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Vestibular disorders affect the body’s balance system, which helps control balance, eye movement, and spatial awareness. These conditions are common, with about one in three adults experiencing dizziness or balance problems at some point, and rates increasing with age.1 Vestibular issues can affect people of all ages, including those recovering from illness, injury, or concussion. Symptoms may range from mild and occasional to persistent and debilitating, interfering with walking, work, exercise, and daily activities. Vestibular physical therapy focuses on improving balance, movement tolerance, and confidence when these symptoms disrupt everyday life.
Vestibular disorders are often grouped based on where the problem originates—either in the inner ear or in how the brain processes balance information. While symptoms can overlap, this distinction helps explain why vestibular conditions can feel different from person to person.
These conditions affect the balance organs of the inner ear or the nerve that sends balance signals to the brain.
These conditions affect how the brain processes balance and movement information.
Many vestibular disorders share similar symptoms, and it’s common for inner ear and brain-related factors to overlap. Treatment focuses on improving balance, movement tolerance, and daily function rather than treating the underlying medical condition itself.
Vestibular disorders are often grouped based on where the problem originates—either in the inner ear or in how the brain processes balance information. While symptoms can overlap, this distinction helps explain why vestibular conditions can feel different from person to person.
These conditions affect the balance organs of the inner ear or the nerve that sends balance signals to the brain.
These conditions affect how the brain processes balance and movement information.
Many vestibular disorders share similar symptoms, and it’s common for inner ear and brain-related factors to overlap. Treatment focuses on improving balance, movement tolerance, and daily function rather than treating the underlying medical condition itself.
Symptoms of vestibular disorders can vary widely depending on the underlying cause. Some people experience mild, occasional dizziness, while others may have more persistent or disruptive symptoms that affect walking, vision, and daily activities.
Problems originating in the inner ear commonly affect how the body senses movement and position. Symptoms may include:
When balance issues involve how the brain processes sensory information, symptoms may feel different and can include:
Many vestibular disorders share similar symptoms, and it’s common for inner ear and brain-related factors to overlap. Because of this, symptoms alone don’t always point to a single cause. A thorough evaluation helps determine which systems are involved and guides appropriate care.
Not all dizziness is vestibular in origin. Symptoms such as lightheadedness, fainting, or chest discomfort may be related to other medical conditions and should be evaluated by a healthcare provider.
Diagnosing a vestibular disorder often involves more than a single test or scan. Because balance relies on multiple systems working together, healthcare providers use a combination of medical history, physical examination, and targeted testing to understand what may be contributing to a person’s symptoms.
In many cases, the diagnosis is clinical, meaning it is based on symptom patterns and how the body responds to certain movements, rather than relying solely on imaging.
A detailed history is one of the most important parts of diagnosing vestibular disorders. Providers often ask about:
Patterns in symptoms often provide more useful information than a single test result.
Physical exams for vestibular disorders commonly involve observing how symptoms respond to specific movements or positions. These tests help identify which parts of the balance system may be involved and whether symptoms are more likely related to the inner ear, brain processing, or a combination of systems.
In some cases, medical testing is used to rule out other conditions or clarify the cause of symptoms. These tests may include:
These tools help providers make informed decisions, but they are typically just one part of the overall diagnostic process.
Physical therapists play an important role in evaluating how the balance system is functioning and how symptoms are affecting daily life. Physical therapists do not diagnose medical conditions, but they are experts in assessing movement, balance, and coordination.
A vestibular physical therapy evaluation typically begins with a review of symptoms and how they impact activities such as walking, turning the head, working, or exercising. From there, the assessment focuses on identifying functional limitations that can be addressed through therapy.
Physical therapists may evaluate:
Depending on symptoms, a physical therapist may include vestibular-specific assessments such as:
These tests help identify patterns that guide treatment planning.Every evaluation is tailored to the individual. Rather than focusing on a diagnosis label, physical therapists use findings from the evaluation to design a plan that targets balance, movement tolerance, and confidence.
Vestibular care often involves collaboration between multiple healthcare providers, such ENTs and neurologists.
ENT specialists may be involved to:
Neurologists may evaluate:
Depending on symptoms, patients may undergo:
Results from these evaluations help inform the overall plan of care.
Vestibular care is often most effective when providers work together. Different specialists evaluate different parts of the balance system, while physical therapy focuses on restoring function. Physical therapists use medical findings to guide treatment but focus on:
While diagnosis helps clarify contributing factors, treatment is centered on function and recovery.
Treatment for vestibular disorders depends on the underlying cause, symptom severity, and how symptoms affect daily life. In most cases, care focuses on non-surgical approaches, with surgery reserved for rare or advanced situations.
Vestibular rehabilitation therapy (VRT) is the most common and first-line treatment for many vestibular disorders. Rather than treating a specific disease, VRT focuses on improving how the balance system functions.
Physical therapy may help by:
Treatment is individualized and may include:
VRT is commonly used for vestibular imbalance, hypofunction, post-concussion symptoms, and persistent dizziness after medical treatment.
Surgery is not commonly needed for vestibular disorders and is typically considered only in specific or advanced cases when symptoms are severe and do not respond to conservative care.
Examples where surgery may be considered include:
When surgery is recommended, it is usually managed by a medical specialist such as an ENT or neurologist. Physical therapy may still play a role before or after surgery to support balance recovery and functional improvement.
Living with a vestibular disorder often means learning how to move confidently again while symptoms improve. Physical therapy focuses on helping people safely return to daily activities rather than avoiding movement altogether.
Vestibular physical therapy commonly includes:
Exercises are tailored to each person’s symptoms and are progressed over time as tolerance improves.
The primary goals of vestibular physical therapy are to:
Many people find that symptoms improve gradually with consistent practice and guided progression.
Physical therapy plays a key role in treating many vestibular disorders by helping the balance system adapt, recover, or compensate. Rather than treating the underlying medical condition, physical therapy focuses on improving how the body responds to movement, visual input, and changes in position. Treatment is individualized and based on findings from the evaluation, with exercises progressed as symptoms improve.
Vestibular physical therapy is designed to:
These improvements occur as the brain learns to better interpret balance signals and adapt to movement again.
Vestibular rehabilitation therapy (VRT) is supported by strong clinical evidence and is widely recommended as a first-line treatment for many vestibular conditions. Programs are tailored to each individual and may include a combination of balance, eye–head coordination, and movement-based exercises.
When benign paroxysmal positional vertigo (BPPV) is identified, physical therapists use specific repositioning maneuvers to address the problem directly. These maneuvers help guide displaced inner ear crystals back to their proper location.
Common maneuvers include:
In many cases, BPPV can improve significantly in one to a few treatment sessions.
For other vestibular disorders, treatment often involves targeted exercises that help retrain the balance system. These may include:
Exercises are progressed over time and adjusted based on symptom response and functional goals. Some exercises may temporarily increase symptoms, which is a normal part of retraining the balance system. Over time, symptoms typically become less intense and easier to manage with movement.
Treatment length varies depending on the condition and symptom severity. Some issues, like BPPV, may resolve in just one session, while others require several weeks of guided therapy.
Some symptoms may improve over time, but persistent dizziness or balance problems often benefit from targeted physical therapy to support recovery and reduce long-term issues.
Mild, temporary symptom increases can be normal during vestibular rehabilitation. Your physical therapist will guide progression to keep symptoms manageable and productive.
Not always. Many vestibular disorders are diagnosed clinically, and physical therapy can often begin based on symptom patterns and functional findings.