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Vestibular Rehabilitation Therapy

The management of dizziness and vertigo

How can physiotherapy help and what causes dizziness/vertigo?

  • Imbalances within the inner ear e.g. after ear infection/labrynthitis/neuritis.
  • Problems with the neck.
  • Migraines.
  • Vascular Problems.
  • Low Blood Pressure.
  • Normal, but challenging environmental factors such as heights or fairground rides.

Physiotherapy can be very helpful in the first three examples. Physiotherapy is a very successful way of managing dizziness and vertigo.  In the majority of cases people will become symptom free with the help of Physiotherapy.

The Vestibular System and Balance

The Vestibular system is located in each ear and they work in conjunction with messages from the eyes and our joints to keep us balanced.  If something disrupts the messages coming from the vestibular system, our brain becomes confused and the outcome is dizziness and imbalance.


A normally functioning Vestibular system is key to our senses of balance, motion, and body position.  The Otolith senses the direction and speed of linear acceleration and the position (tilt) of the head. The semicircular canals allow us to sense the direction and speed of angular acceleration such as turning the head.

What symptoms might relate to an inner ear problems causing dizziness?

Positional Vertigo

A very common and easily treatable form of dizziness is called Benign Paroxysmal Positional Vertigo (BPPV).  With BPPV people often report very short lived spells of spinning vertigo with certain movements such as turning over in bed, getting out of bed in the morning, on bending over or looking up.  The symptoms are often associated with nausea and can be quite frightening. People often manage their problem by avoiding the irritable movements.  The problem of BPPV relates to calcium crystals known as otoconia. In people with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals, which then cause disrupted messages to the brain.

Vestibular Hypofunction following acute Vertigo attack. People who have an episode of severe vertigo from problems such as an inner ear infection, vestibular neuritis or labrynthitis can be left with ongoing balance and dizziness problems.  The initial Vertigo attack can last a few days (often causing severe dizziness and sickness), but once these severe symptoms settle, a milder form of dizziness can continue.  People may report dizziness with fast head movements, on bending, on increased levels of activity and in busy situations such as in the supermarket.  They may also report that the dizziness feels worse when they close their eyes.

What to expect from physiotherapy.

When you first come to see our Physio she will assess your head and eye movements for reflex control and to see if any dizziness is replicated.  Your balance will be assessed and your neck may be examined.  If it looks like you may have BPPV a specific test will be performed which will try to replicate your symptoms.  If this test is positive then a treatment called the Epley Manoeuvre can be performed.  This is a very successful form of treatment for BPPV and in most cases symptoms will resolve in 1-2 treatments.

After the assessment, depending on findings, you may be given a programme of exercises.  The principle of Vestibular Rehabilitation exercises (often known as Cawthorne Cooksey exercises) aim to provoke dizziness, which when performed regularly will enable the brain to compensate for the unequal balance in the ears. 

After your assessment it is advisable to have someone with you to drive you home as there is a risk your symptoms may be temporarily increased. Your Physiotherapist will guide subsequent appointments. 


Vestibular Rehabilitation Therapy (VRT) Fees
Treatment Appointment Length Price
Vestibular Rehabilitation Therapy Assessment 60 mins £89.50
Vestibular Rehabilitation Therapy Apointment 45 mins £91.00
Vestibular Rehabilitation Therapy follow on Appointment 30 mins £61.00



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