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  • Writer's pictureKelsy Rayl

Understanding Vestibular Rehabilitation Therapy: Will It Get Worse Before It Gets Better?

Experiencing vertigo, dizziness, or headaches? Been diagnosed with things like BPPV or a concussion? You're not alone! Around 35% of adults in the US aged 40 and above have dealt with issues linked to a vestibular disorder [1]. If you're aiming to tackle your condition, your doctor might suggest Vestibular Rehabilitation Therapy (VRT). But what exactly is VRT, and why did your doctor make it sound like it’d be awful?!

VRT is a common treatment approach to deal with symptoms from vestibular hypofunction, vestibulo-ocular dysfunctions, cervicogenic dizziness, and concussions. A VRT plan is tailored to your specific symptoms, problems, and tolerance. While VRT might aggravated your symptoms, it's done in an intentional and controlled way, and it definitely shouldn't be something you dread!

Need a quick reminder about your vestibular system and how it works? Read here. Keep reading to learn more about VRT!

physical therapist performing eye exercise with patient

Vestibular Exam: What to Expect

The tests that make up a full vestibular exam are called "provocative tests." These tests aim to recreate your symptoms. A test that brings out your symptoms helps identify a specific issue. Your provider can then focus on the parts that need attention with VRT.

It's common for the vestibular exam to make your symptoms worse if you have a vestibular problem. Your symptoms might be more intense for hours or a few days after a thorough vestibular exam. Don't be discouraged by this! Let your provider know how you're handling the exam. The exam can be spread out over multiple sessions to avoid major flare-ups. Plus, how you react to the exam helps your provider create treatment sessions that you can handle.

A complete vestibular exam involves:

  • Talking about your history, current state, and past illnesses

  • Discussing your symptoms

  • Exploring how your symptoms limit your daily life

  • Neurological check

  • Examining your eye movements

  • Checking your muscles and joints

  • Testing how your symptoms change with different positions

  • Evaluating your balance

  • Looking at how you walk

Vestibular Treatment: More Isn't Always Better

The exercises in VRT depend on the results of your full vestibular exam. This means your treatment's dose, speed, and duration are personalized for you! If you've tried exercises from the internet or ones that helped a friend and they didn't work, don't give up. Working with a certified physical therapist specialized in VRT can put you on the right track to recovery!

It's important to know what to expect with VRT. During treatment, there might be moments when your symptoms get worse. But these times should be brief. The goal is to challenge your system so it can learn to work better. Rest breaks help prevent your vestibular system and brain from getting overwhelmed. Sometimes you might push a bit too hard and feel it. That's normal. However, the aim isn't to overdo it. If you feel strained, you'll learn your limits and can adjust to get better results.

Tailored treatment plans might include:

  • Repositioning maneuvers

  • Adaptation exercises

  • Habituation exercises

  • Compensation strategies

  • Visual exercises 

  • Balance exercises

  • Posture retraining

  • Joint mobilization

  • Soft tissue mobilization

  • Trigger point dry needling

balance exercise at physical therapy

Home exercise program

A successful VRT program relies on finding the right balance—just enough to retrain your brain without overwhelming it. Overdoing it can lead to symptoms that last for hours or even days. With VRT, it's crucial to stop and rest when your symptoms get worse. Getting the right dose and taking breaks are key to keeping you functional for the rest of the day after treatment.

So, when is it too much? Listen to your body! Before starting an exercise, rate your symptoms. As you do your exercises, try to keep your symptoms within 3 points of your starting values. As a general rule, keeping symptoms at or below 5 out of 10 is a good goal. If you reach that point, take a break or stop the exercise.

Does VRT Really Work?

Absolutely! Research shows VRT is effective for people of all ages. It has improved the quality of life, reduced dizziness intensity, and enhanced balance in those with vertigo [2]. Furthermore, "evidence supports that VRT is more effective than continued cognitive and physical rest in reducing persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents with PCS [post-concussion syndrome]" [3].

If you're dealing with any of these diagnoses, VRT can help you manage your symptoms and improve your quality of life!

Common Vestibular Problems:

  • BPPV

  • Vestibular Neuritis

  • Vestibular Labyrinthitis

  • Meniere's Disease

  • Vestibulopathy

  • PPPD (Persistent Perceptual Postural Dizziness)

  • Concussion and Post-Concussion Syndrome (PCS)

  • Cervicogenic Dizziness

Your next step is to see a certified physical therapist specializing in vestibular issues. At SparqPT, you'll get a one-on-one personalized attention and a treatment plan created just for you. Together, we can reduce your symptoms, boost your balance, and bring back your quality of life!

Ready to start with Vestibular Rehabilitation Therapy? Book here!

Please note that the thoughts and ideas presented in this article reflect the author's viewpoint, unless stated otherwise. This content should not be considered as individual medical guidance. The details shared are designed to assist readers in making well-informed choices regarding their own health and well-being.


  1. Vestibular Disorders Association (VeDA): About Vestibular Disorders

  2. Tsukamoto, H.F., et al. Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo. Int Arch Otorhinolaryngol. 2015 Jul;19(3):238-47. doi: 10.1055/s-0035-1547523. Epub 2015 May 6.

  3. Park, K, et al. Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance. J Sport Rehabil. 2018 Sep 1;27(5):485-490. doi: 10.1123/jsr.2016-0222. Epub 2018 May 4.



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