Your Questions, Answered

Vestibular therapy (also called vestibular rehabilitation therapy, or VRT) is a specialized form of physical therapy designed to evaluate and treat disorders affecting the vestibular system—the inner ear and brain pathways responsible for balance, head movement, vision, and spatial orientation.

A vestibular physical therapist uses individualized assessment and evidence-based treatment strategies to help retrain the brain, improve balance, and reduce symptoms such as dizziness, vertigo, motion sensitivity, unsteadiness, and nausea.

At Balancing Act Rehabilitation, we believe recovery involves more than exercises alone. Our whole-person approach recognizes that chronic dizziness can affect every aspect of life—from physical function and confidence to mental well-being and daily routines. We combine expert vestibular rehabilitation with education and practical strategies to help you regain confidence and get back to living your life.

Vestibular therapy is designed to evaluate and treat many causes of dizziness, vertigo, balance problems, and motion sensitivity. Common conditions include:

• Benign Paroxysmal Positional Vertigo (BPPV)
• Persistent Postural-Perceptual Dizziness (PPPD)
• Vestibular Migraine
• Vestibular Neuritis and Labyrinthitis
• Ménière's Disease
• Unilateral and bilateral vestibular hypofunction (vestibular loss)
• Concussion and persistent post-concussive symptoms
• Mal de Débarquement Syndrome (MdDS)
• Chronic dizziness, imbalance, and motion sensitivity from a variety of vestibular conditions

Every person's symptoms and diagnosis are different, so treatment is based on a comprehensive evaluation to create a personalized plan for recovery.

Vestibular therapy is a specialized area of physical therapy focused on evaluating and treating dizziness, vertigo, balance problems, and motion sensitivity caused by disorders of the vestibular system—the inner ear and the brain pathways that process balance and spatial orientation.

While many physical therapists treat musculoskeletal conditions such as back pain, joint injuries, and post-surgical recovery, vestibular therapists receive advanced training in assessing and treating vestibular disorders.

Treatment may include canalith repositioning maneuvers (such as the Epley maneuver for BPPV), gaze stabilization exercises, balance and walking retraining, habituation exercises, and strategies to reduce dizziness and improve confidence with everyday activities.

At Balancing Act Rehabilitation, we also recognize that persistent dizziness often affects much more than balance. Our whole-person approach addresses the physical, emotional, mental, relational, and lifestyle factors that influence recovery, helping you build confidence and return to the activities that matter most.

Yes! Balancing Act Rehabilitation specializes in virtual vestibular physical therapy, allowing you to receive expert care from the comfort of your own home. Research supports the use of telehealth for many vestibular conditions, and studies have shown that virtual care can be both effective and convenient for the right individuals.

All you need is a video-capable device, a safe space to move around, and a reliable internet connection.

In addition to one-on-one virtual vestibular therapy, we also offer The Dizzy Reset™, an online coaching and educational program for people living with chronic dizziness. Unlike physical therapy, The Dizzy Reset™ does not provide medical evaluation or treatment. Instead, it offers evidence-informed education, group coaching, practical recovery strategies, and a supportive community to help you better understand and navigate life with chronic dizziness.

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common cause of vertigo. It occurs when tiny calcium carbonate crystals (called otoconia, or sometimes "ear crystals") become displaced from their normal location in the inner ear and enter one of the semicircular canals, where they don't belong.

As your head changes position, these misplaced crystals send false signals to the brain, causing brief but intense episodes of spinning vertigo. Symptoms typically last less than one minute and are commonly triggered by movements such as rolling over in bed, lying down, sitting up, looking up, or bending forward.

The good news is that BPPV is highly treatable. In most cases, a trained vestibular physical therapist can identify the affected canal and use a series of gentle repositioning maneuvers to move the crystals back where they belong—often providing significant relief in just one or a few treatment sessions.

The hallmark symptom of BPPV is vertigo that is triggered by specific changes in head position. For many people, this feels like a sudden episode of room-spinning vertigo that lasts just a few seconds to about one minute. However, not everyone experiences a true spinning sensation. Some people describe feeling off balance, tilted, pulled, or generally "off" when they move their head in certain directions.

The brief episodes are commonly triggered by rolling over in bed, lying down, sitting up, looking up, or bending over. Aside from vertigo, BPPV may cause nausea during or after an episode, unsteadiness or imbalance between episodes, or a lingering sense of disequilibrium.

One of the key features of BPPV is that symptoms are brief and positional—they are brought on by specific head movements rather than causing constant dizziness throughout the day.

The Epley maneuver is a series of guided head movements used to treat the most common type of Benign Paroxysmal Posterior Canalithiasis (BPPV), which is posterior semicircular canal BPPV. It works by moving the displaced crystals (otoconia) out of the semicircular canal and back into their proper location in the inner ear, the utricle.

The Epley maneuver is a type of canalith repositioning procedure (CRP) and is considered the first-line treatment for posterior canal BPPV. Research has consistently shown it to be highly effective, with most people experiencing significant improvement or complete resolution after one to three treatments.

At Balancing Act Rehabilitation, we can evaluate your symptoms during a virtual vestibular physical therapy session to determine whether BPPV is present and, when appropriate, guide you safely through the correct repositioning maneuver for your specific type of BPPV.

If you've already been diagnosed with posterior canal BPPV, you can find step-by-step instructions for the appropriate maneuver here:

• Right Epley Maneuver
• Left Epley Maneuver

Important: The Epley maneuver is not the correct treatment for every type of BPPV. Performing the wrong maneuver—or treating the wrong ear or canal—can make symptoms worse or simply be ineffective. If you're unsure which ear or canal is affected, we recommend being evaluated by a trained vestibular physical therapist before attempting treatment at home.

Yes. Although the Epley maneuver and other repositioning maneuvers are highly effective, BPPV can recur. Research suggests that approximately 15–20% of people experience another episode within the first year, and recurrence becomes more common over time, with up to half of people experiencing another episode over several years.

One of our mentors once told us, "if you live long enough, you'll probably experience BPPV again."

While that may sound discouraging at first, we actually find it reassuring. Recurrent BPPV is typically just as treatable as the first episode. At Balancing Act Rehabilitation, we teach our patients how to recognize the signs of recurrence, access care quickly, and, when appropriate, safely manage future episodes with guidance from a vestibular physical therapist.

PPPD (Persistent Postural-Perceptual Dizziness) is a chronic functional vestibular disorder characterized by persistent dizziness, unsteadiness, and/or non-spinning vertigo that lasts for three months or longer. Symptoms are typically worse when standing or sitting upright without support, during active or passive movement, and in visually busy environments such as grocery stores, airports, or crowded spaces.

PPPD often develops after a triggering event that challenges the brain's balance system. This may be a vestibular condition such as vestibular neuritis, BPPV, or vestibular migraine, but it can also follow a concussion, a panic attack, a significant medical illness, or another event that causes the brain to become more vigilant about balance and movement.

In PPPD, the brain becomes "stuck" in an overly protective mode, continuing to interpret normal movement and balance signals as potential threats. This can cause dizziness to persist long after the initial trigger—or alongside an ongoing vestibular condition.

PPPD is highly treatable. With the right combination of education, vestibular rehabilitation, graded exposure to movement, and, when appropriate, additional medical or psychological support, most people can significantly reduce their symptoms and regain confidence in everyday life.

Persistent Postural-Perceptual Dizziness (PPPD) typically develops after an event that challenges the brain's balance system. Common triggers include vestibular disorders such as BPPV, vestibular neuritis, and vestibular migraine, as well as concussion, panic attacks, or other medical illnesses.

For most people, the initial event resolves or improves, but the brain remains in a heightened state of vigilance. It becomes more sensitive to normal movement and visual information, causing dizziness to persist long after the original trigger—or alongside an ongoing vestibular condition.

Persistent Postural-Perceptual Dizziness (PPPD) symptoms can vary from person to person, but most people describe a persistent sense of non-spinning dizziness (rocking, swaying, sense of disconnectedness), unsteadiness, or feeling "off" that is present for much of the day, on most days, for three months or longer. Unlike BPPV, symptoms usually aren't brief spinning episodes. Instead, many people describe PPPD as a constant "background hum" of dizziness that fluctuates in intensity throughout the day.

People with PPPD commonly experience:

• Persistent dizziness, unsteadiness, or non-spinning vertigo
• Feeling worse when standing or sitting upright without support
• Symptoms that increase with your own movement or while riding in a car, elevator, or escalator
• Difficulty in visually-busy environments such as grocery stores, airports, crowds, or while scrolling on a phone or computer
• Feeling overwhelmed by busy patterns, flashing lights, or lots of visual motion
• Brain fog, difficulty concentrating, or feeling mentally fatigued
• A sensation of rocking, swaying, floating, or walking on a boat

Symptoms often fluctuate from day to day but tend to be consistently present rather than occurring as isolated episodes.

Persistent Postural-Perceptual Dizziness (PPPD) responds best to a comprehensive, whole-person approach. Treatment often includes vestibular rehabilitation therapy, education about how PPPD develops, gradual exposure to movement and visually busy environments, nervous system regulation strategies, and, when appropriate, medication or psychological support.

Unlike treatment for BPPV, vestibular rehabilitation for PPPD isn't about repositioning crystals. Instead, it focuses on helping the brain become less sensitive to movement, balance, and visual information while rebuilding confidence in everyday activities.

At Balancing Act Rehabilitation, we specialize in treating PPPD through one-on-one virtual vestibular physical therapy. We also offer The Dizzy Reset™, an online coaching and education program designed for people living with chronic dizziness. The Dizzy Reset™ complements medical care by providing structured education, a growing exercise library featuring movement, nervous system regulation, confidence-building exercises, and guided meditations, practical recovery strategies, weekly group coaching, research reviews, and a supportive community to help you navigate life with chronic dizziness.

Vestibular migraine (VM) is a neurological condition that can cause a wide variety of symptoms, and no two people experience it exactly the same way. Despite its name, it's much more than a headache. For many people, dizziness and vertigo are the most prominent symptoms, with—or even without—head pain.

You may be experiencing vestibular migraine if you notice:

• Vertigo, dizziness, or a constant feeling of being "off," with or without head pain
• Busy environments like grocery stores, airports, or crowds make you feel "drunk," overwhelmed, or off balance
• Sensitivity to light, sound, smell, or visual motion
• Symptoms flare with stress, poor sleep, hormonal shifts, weather changes, or skipping meals
• Brain fog, low energy, or feeling easily overwhelmed
• Ear fullness, ringing in the ears (tinnitus), or neck pain and tightness
• Visual aura, visual changes, or a sensation that your body or the space around you feels distorted
• Motion sickness as a child
• A personal or family history of migraine
• Anxiety that seems to accompany the dizziness, but doesn't fully explain it
• "Weird" symptoms that no one has been able to explain.

With the right diagnosis and treatment plan, many people experience significant improvement and regain confidence in their daily lives.

Vestibular migraine is diagnosed based on your medical history and symptoms. There isn't a single test to confirm it. A diagnosis of vestibular migraine generally requires:

I. At least five episodes of vestibular symptoms: Episodes of dizziness, vertigo, or imbalance lasting anywhere from 5 minutes to 72 hours.

II. A current or past history of migraine: Even if you haven't had a headache in years, a previous history of migraine counts. A family history of migraine can also provide helpful clues.

III. Migraine features during at least half of your episodes: These may include a migraine headache, sensitivity to light (photophobia), sensitivity to sound (phonophobia), or a visual disturbance. You don't need to experience all of these symptoms.

IV: No better explanation for your symptoms: Other vestibular or neurological conditions have been considered and don't better explain what you're experiencing.

Because vestibular migraine can overlap with conditions such as BPPV, PPPD, Ménière's disease, and other vestibular disorders, a thorough evaluation is important to ensure an accurate diagnosis.

Yes. In fact, this is one of the reasons vestibular migraine is so often overlooked or misdiagnosed. Many people with vestibular migraine experience dizziness, vertigo, imbalance, and motion sensitivity as their primary symptoms, with little or no head pain at all.

If you have a personal or family history of migraine and experience unexplained episodes of dizziness, vertigo, or sensitivity to motion or busy environments, vestibular migraine should be considered as a possible diagnosis... even if headaches aren't part of the picture.

Treatment for vestibular migraine requires a whole-person approach. In other words, it requires much more than exercise alone, and the approach is very different from rehabilitation for conditions like vestibular neuritis or BPPV.

An effective vestibular rehabilitation program should address not only movement and balance retraining, but also education, nervous system regulation, identifying and managing triggers, lifestyle habits that support recovery and build capacity, pacing, learning the difference between restorative rest and avoidant rest, and more. It should help you gradually build your capacity physically, mentally, and emotionally so you can participate in more of the things you enjoy without your symptoms dictating every decision.

At Balancing Act Rehabilitation, we believe recovery goes beyond reducing symptoms. Our approach combines evidence-based vestibular rehabilitation with education and practical strategies to help you better understand your condition, rebuild confidence, build your capacity, and get back to living your life.

If you live outside one of the states where we are licensed to provide one-on-one vestibular physical therapy, we also offer The Dizzy Reset™, our online coaching and educational program. It features structured education, a growing exercise library, weekly group coaching, research reviews, and a supportive community to help you navigate life with chronic dizziness.

The Dizzy Reset™ is an online coaching and educational program for people living with chronic dizziness and vestibular disorders. It's designed to help you better understand your symptoms, rebuild confidence, build your capacity, and gradually get back to the activities that matter most.

The program combines structured education, a growing exercise library featuring movement, nervous system regulation, confidence-building exercises, and guided meditations, weekly group coaching, research reviews, and a supportive community of people who truly understand what you're going through.

Unlike one-on-one vestibular therapy, The Dizzy Reset™ does not provide individualized medical evaluation or treatment. Instead, it complements medical care by providing education, practical recovery strategies, accountability, and ongoing support throughout your recovery.

Whether you're looking for additional support alongside physical therapy, don't have access to a vestibular specialist in your area, or simply want a community that understands what you're going through, The Dizzy Reset™ was created to empower you with the knowledge, tools, and confidence to take an active role in your recovery and reclaim your life.

If you're ready for more guidance, structure, and support as you navigate chronic dizziness, we'd love to welcome you into The Dizzy Reset™. Click here to explore everything that's included and see if it's the right fit for you.

We believe that everyone deserves access to high-quality vestibular education, whether or not they're a patient.

Our free resources include:

• Talk Dizzy to Me, our podcast featuring conversations with leading experts and people with lived experience covering topics such as vestibular migraine, PPPD, BPPV, concussion, nervous system regulation, and more.
• Free condition guides for vestibular migraine, PPPD, and BPPV, designed to help you better understand your symptoms, treatment options, and recovery.
• Making Sense of Chronic Dizziness and the Path Forward, our free on-demand masterclass that explains why chronic dizziness can be so confusing, why so many people feel stuck, and the steps you can take to move forward with greater confidence.

Whether you're newly diagnosed, still searching for answers, or simply want to learn more about vestibular disorders, these resources are designed to empower you with the knowledge and confidence to take an active role in your recovery.

Click here to explore our free resources and start learning today.

Generally speaking, no. While a diagnosis can be helpful, many people come to vestibular therapy with symptoms such as dizziness, vertigo, imbalance, motion sensitivity, or an unexplained feeling of being "off" without knowing exactly what's causing them.

A comprehensive vestibular evaluation can help identify patterns that narrow down the possible cause of your symptoms, determine whether vestibular therapy is appropriate, and guide an individualized treatment plan. If your presentation suggests another condition that requires additional medical evaluation, we'll help point you in the right direction.

Dizziness is a symptom, not a diagnosis, and it can have many different causes. Vestibular disorders often cause symptoms such as vertigo, imbalance, motion sensitivity, difficulty in busy environments, or feeling as though you're rocking, swaying, or walking on a boat. Some people also experience nausea, brain fog, or difficulty focusing.

The best way to determine whether your symptoms are related to the vestibular system is through a thorough history and vestibular evaluation. We take the time to understand your symptoms, identify patterns and triggers, and determine whether vestibular therapy is likely to help.

Your first session begins with an in-depth conversation about your symptoms, medical history, lifestyle, and goals. From there, we'll perform a comprehensive virtual vestibular evaluation, assessing areas such as eye movements, balance, positional testing when appropriate, and functional movement.

Before the session ends, we'll discuss our findings, answer your questions, and develop a personalized plan of care. You'll leave with a better understanding of what may be contributing to your symptoms, how your vestibular system impacts your everyday life, practical strategies you can begin using right away, a clear roadmap for moving forward, and the confidence that you don't have to navigate this journey alone.

Absolutely. In fact, many of the people we work with have been experiencing dizziness for months or even years before finding us. They may have seen multiple healthcare providers, undergone extensive testing, or even tried vestibular therapy in the past without getting the answers or progress they were hoping for.

Persistent dizziness can be complex, but that doesn't mean recovery isn't possible. Whether your symptoms are related to vestibular migraine, PPPD, recurrent BPPV, vestibular hypofunction, concussion, or another vestibular disorder, our goal is to help you better understand what's contributing to your symptoms and develop a personalized plan to help you move forward.

Yes, and in many cases, that's expected. Vestibular rehabilitation is designed to challenge the balance system and encourage the brain to adapt. As a result, it's common to experience a temporary increase in symptoms during or shortly after certain exercises.

That said, more isn't always better. Therapy should challenge your system enough to promote learning without overwhelming it. We work closely with you to find the right dosage for your nervous system, adjusting exercises as needed to encourage progress while keeping symptoms manageable.

A temporary increase in symptoms doesn't necessarily mean you're getting worse. Often, it's a normal part of the recovery process.

Not all vestibular therapy is the same.

The right treatment depends on taking the right steps, in the right order, with the right guidance. For example, someone with vestibular migraine or PPPD often requires a very different approach than someone recovering from vestibular neuritis or treating BPPV. In some cases, people are prescribed exercises that are too easy, too difficult, or simply not appropriate for what's driving their symptoms.

We frequently work with people who have tried vestibular therapy before without the results they were hoping for. A fresh evaluation, a clearer understanding of what's contributing to your symptoms, and a more comprehensive, whole-person approach can often make a meaningful difference.

Just because vestibular therapy hasn't helped in the past doesn't mean it can't help now.