Vertigo, BPPV and Dizziness Physical Therapy

First, rule out an emergency. Call 911 if the dizziness came on suddenly and you also have slurred speech, double vision, trouble swallowing, facial drooping, weakness or numbness on one side, a severe headache unlike your usual, sudden hearing loss in one ear, or new trouble walking or coordinating your limbs. Those can be signs of a stroke, and dizziness can be the first sign of one.

If none of that applies: sit or lie down until the spinning settles, and avoid driving. Move slowly rather than freezing entirely — staying completely still tends to prolong things. If the spinning lasts only seconds at a time and starts when you roll over or tip your head back, that pattern points toward BPPV, which is often fixed quickly. If dizziness is constant, lasts more than a day, or keeps coming back, get it evaluated.

To book an evaluation, call 516-307-9166.

It is physical therapy for the balance system. Using gaze-stabilization, balance and walking exercises, it helps your brain adapt to inner-ear signals that have changed, so that dizziness and unsteadiness settle down. Most of the exercises are done at home; visits are for assessment and progression.

For dizziness caused by reduced inner-ear balance function on one or both sides, the evidence is strong. The Academy of Neurologic Physical Therapy's 2022 clinical practice guideline states that clinicians should offer vestibular physical therapy for this problem, and grades that recommendation strong, on its highest quality of evidence. A Cochrane review of 39 randomized trials likewise found exercise-based vestibular rehabilitation to be safe and more effective than no treatment for dizziness and function.

The picture is more mixed for dizziness from causes outside the inner ear — vestibular migraine, dizziness after a concussion, and persistent postural-perceptual dizziness. Vestibular therapy is often part of care for those, but the research is thinner and it usually works alongside other treatment rather than on its own. We will tell you which group you are in after the evaluation, rather than before it.

Usually not as the main treatment. BPPV is caused by loose crystals in an inner-ear canal, and the national ear, nose and throat guideline recommends a repositioning maneuver — a set sequence of head and body positions that moves the crystals out of the canal. That is a mechanical fix, not an exercise program, and it often works in a small number of visits. Exercise-based vestibular therapy is listed in the same guideline as an option a clinician may offer, and it is most useful for unsteadiness that remains after the repositioning has worked.

The Dix-Hallpike maneuver is the test we use to confirm BPPV. The Epley maneuver is the repositioning treatment; we also perform the Semont maneuver. If that is what is causing your vertigo, you are in the right place and it is usually a short course of care.

The visit runs 60 to 90 minutes. We take a history, then test the balance system, choosing the tests that fit what you are describing: how your eyes respond when your head moves, whether particular head positions bring on the spinning — the Dix-Hallpike test, when what you describe points toward BPPV — and how steady you are standing and walking. What we find determines the plan, and we go through it with you before you go. If a home program is part of it, we can print it, walk you through it in person, and follow up by phone.

It depends on the cause. BPPV treated with repositioning often resolves in a few visits. For reduced inner-ear balance function, the 2022 practice guideline's exercise dosing runs about four to six weeks when one side is affected, and roughly five to nine weeks when both are, with short exercise sessions several times a day at home. Some people improve sooner and some take longer. We reassess as we go and stop when you have met your goals or progress has plateaued.

For inner-ear causes, most people see less spinning and nausea, steadier balance, and easier movement in daily life. Better balance may also lower your chance of falling, though the research on falls specifically is less settled than the research on dizziness and steadiness, so we will not promise it. What we can say is that this is a well-studied treatment, and that we will measure your progress rather than guess at it.

No. The exercises are gentle and nothing is invasive. Some of them will make you feel dizzy for a short time — that is how the brain adapts, and it is expected rather than a sign something is wrong. Tell us if it is more than you can manage and we will adjust the dose.

No, you don't need a prescription for vertigo physical therapy in New York State. New York State lets you start with a physical therapist directly for up to 10 visits or 30 days. Some insurance plans, including Medicare, still need a doctor's sign-off to pay, so check with your plan.

Cost depends on how many visits your plan calls for. Coverage varies by carrier and by plan. Call us at 516-307-9166 and we will help you check your specific benefits before you commit to anything.

Call 516-307-9166 and describe what is happening. If vestibular therapy is not the right answer, we will tell you what is.

This page was reviewed by Dr. Sabaa Mundia, PT, DPT, CLT, Doctor of Physical Therapy, South Nassau Physical Therapy.