Vestibular is more than just balance but incorporating the symptoms and findings to make the most appropriate treatment that will yield the greatest results.
— Samie Seeley, PT

What is the vestibular system?


The inner ear contains 5 structures that provide input to the vestibular system: 3 semicircular canals (anterior, posterior, and horizontal), the utricle, and the saccule. These fluid-filled structures contain ciliary hair cells that help provide information to the brain regarding head position and movement. This information is processed in an area of the brain called the cerebellum. In addition to vestibular input, the cerebellum processes information from the oculomotor and somatosensory systems which provide information about perception of touch and joint movement. Together, information from all 3 sensory systems is used to control balance and stability.

What is a vestibular disorder?

A vestibular disorder occurs when there is a change from the normal functioning of the vestibular organs, nerves and/or processing centers along the pathway described above. Because the vestibular system is one of 3 systems used to maintain balance, vestibular disorders often present with sensations of dizziness or vertigo.  Additional symptoms may include nausea, headaches, neck pain and increased sensitivity to movement, light, or busy patterns. Specific provoking movements and/or types of symptoms may vary depending on the area of the vestibular pathway that has been affected.

How does physical therapy play a role in vestibular disorders?

Physical therapists trained in vestibular rehabilitation can perform an evaluation to help determine which area of the vestibular pathway is affected. Once this is determined, an appropriate and comprehensive treatment plan can be developed. 

One of the most common and treatable causes of vertigo is Benign Paroxysmal Positional Vertigo (BPPV). This occurs when otoconia, small calcium “crystals” that occur normally within the inner ear, become dislodged from their usual location and end up in one or more of the semicircular canals. This results in brief episodes of vertigo caused by changes in head position, such as rolling over in bed or bending forward. Once a physical therapist or appropriate health professional has determined which canal is affected, treatment involves a Canalith Repositioning Maneuver. The technique varies depending on the semicircular canal affected, although these maneuvers usually take less than 5 minutes to perform. Depending on the severity of symptoms, multiple treatments and additional vestibular rehabilitation may be necessary.


                  There are numerous other pathologies that can impact the short or long term functioning of the vestibular system. Luckily, neural plasticity allows the human brain to adapt and compensate for areas of impaired function.  The cerebellum is responsible for fine-tuning motor output based on vestibular input. Over time and with training, neural plasticity in the cerebellum can help compensate for impairments which can reduce the symptoms of dizziness and instability. In many cases, this process can be facilitated by adaptation and habituation activities within a physical therapy setting.

Vestibular Treating Therapists

Author:  Samie Seeley  PT, DPT

Author: Samie Seeley

Mandie Majerus PT, MSPT, OCS, CSCS, SFMAc, CMPT

Mandie Majerus

Heidi Biehl  PT, DPT, OCS, CSCS

Heidi Biehl

Justin Ho  PT, DPT, CSCS

Justin Ho