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Vestibular Rehabilitation Therapy: Does It Have to Make You Feel Worse Before You Feel Better?

In short, the answer is NO. For a more in depth response, keep reading!

What is Vestibular Rehabilitation Therapy (VRT)?

VRT is a common treatment approach to address symptoms related to concussions, vestibular hypofunction, Meniere's, cervicogenic dizziness, and vestibulocular dysfunctions. VRT is used to address symptoms such as dizziness, sensations of being off-balance, visual disturbances, and headaches. For VRT to have the most effective and efficient results, an in-depth clinical examination, performed by a trained professional, is essential. Based on the findings of the clinical exam, a VRT program is designed specific to your symptoms, dysfunctions, and tolerance.

What to expect with a vestibular exam?

VRT exams can be performed by a trained physical therapist, occupational therapist, vision therapist, or a combination. Most vestibular tests are considered "provocative tests"; this means that they are designed to reproduce your familiar symptoms. If a test does not provoke your symptoms, that means that specific component is not part of your problem. If the test does produce your symptoms, that means that component is part of the problem and needs to be addressed with VRT.

If you have a vestibular problem, the vestibular exam will increase your symptoms. Depending on your sensitivity, your symptoms make be elevated for hours, or even days, following a thorough vestibular exam. For some, it is necessary to perform the exam over several days to avoid significant flare-ups.

What to expect with treatment:

The specific VRT exercises, dosing, speed, and duration is dependent on the information collected during the exam. This means your VRT program is specific to you. Unfortunately, this makes it hard to find exercises on the internet, or share with a friend.

VRT may include the following:

  • Neck mobility

  • Neck and posture strengthening

  • Smooth pursuits

  • Saccades

  • VOR training

  • Balance challenges

  • Cognitive tasks with functional activities

  • Habituation to movement

  • Activity modification/compensation strategies

  • Walking program

The big question: Does VRT have to make you feel worse to help you get better?

I already indicated that the simple answer is "no". But, like most things related to the vestibular system, it is a little more complicated than that. VRT exercises should produce some increase in symptoms while you are performing the exercise. This slight increase in symptoms indicates that the system is being challenged to help it learn how to function better. Based on this, VRT does make you feel worse. BUT, the key is to stop and rest when you start feeling elevated symptoms. This rest break prevents the brain and vestibular system from getting too overwhelmed which can cause symptoms that last for hours or days. Based on this strategy, VRT makes you feel worse for a very short period of time while you are doing the exercise, but with proper dosing and rest breaks, does not make you feel worse for the rest of the day or into the next day.

More is NOT better!

The key to an effective VRT program is to do enough (of the right exercise) to retrain the brain, but not do too much to overwhelm it. If we do too much of a good thing, it can become a bad thing that can create symptoms for hours, or even days.

How do you know what is too much?

Listen to your body and trust your gut. Everyone is different and you're the only one that truly knows how you feel. VRT exercise tolerance can change based on sleep, hunger, stress, time of day, weather, etc.

My general rule for VRT dosing:

  • Symptoms > 4-5/10: too much/take a break/stop

  • Symptoms < 2-3/10 ok/keep going/monitor closely

Does VRT Actually Work?

Research supports the use of VRT in both young and old populations. From the article Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance (K. Park) "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]."

From the article Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo (Heloísa Freiria Tsukamoto) "There was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests."

Unfortunately, there is no "one-size fits all" for VRT. Therefore, an effective VRT requires a trained professional examining and guiding you through a treatment plan. With proper guidance, VRT is shown to improve symptoms, function and quality of life.

If you are experiencing dizziness, post-concussion symptoms, imbalance or any other vestibular symptoms, make an appointment today:

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