Balance exercises for vertigo: vestibular rehabilitation movements

Vertigo can make you feel like the room is spinning, the ground is shifting, or your body is moving even when you’re standing still. If you’ve experienced it, your gut may tell you it’s best to sit down and avoid whatever triggered the sensation.

That can understandably make exercise seem counterintuitive. But depending on what’s causing your vertigo, specific movements and exercises can actually be part of treatment. Vestibular rehabilitation can help your brain and body adapt to changes in the balance system, while conditions such as benign paroxysmal positional vertigo (BPPV) may respond to specific repositioning maneuvers.

“Vertigo quite literally messes with your head,” says Nicholas Mercer, PT, DPT, a physical therapist with Hinge Health. “But movement often helps, especially when it includes specific vestibular exercises guided by a physical therapist. It’s normal to feel anxious if you notice temporary dizziness during vestibular exercises, but it’s a sign your brain is adapting, not a sign of harm.”

The right exercises depend on what’s causing your symptoms, so it’s important to know that there isn’t one set of designated “vertigo exercises” that works for everyone.

Ahead, Hinge Health physical therapists explain how movement and exercise therapy may help with vertigo and balance problems, plus when to seek medical care.

These exercises challenge your balance in different ways, from narrowing your base of support to shifting your weight and changing positions. You don’t need to master them all at once. Start with exercises that feel manageable and gradually progress as your balance and confidence improve.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

How vestibular rehabilitation retrains your balance

Vestibular rehabilitation aims to help you move more comfortably and confidently despite changes in your vestibular system. Rather than simply avoiding movements that make you dizzy, therapy gradually challenges the systems your body uses for balance so you can return to everyday activities.

“When you gradually expose yourself to little bits of vertigo, your brain learns ways to adapt to it over time,” explains Dr. Mercer.

Your physical therapist may use vestibular rehabilitation exercises that fall into several categories:

• Gaze stabilization exercises help you keep your vision focused while your head moves.

• Habituation exercises use repeated exposure to certain symptom-provoking movements to gradually reduce sensitivity to them.

• Balance and mobility training challenges your ability to stay steady while standing, walking, and performing everyday activities.

Remember, your program should be tailored to your symptoms and diagnosis. Once you learn the appropriate exercises and technique, your physical therapist may have you continue practicing them at home.

How long does vestibular rehab take to work?

There isn’t one recovery timeline for vertigo. How quickly you improve depends on what’s causing your symptoms, how long you’ve had them, their severity, and the type of treatment you need.

Some people with BPPV improve quickly after an effective repositioning maneuver. Other vestibular conditions may require several weeks or longer of rehabilitation. Rather than focusing on a specific deadline, look for gradual improvements in symptoms, balance, and your ability to do everyday activities.

“The key is to be consistent and do vertigo physical therapy exercises daily,” says Dr. Mercer.

Follow the frequency recommended by your physical therapist, since different vestibular exercises may require different amounts of practice.

Tips for doing vertigo exercises safely

Because dizziness can affect your balance, set yourself up so you can safely practice without unnecessarily limiting movement.

• Start near a stable surface. Practice new standing exercises near a wall, counter, or sturdy piece of furniture so support is readily available if you need it.

• Build up gradually. Start with an exercise and duration you can tolerate, then increase the challenge as your symptoms and balance allow.

• Some temporary dizziness may be expected. Certain vestibular exercises are designed to mildly provoke symptoms. Severe, prolonged, or progressively worsening dizziness isn’t something you need to push through. Stop and check with your physical therapist or healthcare provider.

• Practice consistently. Vestibular rehabilitation relies on repetition, so follow the home program and frequency recommended by your physical therapist.

• Reduce your fall risk. If you feel very unsteady, have someone nearby or practice with professional supervision until you can perform the exercise safely on your own.

Can vertigo come back after vestibular rehab?

About a quarter of people with vertigo due to BPPV see symptoms return within a year. One way to help reduce chances of recurrence is to focus on your overall health: research shows people with high blood pressure, elevated cholesterol or type two diabetes are at greatest risk. “The good news is that the treatment that worked before like vertigo exercises will most likely be effective again,” reassures Dr. Mercer. 

BPPV can return even after successful treatment. Research suggests recurrence is common, and a 2021 review found that certain health conditions, including hypertension, high cholesterol, and diabetes, were associated with a greater risk of recurrence.

That doesn’t mean recurrence is inevitable, or that you did something wrong if symptoms return. And the presence of these risk factors doesn’t guarantee that changing them will prevent another BPPV episode.

If symptoms return, check in with your healthcare provider or vestibular physical therapist. They can confirm whether BPPV has returned and determine whether another repositioning maneuver or other treatment is appropriate.

When to see a doctor

Because vertigo can have so many different causes, consider getting evaluated if it’s new, keeps returning, or interferes with walking and everyday activities. Importantly, seek urgent medical attention for sudden dizziness or vertigo accompanied by symptoms such as:

• New difficulty speaking or understanding speech

• New weakness or numbness, particularly on one side of your body

• New double vision or significant vision changes

• Severe difficulty walking or loss of coordination

• A sudden, severe headache

• Fainting or loss of consciousness

Note: You should also contact a healthcare provider if vertigo occurs with new hearing loss, follows a head injury, keeps returning, or isn’t improving as expected.

PT Tip: Don’t push through plateaus

“If you’ve stopped making progress with vestibular rehabilitation exercises at home, talk to your physical therapist or doctor right away,” says Dr. Mercer. “It could be due to pushing too hard, or not doing enough, or even due to a medical change like starting or going off of a certain drug.”

Alternatively, your exercise program may need to be adjusted as your balance improves or your symptoms change.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.