Vestibular rehabilitation: a clear guide to dizziness

Vestibular rehabilitation is an individual exercise-based approach that may help some people with dizziness or imbalance linked to the vestibular system. It starts with assessment. Not every dizzy spell comes from the inner ear, and an exercise programme should not replace medical investigation when the cause is uncertain or symptoms are concerning.

People use “dizzy” to describe several different experiences: spinning, light-headedness, unsteadiness or feeling as though they might faint. Explaining what you mean is one of the most helpful things you can do before an appointment.

Village Physiotherapy offers vestibular rehabilitation therapy in Farnborough Village, Orpington. This guide explains what to ask and how to prepare for assessment.

What is vestibular rehabilitation?

The vestibular system includes structures in the inner ear involved in balance and the coordination of head and eye movements. When an appropriate problem has been identified, rehabilitation may use selected exercises to address the difficulties found during assessment.

Kingston and Richmond NHS Foundation Trust’s vestibular information explains that dizziness and imbalance have many possible causes. It distinguishes vestibular problems from other contributors, including blood pressure changes, medicines and other health conditions.

That distinction matters. The fact that an exercise is labelled for vertigo does not establish that it is suitable for you. A plan needs to reflect the assessment rather than the first online video that resembles your symptoms.

When does dizziness need urgent medical help?

Call 999 or go to A&E for vertigo with symptoms such as double vision or loss of vision, difficulty speaking, new limb weakness or numbness, or hearing loss. These symptoms should not wait for a routine rehabilitation appointment.

The NHS vertigo guidance also advises urgent GP or NHS 111 help when vertigo is accompanied by a severe headache, significant sickness or a high temperature. If you are unsure about new or rapidly changing symptoms, seek medical advice.

Do not drive when dizziness makes it unsafe. Arrange help with travel and essential tasks as needed. A previous diagnosis of a balance problem does not mean every new symptom can safely be treated as the same episode.

What should you record before an appointment?

A short description of a typical episode is often more useful than a long list of possible diagnoses. Think about what you feel, what you are doing when it starts and how long it lasts.

Useful information includes:

• Whether the sensation is spinning, faintness or unsteadiness.
• Whether it happens with a change of position or while still.
• How long an episode lasts and how often it occurs.
• Any falls, near falls or difficulty walking.
• Associated hearing, visual or headache symptoms.
• Relevant illnesses, medicines and previous assessments.

Bring medical letters or test results you already have. Do not stop medicines before an appointment unless the professional responsible has specifically told you to do so. Different tests and services have different preparation instructions, so check your own appointment details.

What might a physiotherapy assessment involve?

The clinician will ask about symptoms, health history and how dizziness affects everyday life. Depending on the situation, assessment may consider eye and head movements, balance, walking or positional symptoms. Not every person needs every test.

Some assessments may reproduce symptoms. The clinician should explain what is proposed, why it could help and how you can pause or stop. Tell them about neck problems, recent surgery or other conditions that could affect how a test is carried out.

If the findings do not support physiotherapy or further investigation is needed, ask what happens next. A good assessment can be useful even when the outcome is a recommendation for another professional rather than an immediate exercise programme.

Is vestibular rehabilitation the same as an Epley manoeuvre?

No. A repositioning manoeuvre such as the Epley may be used when a clinician identifies an appropriate form of benign paroxysmal positional vertigo, often shortened to BPPV. It is not the treatment for every cause of dizziness.

Vestibular rehabilitation can involve a wider individual exercise programme. The appropriate approach depends on the assessment. Do not assume that spinning means you should repeatedly perform a manoeuvre without checking whether it is indicated and safe for your circumstances.

If a manoeuvre or exercise has already been prescribed, explain when it was given and what happened afterwards. Persistent or changed symptoms may need reassessment rather than simply repeating the same movement more forcefully.

What could an exercise plan include?

Depending on the findings, a programme may focus on gaze stability, selected head movements, balance, walking or confidence with appropriate daily activities. The clinician should explain the purpose of each exercise and demonstrate how to perform it.

Ask how much symptom provocation is acceptable for your specific plan, how long it should take to settle and what would be a reason to stop. There is no single instruction to push through dizziness that is appropriate for every person.

Safety comes first. Ask where to practise, whether someone should be nearby and what support you should use. Do not practise a challenging balance exercise beside stairs or rely on unstable furniture. If you cannot create a suitable practice area, discuss an alternative.

How to fit rehabilitation into daily life

Explain the situations you want help with, such as walking around a shop, turning to speak to someone or moving around the home. The plan should connect with those priorities rather than existing as a disconnected set of drills.

Use a brief record of exercises and responses if your clinician recommends it. This can help you describe whether an activity is becoming more manageable and identify a programme that is difficult to maintain. More exercise is not automatically better if the dose is inappropriate.

Ask when progress will be reviewed and what should happen if the plan is not helping. If your needs involve broader mobility or strength difficulties, discuss whether another part of our physiotherapy service is also relevant.

Discuss dizziness assessment in Orpington

Vestibular rehabilitation begins with checking what may be causing the symptoms and whether this approach is suitable. Bring a clear description, existing medical advice and the practical goals that matter most to you.

Contact Village Physiotherapy or call 01689 851143 to discuss an appointment. Tell reception about any diagnosis, recent medical assessment and help you may need getting to the clinic. New urgent symptoms should be assessed medically first.