Why Specialized Vestibular Physical Therapy Matters for Dizziness and Vertigo
Guest Blog by Dr. Kim Bell, PT, DPT – The Vertigo Detective®
Dizziness and vertigo can feel confusing, unpredictable, and sometimes even frightening. Because these symptoms can stem from so many different causes — from the inner ear to the nervous system or even the neck — it’s not always easy to know where to start when looking for help.
Physical therapy can play an important role in recovery, but not all dizziness is the same. That’s where vestibular physical therapy comes in.
Vestibular means inner ear. The vestibular system allows you to balance, maintain equilibrium (even in the dark), navigate a straight walking path, and focus your eyes for clear vision while your head is moving fast.
What Is Vestibular Physical Therapy?
Vestibular physical therapy (also known as vestibular rehabilitation and vestibular PT) is a specialized area of physical therapy focused on assessing and treating conditions that cause dizziness, vertigo, and balance problems.
Vestibular physical therapists have all pursued additional specialized training to evaluate how the inner ear, eyes, and body work together to maintain balance. They use advanced assessment tools and techniques — such as infrared video oculography goggles and very specific vestibular testing — to identify if the vestibular system may be the root cause of your discomfort.
The surprising fact is that most standardized medical testing offered at urgent care, the emergency room and traditional primary care medical offices does not assess, test, or identify the vestibular system.
Therefore, a lot of patients with dizziness, vertigo, and imbalance from a vestibular problem have never been properly diagnosed. Lack of answers and relief over time can cause frustration, confusion, worry, and despair.
Once the root cause is identified through a skilled evaluation by a vestibular PT, they can create a customized treatment plan that may include:
- Repositioning maneuvers for conditions like BPPV
- Balance and gaze stabilization exercises
- Habituation training to reduce motion sensitivity
- Education on safety and confidence in daily activities
- Tips on managing symptoms if they flare up
- Strategies to target the exact root cause of the problem
How Vestibular PT Differs from General PT
General physical therapists are highly skilled in helping patients recover from orthopedic injuries, surgeries, and mobility challenges. All professionals with a physical therapy license can address pain, stiffness, and movement as a foundation of the physical therapy profession.
However, dizziness, vertigo, and balance problems often require skilled vestibular assessment and intervention, in addition to any necessary orthopedic care. Physical therapists with specialized skills and additional training in vestibular rehabilitation are uniquely qualified to reduce, if not completely resolve, symptoms of dizziness and vertigo.
Patients with dizziness, vertigo, and imbalance can request a referral for vestibular PT from their primary care provider or seek a consultation privately. Many patients with dizziness or vertigo report paying more out of pocket than their insurance paid for their health care.
In some cases, patients with dizziness or vertigo may start with a general physical therapist — especially if their symptoms are unclear — and later benefit from a referral to a vestibular physical therapist for more focused testing and specialized care. This collaborative approach helps ensure that no potential cause is overlooked and that patients receive the most effective treatment for their specific situation.
The Value of Collaboration
Primary care providers, medical specialists, general physical therapists, and vestibular physical therapists share the same goal: helping patients move better and feel better. Some patients may need a multidisciplinary team of providers to get the best results, especially if the case is complex. A team of health care providers, including a vestibular physical therapist, can offer a comprehensive, patient-centered treatment plan to address all contributing factors.
For example, a patient may see a general PT for neck stiffness or posture issues that contribute to dizziness, while also working with a vestibular PT to address inner ear or visual components. Concurrently, the primary care provider or medical specialists may order more testing or prescribe medication for medical management of uncomfortable symptoms.
Many patients with dizziness and vertigo benefit from some type of medication to reduce discomfort as well as vestibular physical therapy for the best long-term outcomes. Yet if the vestibular problem is never identified as the root cause of the dizziness or vertigo, that patient may end up relying on medication for the rest of their life. Reliance on medications is not ideal due to the risk of medication side effects, especially with long term use.
Finding the Right Fit
If you are experiencing dizziness, vertigo, or balance challenges, it may be helpful to seek out a vestibular-trained physical therapist for an evaluation. A vestibular PT can determine whether your symptoms are related to the inner ear, the neck, vision, or another body system, and design a personalized plan that fits your needs.
Since vestibular physical therapy has a huge body of research supporting successful outcomes for patients with dizziness, vertigo, and balance problems, consulting a vestibular physical therapist is an important step. Since many doctors are not aware of vestibular PT as an option for health care, you may need to advocate for yourself to take that step on your healing journey.
Even if you have tried all the medical care your health insurance offers and worked with a general physical therapist for a full course of care, consulting a vestibular physical therapist could give you the breakthrough you need and deserve.