated within one or two appointments. Other conditions, including vestibular hypofunction and persistent dizziness, may require a structured rehabilitation programme over several appointments.

Follow-up appointments are approximately 45 minutes and allow us to review your progress, repeat relevant outcome measures and adjust your treatment programme as needed.

The aim is to give you the tools and confidence to manage your symptoms and return to the activities that are important to you.

Will the exercises make me dizzy?

Some vestibular exercises are designed to challenge your balance system, so it is normal for them to temporarily increase your symptoms.

This can be an important part of rehabilitation, as it encourages your brain to adapt to altered balance information. However, exercises should be appropriately dosed and progressed for you.

If an exercise causes a significant or prolonged increase in your symptoms, you should stop and discuss this with your physiotherapist. Your programme can then be adjusted to an appropriate level.

Do I need a GP referral?

No. You do not need a GP referral to book a vestibular assessment.

You can book directly with us if you are experiencing dizziness, vertigo or balance problems.

Following your assessment, if we feel that further medical investigation or specialist input would be beneficial, we will discuss this with you and recommend appropriate onward care.