Vestibular Therapy is Effective

For people with dizziness, vertigo, imbalance, and falls, I highly recommend Vestibular Therapy, also called VRT, Vestibular Rehab, Vestibular Rehabilitation, and Vestibular Physical Therapy.

There is a very large and growing body of research that supports Vestibular Therapy. The published research from around the world proves that this specialized type of physical therapy works!

However, I hear from people all the time who have completed 6-8 weeks of Vestibular Physical Therapy at another clinic and have not improved. One new patient I just worked with had actually completed two consecutive rounds of therapy with no improvement before I met her.

So the question becomes why doesn’t Vestibular Therapy always work?

Seven Reasons VRT Doesn’t Work

Missed the BPPV Crystals

One of the most common reasons that someone will not get better with a full 4-8 week course of Vestibular Therapy is because BPPV was missed.

BPPV crystals must be assessed and treated at the very beginning of VRT. I meet many people who have been unsuccessful with Vestibular Rehab and I find atypical BPPV when I examine them.

Atypical BPPV is an unusual type of BPPV. Treating BPPV or ruling it out is necessary for a good outcome with VRT.

The Neck is Getting Aggravated

Vestibular Physical Therapy often involves movements of the head and neck.

I have met many people who were unsuccessful in Vestibular Therapy because they had a neck problem that was not addressed. Neck problems can become aggravated with VRT exercises. This can exacerbate headaches and neck pain. Lightheadedness can be caused by neck problems being aggravated by VRT exercises. Neck problems that are not addressed may limit the results of Vestibular Therapy or make patients feel worse.

Incorrect Exercise Parameters

The research is very clear about what works for Vestibular exercise protocols. If the exercise protocols are not being followed correctly, then the exercises may not work.

Exercise parameters include a lot of details such as the angle of the head, the speed of movement, the arc of motion, the direction of movement, the duration of the exercise, any pause or hold times, etc. Precision and accuracy are keys to success with Vestibular Therapy exercise protocols.

Incorrect exercise parameters are a third reason why Vestiubular Therapy may not work.

Overlooked a Piece of the Puzzle

Most patients I meet have more than one cause of their dizziness or balance issues.

Vestibular problems are a common cause of discomfort, but sometimes other pieces of the puzzle are overlooked.

This may occur due to tunnel vision of healthcare providers focusing only on their area of specialty. For example, there may be a missing piece of puzzle, like a cardiac issue or vision problem. Blood sugar, auto-immune, and thyroid problems may be overlooked and go unaddressed.

Another puzzle piece in Vestibular Therapy that often gets missed is mental health. Sometimes anxiety, depression, or PTSD may go unaddressed. I share below more about mental health affecting VRT outcomes.

Missing puzzle pieces can limit the final level of recovery. In order to make sure that my patients consult with all the relevant professionals, I have developed my own method of evaluation for complaints of dizziness, vertigo, imbalance, and falls.

Interference affecting Brain Function

Certain things can interfere with the brain’s ability to benefit from Vestibular Therapy. The top two causes of interference are stress and medications that affect the central nervous system. Both of those things affect the function of the brain.

In order to fully benefit from Vestibular Physical Therapy, the brain function must be working well!

Medications must be reviewed by the Vestibular Physical Therapist in coordination with the prescribing physician.

Stress must be managed in order the get the best results from Vestibular Therapy.

Mental Health

People with unaddressed mental health fluctuations do not get the optimal outcomes from vestibular rehab.

This may be due to anxiety causing stress which interferes with the brain’s re-calibration.

Excessive worrying can definitely magnify symptoms. This can prolong the recovery process and possibly limiting the final level of recovery.

Severe anxiety or a panic attack during a treatment session may cause the treatment session to end early without accomplishing the goal of care.

Research indicates that patients with anxiety do not recover as well from vestibular problems as those without anxiety.

Depression may prevent patients from taking their medications correctly or keeping their healthcare appointments.

People with depression are less likely to complete exercises and perform self-care at home as instructed.

Lack of Sleep

I have treated many patients with infants or teenagers who keep them awake at night. Disrupted sleep can definitely interfere with the recovery process.

One of my patients with three teenage boys stayed overnight at a hotel room for the weekend so she could get a solid sleep without interruption.

Some of my patients with an infant will arrange for nanny or family member to stay overnight after a treatment session to attend to the baby in the middle of the night.

People with insomnia do not usually recover as quickly as my other patients who sleep deeply after a treatment session.

Some people may take over-the-counter remedies or medications prescribed by their doctor to improve sleep.

Sleep is a key time for the brain to reset and re-calibrate after each treatment for vestibular rehabilitation.

If you are in VRT and you are not getting results, please check out my other blog on the Top Ten Barriers to Vestibular Recovery.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.