• ChoosePT Guide

    Physical Therapy Guide to Vertigo

    Vertigo is a sensation or feeling that the person or their environment is spinning. It can cause balance problems and often is a result of a problem in the inner ear. People who have vertigo may complain of feeling dizzy. Dizziness is also described as feeling lightheaded. Vertigo and lightheadedness often have different causes and different treatments, but they can occur together.

    Vertigo affects people of all ages. Although it is very rare among children, it is common in adults over the age of 20. Vertigo and balance problems are more dangerous for people ages 65 and over. Older adults are at greater risk for fractures and major injuries from a fall caused by imbalance.

    A physical therapist can help people manage vertigo and dizziness symptoms so they can get moving again. Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To locate a physical therapist in your area, visit Find a PT.

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    If you experience vertigo, along with one or more of the following symptoms, call 911 at once:

    • Double vision.
    • Difficulty speaking.
    • A change in alertness.
    • Arm or leg weakness.
    • Inability to walk.

     

    What Is Vertigo?

    Women with vertigo feeling like the room is spinning.

    Vertigo is the sensation of spinning — even when you are perfectly still. You might feel like you are moving or that the room is moving around you. Most causes of vertigo involve the vestibular system (the part of the inner ear responsible for balance). A number of conditions can produce vertigo, such as:

    • Inner ear infections or disorders.
    • Migraines.
    • Tumors, such as acoustic neuroma.
    • Surgery that removes or injures the inner ear or its nerves.
    • Head injury that results in injury to the inner ear.
    • A hole in the inner ear.
    • Stroke.

    You also might have:

    • Nausea.
    • Vomiting.
    • Sweating.
    • Abnormal eye movements.
    • Ringing in one or both ears.
    • Difficulty walking due to imbalance.

    One of the most common forms of vertigo is benign paroxysmal positional vertigo. BPPV is an inner ear problem. It causes short periods of a spinning sensation when your head is moved in certain directions.

    Some people have visual vertigo (a dizzy or unsteady feeling when in stimulating visual settings). Activities such as walking in store aisles or driving in traffic may induce visual vertigo or make it worse.

     

    How Is It Diagnosed?

    Your physical therapist will ask you questions to help identify the cause of your vertigo and determine the best treatment. Examples of questions they may ask include:

    • When did you first have vertigo (the feeling of spinning)?
    • What are you doing when you have vertigo? Does it happen when you turn your head, bend over, stand perfectly still, or roll over in bed? Does walking or driving in a busy environment cause symptoms?
    • How long does the vertigo last (seconds, minutes, hours, days)?
    • Have you had vertigo before?
    • Do you have hearing loss, ringing, or a feeling of fullness in your ears?
    • Do you have nausea with the spinning?
    • Have you had any changes in your heart rate or breathing?

    Your physical therapist will perform tests to determine the causes of your vertigo. They also will determine your risk of falling. Depending on the results, your physical therapist may recommend further testing, or that you see your doctor.

     

    How Can a Physical Therapist Help?

    Based on their evaluation and your goals, your physical therapist will design a treatment plan specific to you. The exact treatments will depend on the cause of your vertigo. Your physical therapist's main focus is to help you get moving again and manage the vertigo at the same time. Treatment may include specialized head and neck movements that your physical therapist can gently perform for you or teach you to do. It also will include exercises to help get rid of your symptoms. Conditions such as BPPV have very specific tests and treatments.

    If you still have dizziness and balance problems after vertigo stops, your physical therapist can target those problems. They will develop a treatment plan and teach you strategies to help you cope with your specific symptoms.

    For example:

    • If performing certain activities or chores at home cause you to become dizzy, your physical therapist will show you how to do them in a different way to help reduce dizziness.
    • If simple activities become difficult, or cause fatigue and more dizziness, your physical therapist will help you work through them. This training will help you get moving again and return to your home and work activities.

    Physical therapy treatments for dizziness can take many forms. The type of exercise program that your physical therapist designs for you will depend on your unique problems, and might include:

    • Exercises to improve your balance.
    • Exercises to help the brain "correct" differences between your inner ears.
    • Exercises to improve your ability to focus your eyes and vision.
    • Exercises to increase tolerance to visually stimulating environments.

    Your physical therapist also may prescribe exercises to improve your strength, flexibility, and heart health. The goal of these exercises is to improve your overall physical health and well-being.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat people with vertigo, BPPV, dizziness, and balance problems. You may want to consider:

    • A physical therapist who has experience in treating people with neurological (nervous system) problems. Some physical therapists have a practice with a neurological vestibular rehabilitation focus.
    • A physical therapist who is a board-certified clinical specialist or who completed a residency in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists in your area with these and other credentials or clinical expertise at Find a PT, a tool built by the American Physical Therapy Association.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family, friends, or other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with vertigo.
    • Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

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    Further Reading

    The American Physical Therapy Association believes that consumers should have access to information to help them make informed health care decisions and prepare them for their visit with a health care provider.

    The following resources offer some of the best scientific evidence related to physical therapy treatment for vertigo. They report recent research and give an overview of the standards of practice both in the United States and internationally. They link to a PubMed* abstract, which also may offer free access to the full text, or to other resources. You can read them or print out a copy to bring with you to your health care provider.

    Lou Y, Cai M, Xu L, Wang Y, Zhuang L, Liu X. Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo. Am J Otolaryngol. 2020;41(3):102412. Article Summary in PubMed.

    Bronstein AM, Golding JF, Gresty MA. Visual vertigo, motion sickness, and disorientation in vehicles. Semin Neurol. 2020;40(1):116–129. Article Summary in PubMed.

    Staab JP. Persistent postural-perceptual dizziness. Semin Neurol. 2020;40(1):130–137. Article Summary in PubMed.

    Pfieffer ML, Anthamatten A, Glassford M. Assessment and treatment of dizziness and vertigo. Nurse Pract. 2019;44(10):29–36. Article Summary in PubMed.

    Lempert T, von Brevern M. Vestibular migraine. Article Summary in PubMedNeurol Clin. 2019;37(4):695–706..

    McKinley JE, Perkins A. Neurologic conditions: dizziness and vertigo. FP Essent. 2019;477:29–39. Article Summary in PubMed.

    Luryi AL, LaRouere M, Babu S, et al. Traumatic versus idiopathic benign positional vertigo: analysis of disease, treatment, and outcome characteristics. Otolaryngol Head Neck Surg. 2019;160(1):131–136. Article Summary in PubMed.

    Hebert JR, Subramanian PS. Perceptual postural imbalance and visual vertigo. Curr Neurol Neurosci Rep. 2019;19(5):19. Article Summary in PubMed.

    Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging. 2018;13:2251–2266. Article Summary in PubMed.

    Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic, and treatable cause of chronic dizziness. Pract Neurol. 2018;18(1):5–13. Article Summary in PubMed.

    Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1–S47. Article Summary in PubMed.

    Hall C, Herdman S, Whitney S, et al. Vestibular rehabilitation for peripheral vestibular hypofunction. J Neurol Phys Ther. 2016;40(2):124–155. Article Summary in PubMed.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Revised in 2021 by Anne Kloos, PT, PhD, board-certified clinical specialist in neurologic physical therapy, on behalf of the Academy of Neurologic Physical Therapy. Authored in 2011 by Melissa S. Bloom, PT, DPT; Bob Wellmon, PT, PhD, board-certified clinical specialist in neurologic physical therapy; and APTA's Academy of Neurologic Physical Therapy.

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