Should I Get Worse Before I Get Better? Understanding Vestibular Rehabilitation Therapy

Written by:
Dr. Kelsy Rayl
March 2, 2022

If you are experiencing vertigo, dizziness, or headaches and have been diagnosed with anything from BPPV to a concussion, you are not alone! It is estimated that 35% of adults in the United States ages 40+ have experienced symptoms related to a vestibular disorder. [1]

If you are looking to address your condition, your doctor may refer you to Vestibular Rehabilitation Therapy (VRT). But what is VRT and why did they make it sound like it’d be awful?!

VRT is a common treatment approach that targets symptoms related to vestibular hypofunction, vestibulo-ocular dysfunctions, cervicogenic dizziness, and concussions. A VRT program is designed specifically for you and your tolerance to it. While VRT does intentionally provoke your symptoms, it is meant to be done in a graded fashion and by no means should be something you dread!

If you need a quick refresher on what the vestibular system is and how it functions, click here. Keep reading to learn more about VRT!

A Vestibular Exam: What to Expect

The specific tests that make up a comprehensive vestibular exam are considered “provocative tests.” They are designed to reproduce your symptoms. A test which provokes your symptoms can help identify a specific component as a part of the problem. Based on your test results, your physical therapist will hone in on the components that need to be addressed with VRT.

If you have a vestibular problem, it is normal for the vestibular exam to increase your symptoms. You may experience this for hours or even days following a thorough vestibular exam. Don’t let it deter you! Let your provider know how you tolerate the exam. 

The exam can be performed over multiple sessions to avoid significant flare ups. Additionally, your exam response allows your physical therapist to better design the treatment sessions in order to keep everything within a tolerable range for you.

A comprehensive vestibular exam includes:

  • Interview of your history, including current condition and past illnesses
  • Discussion of symptom complaints
  • Review of functional limitations related to your symptoms
  • Neurological exam
  • Oculomotor exam
  • Musculoskeletal exam
  • Positional testing
  • Balance assessment
  • Gait assessment

 

Vestibular Treatments: More is NOT Better

VRT exercises are dependent on the results of your comprehensive vestibular exam. This means the dosage, speed, and duration of your treatment sessions are individual to you! If you’ve been unsuccessful with exercises that you found on the internet or ones that helped your friend, don’t give up. Working with a vestibular certified physical therapist can get you on the right path to recovery!

It is important to set expectations when it comes to VRT therapy. There will be times during the treatment sessions when your symptoms become aggravated. However, those times should be short lived. The goal is to challenge your vestibular system and help it learn new ways to function more efficiently. The use of rest breaks prevents the brain from getting overwhelmed. Will there be times where you go a little too hard and feel it? Certainly. But the goal is not to overwhelm your system. If you do feel overworked, you’ll gain a better understanding of your limitations and can adapt to achieve better outcomes.

Tailored treatment plans may include:

  • Repositioning maneuvers
  • Adaptation exercises
  • Habituation exercises
  • Compensation strategies
  • Visual exercises 
  • Balance exercises
  • Posture retraining
  • Neuromuscular activation using the Redcord Suspension System
  • Joint mobilization
  • Soft tissue mobilization
  • Trigger point dry needling
  • Home exercise program

 

An effective VRT program is much like Goldy Locks–it needs to be just right! The key is to do enough of the right exercises to retrain the brain without overwhelming it. Doing too much can result in symptoms that last for hours or even days. With VRT it is important to stop and rest when you feel your symptoms increase. Proper dosing and rest breaks are essential to keep you functional for the remainder of the day following treatment.

So how much is too much? Listen to your body! Before beginning an exercise, place a value on your symptoms. As you progress through the exercises, try and keep your symptoms within 3 points of your starting values. As a general rule, I suggest keeping your symptoms at or below a 5/10. If you reach that point, take a break to let your symptoms settle or stop the exercise altogether.

Does VRT Actually Work?

Yes! Research identifies VRT as an effective treatment method for all ages. “There was improvement in quality of life…intensity of dizziness…postural balance observed through functional tests” for those suffering from vertigo. [2] Additionally, “evidence exists to support that VRT is more effective than continued cognitive and physical rest in reducing persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents who suffer PCS (Post Concussion Syndrome).”[3]

If you are dealing with any of the below diagnoses, VRT can help you address your symptoms and improve your quality of life!

Common Vestibular Ailments:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Vestibular Neuritis
  • Vestibular Labyrinthitis
  • Meniere’s Disease
  • Vestibulopathy 
  • Persistent Perceptual Postural Dizziness (PPPD)
  • Concussion and Post Concussion Syndrome (PCS)
  • Cervicogenic Dizziness

 

Your next step is to get evaluated by a vestibular certified physical therapist. At Activcore, you will receive a full hour of one-on-one attention. Our techniques and technology are engaging and effective. You’ll receive a treatment customized to help you achieve your goals in fewer visits.

Together, we can help you reduce your symptoms, improve your balance, and restore your quality of life! Contact us to get started with Vestibular Rehabilitation Therapy.

REFERENCES:

  1. Vestibular Disorders Association (VeDA): About Vestibular Disorders
  1. Tsukamoto, H.F., et al. Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo. Int Arch Otorhinolaryngol. 2015 Jul;19(3):238-47. doi: 10.1055/s-0035-1547523. Epub 2015 May 6.
  1. Park, K, et al. Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance. J Sport Rehabil. 2018 Sep 1;27(5):485-490. doi: 10.1123/jsr.2016-0222. Epub 2018 May 4.


Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

Dr. Kelsy Rayl

Physical Therapist
Kelsy Rayl is a Doctor of Physical Therapy (DPT) who specializes in vestibular rehabilitation, concussions, and general orthopedics. She works at Activcore in Castle Rock, CO which is located inside Optimal Health Chiropractic. While she enjoys helping all types of people achieve their activity and lifestyle goals, Kelsy particularly enjoys working with patients dealing with disorders that result in dizziness and patient’s recovering post-concussion. Kelsy is proud to be a part of her patient’s journey as they return to the core activities and daily abilities which make them feel like themselves.
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