Online exercises for vertigo & dizziness
Most of us use “Dr. Google”! Vertigo, dizziness, and balance problems can be very disabling and when these symptoms occur, most of us will try everything we can to get better. There are many videos and instructions online for exercises to help vertigo and dizziness, with variable quality. There can be benefits to finding exercises to do on your own, but also some pitfalls.
Many people tell us they Googled how to do exercises to help vertigo, found a video on YouTube and tried to do a treatment maneuver at home, were given a printout of instructions for how to perform self-treatment, or were handed a list of exercises to try out by themselves. For some people this helps a lot. For others, this helps but does not completely resolve their symptoms. For many people, once we evaluate them it turns out that they were not doing the right thing, or they found the right exercise but were not performing it correctly.
Accurate diagnosis is key to determining effective treatment. Many people who experience vertigo or dizziness are misdiagnosed. If you try exercises that are based on an incorrect diagnosis or do not address the areas where you have difficulties, it could explain why these exercises are not helping.
An experienced vestibular physiotherapist can help you to find the right exercises and maneuvers to do at home. We want to empower you, and give you the knowledge and skills you need to help yourself! Read on for more information about the kinds of exercises and maneuvers you may see online, tips about what you might experience when trying these treatments, and when you might need expert help.
Treatment maneuvers for BPPV
Benign Paroxysmal Positional Vertigo (known as BPPV) is the most common cause of vertigo. Vertigo is an illusion that either you or your environment is moving, and is often a spinning sensation. With BPPV, short spells of vertigo are triggered by changing your head position relative to gravity - like with lying down, turning over in bed, or bending over. BPPV is caused by displaced crystals in your inner ear, and is treated with physical maneuvers that reposition the crystals.
If you have BPPV, you may have been told to perform Brandt-Daroff exercises. This involves turning your head and lying down quickly, then sitting up and doing the same on the other side - usually performing multiple repetitions of this at least twice per day. This is a non-specific exercise, and although there is research evidence that this is effective in treating BPPV, these movements can be difficult to tolerate as they can be quite symptom provoking. It can be challenging to perform enough repetitions sufficiently often to be effective. We generally favour doing specific treatment maneuvers, but Brandt-Daroff exercises could be helpful if you are not able to figure out what ear or what part of the ear is affected.
The Epley maneuver and the Lempert or BBQ roll are the most common maneuvers you will find videos for online. You may also see videos for the Semont maneuver, or the half somersault or Foster maneuver. You need to perform the maneuver specific to the affected side and affected part of the ear, and there are different maneuvers for crystals that are freely floating versus stuck down. Keep in mind that it is possible to have BPPV in both ears or multiple canals at one time - this is less common but can make treatment more complicated.
Before trying treatment maneuvers on your own, you should be aware that if you have BPPV doing these movements will likely provoke symptoms. Sometimes triggering vertigo during a maneuver is actually a good sign that it is working properly, but we need to be able to see and evaluate what direction your eyes are moving in each position to determine if this is the case.
You should be aware that when you sit up from an Epley maneuver you can sometimes feel dizzy or experience a ‘dropping’ or ‘falling’ sensation. This is often a sign of a successful maneuver! This feeling may be triggered by the crystals moving out of the semicircular canal and temporarily affecting the gravity receptors in the inner ear - so it is thought to be a sign that we have moved the crystals effectively. After performing successful treatment maneuvers, some people feel better right away and some people feel off balance for a short period afterwards.
These maneuvers should help right away or at least after a few tries. You will know if the treatment has been effective if your vertigo is gone! If they are not helping it could be that you are not doing the correct maneuver - treating the wrong side or the wrong canal. It could also be that you are not doing the maneuver correctly. A common error is not holding each position long enough. In an Epley maneuver, common errors include not tipping your head back far enough or lifting your head during the maneuver. If treatment maneuvers are not helping, it is also possible that you don’t have BPPV and something else is causing your symptoms.
Vestibular rehabilitation physiotherapists use infrared goggles for more accurate diagnosis and treatment. Infrared goggles allow us to look at your eyes as you move into different positions to determine what ear and what part of the ear is affected, and watch your eyes during treatment maneuvers to be sure they are helping. For many people with BPPV, symptoms resolve completely after 1 or 2 treatment sessions with an experienced physiotherapist.
If you have tried self-treatment maneuvers and your symptoms have not resolved, a vestibular rehab physiotherapist could help provide a complete assessment and determine what maneuver(s) should be performed. If you have recurrent episodes of BPPV, a vestibular physio can help you come up with an individualized action plan for what to try on your own if you have another spell.
Eye and head vestibular exercises
For most people with vestibular dysfunction, exercises that get you moving your head and body are likely to be beneficial. An exercise that gets you moving may be better than doing nothing, and will often be more helpful in the long term than completely avoiding aggravating movements.
Gaze stability or VOR adaptation exercises involve looking at a target while you move your head. These exercises are very important if you have a loss of vestibuloocular reflex
(VOR) function, but may not actually help if you don’t have VOR impairment. If you find your vision gets blurry or bouncy when you move your head (a symptom known as oscillopsia) these exercises could help.
Gaze stability exercises need to be done at the proper speed and with sufficient repetition in order to be maximally effective. While you move your head, you need to keep your eyes on the target and you should not see the target become blurry or jump around. You often start with a single letter as the target, and move your head side to side or up and down. These exercises should be progressed properly to keep challenging your system in order to promote compensation for VOR impairment. If you are not doing these exercises correctly, frequently enough, or for long enough they will not promote compensation for vestibular loss as efficiently. As these exercises can temporarily provoke symptoms, you want to be sure you are getting the full benefit. You don’t want to make yourself feel dizzy without achieving the positive effects of the exercises! A vestibular rehab physiotherapist can evaluate if you need to do these exercises, and check that you are doing them correctly.
Habituation exercises also usually involve head, eye, and/or body movements. The goal with these exercises is to gradually build your tolerance to movements that cause symptoms. These are designed to desensitize your system. They do provoke symptoms and need to be at a ‘just right’ level of challenge. Increasing your symptoms too much or for too long can be counterproductive, but if exercises are not challenging enough they will not help make changes in your tolerance. One example of a general set of exercises you may find online are the Cawthorne Cooksey exercises - these involve eye, head, and body movements. A vestibular physio can give you specific exercises to address the particular things that provoke your symptoms at your level of tolerance, and can help you find strategies to de-escalate symptoms.
Balance exercises
Balance exercises help train your brain to process sensory information from your vision, vestibular system, and body sense more efficiently. These exercises also train your brain to generate fast and coordinated muscle activation in response to challenges to your balance.
Balance exercises need to be challenging enough to get a training effect but not so challenging that they put you at risk of falling. Since these exercises do challenge your balance, you need to do them safely. We often recommend standing in the corner of a room with a chair in front, so you can place your hands down to the back of the chair, and so you have the walls behind and beside you.
Balance exercises often involve trying to maintain steady standing with your feet in different positions. When you have a narrower base of support it is more challenging to keep your balance - placing your feet close together, standing heel to toe, or standing on one foot are examples of this. It is also more difficult to keep your balance when your eyes are closed or when your head is moving. Standing on an unsteady or softer surface, like a foam balance pad, is also more challenging.
We often don’t challenge ourselves to do balance exercises with eyes closed, head movements, or on unstable/uneven surfaces, but in our day-to-day movements these are often the things that throw us off balance the most. When we change the information your eyes, inner ears, and body are sending to your brain we can add challenge to your exercises and help improve your balance abilities that will carry over into everyday life. A vestibular rehabilitation approach to balance training will consider sensory integration and how you are using (or not using!) different sensory inputs.
Balance is not just about being able to stand still - dynamic balance is important in maintaining your postural control while in motion. We also need to be able to react to perturbations to our balance - like when your stability is unexpectedly disturbed by slipping, tripping, or having someone accidentally bump into you.
It can also be important to consider adding exercises that strengthen the muscles in your legs and core that keep you upright. As our ability to move our feet and ankles is very important for good balance reactions, exercises that improve mobility in your foot and ankle joints may also be beneficial.
If you have been looking for balance exercises online to decrease your risk of falling, you may have come across the Otago Exercise Program. This is an example of an evidence-based exercise program that can help decrease risk of falling - and it is generally recommended that a physiotherapist initially assess your abilities and prescribe the exercises, then evaluate your progress. Tai chi is also a form of exercise that has also been shown to improve balance and decrease falls risk. There are also community-based exercise or fall prevention programs like the Together In Movement and Exercise (TIME) Program, which is designed for people with balance and mobility challenges.
A vestibular physiotherapist can give you personalized exercises that are targeted to improve your weaknesses and work towards your activity goals. A physiotherapist can assess your current abilities, design a program of balance, strength, and mobility exercises that targets your areas of challenge, help keep you motivated and on track with doing your exercises, and re-evaluate you to make sure your balance abilities are improving with your program.
Tips for finding good online resources
Look for a reputable source
Look for information that is written, created, or reviewed by a health professional
Look for information that is specific to your symptoms and goals
If it sounds too good to be true, it probably is!
Remember that online resources are not a replacement for evaluation and treatment with a trained health care provider - this article included!
Looking for expert help? Get in touch to speak with one of our physiotherapists!
“After trying to do exercises on my own to correct my BPPV it only cleared up after I was assessed and treated with the expertise and experience of therapists at the clinic. They also taught me how to do the exercises correctly to address any ongoing episodes of vertigo.”
Patient with BPPV
