Vestibular rehabilitation therapy is used for people with a range of vestibular disorders, including vestibular migraine as I live with (VeDA). It can be a bit daunting to begin with and tricky to find the right physical therapist / physiotherapist, but it can be really beneficial in helping reduce symptoms.
This post isn't going to tell you which exercises to do, or why to do them (other than to help symptoms of course!) because I'm not a VRT therapist and so it isn't my place to do so. Instead, it offers some insights from my experiences of doing vestibular rehabilitation therapy (VRT) in the hope that it helps others and prevents you from making the same mistakes I did to begin with.
This post is for informational purposes only, and my experience of VRT. I am not a doctor, and you should always consult a medical professional about your care.
- 1. Find the right physical therapist
- 2. Find a therapist you can trust
- 3. Make sure they perform a thorough assessment, and read the notes from your doctor
- 4. Ensure that you fully understand what the exercise entails
- 5. Talk to your VRT therapist about any symptoms that may arise from doing the exercises
- 6. Schedule when to do the exercises
- 7. And actually do the exercises at home . . .
- 8. Do your exercises in a safe environment
- 9. Wear comfortable clothes
- 10. Congratulate yourself!
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1. Find the right physical therapist
I know, this sounds really obvious. But there are two issues I encountered here and I really don't want anyone else to make the same mistake. First, if a doctor hands you a photocopied sheet of exercises and just tells you to go home and do them, then you likely need to 1) find a new doctor; and 2) throw that sheet in the trash.
This is exactly what happened to me. I saw for one appointment an ENT doctor, who diagnosed me with vestibular migraine (with no tests to rule anything else out), handed me the sheet and then discharged me. This all happened in less than ten minutes. I tried to do the exercises (all ten of them - way too many), but I felt worse. Thankfully, I then saw a brilliant neuro-otologist who set me on the right path and referred me to a specialist physical therapist.
Second, make sure the therapist is a specialist in VRT. It is a specific type of therapy, and needs a different kind of assessment to that of other conditions. So if the therapist is usually a musculo-skeletal therapist, you may want to check their VRT skills and experience before going ahead.
2. Find a therapist you can trust
So you found a VRT therapist, and they have all the right qualifications and experience but you just don't 'click' . . .
VRT can be a slightly 'hands on' therapy if it involves them having to steady you, or re-position you to perform the exercises with correct form. It can also be difficult for some people to discuss their symptoms, or to talk about balance issues or falling if that is an issue. Personally, I need to see a therapist that I trust and feel comfortable with. I saw one prior to my current therapist, but knew that she just wasn't someone I wanted to see for therapy. She hadn't done anything 'wrong', it just didn't feel right. Thankfully my current therapist is lovely, and I'm so glad I made the switch to her.
3. Make sure they perform a thorough assessment, and read the notes from your doctor
Vestibular rehabilitation therapy isn't a one-size-fits-all model of therapy. It needs to be tailored to you, and to your specific needs. As VeDA point out, VRT 'begins with a comprehensive clinical assessment that should include collecting a detailed history of the patient's symptoms and how these symptoms affect daily activities' (VeDA). The therapist should also ask about any other medical conditions, medication and other forms of therapy you are receiving.
Personally, my therapist asks to see any relevant clinic letters from doctor's appointments every time I see her to keep up to speed on my health. This involves my neuro-otology appointments, as well as any developments with my other conditions.
So if they skip this, and hand you any form of photocopied sheet of exercises, this is likely a red flag that you may want to see someone else. My therapist writes out a sheet for me each time, either working more on exercises I am already doing that need more practice, adding in new exercises, or sometimes actually reducing them altogether if my symptoms are flaring. At times she has told me to rest and not do any for a few weeks to let things settle.
4. Ensure that you fully understand what the exercise entails
Did I do one exercise for three months before my therapist realised I was doing it completely wrong? Yes, definitely . . . It wasn't her fault at all. She showed me how to do it, and got me to do it in front of her several times. But somehow I got confused once I was home, and ended up doing it all wrong.
So, make sure you know how to do the exercise correctly! Your therapist should always explain exactly what to do, show you, and have you do it a few times in front of them to make sure you are happy and doing it correctly. If you have questions, make sure you ask at the time rather than thinking you *probably* know what to do, but aren't 100% sure.
5. Talk to your VRT therapist about any symptoms that may arise from doing the exercises
Sometimes vestibular rehabilitation therapy can cause a temporary uptick in symptoms of dizziness to begin with. To help avoid being frustrated from this, and to know how to manage it, have a chat with the therapist as to the 'usual' increase and what is OK and not. Ask at which point they recommend stopping the exercises, if necessary, and when to contact them.
On that note, mentally prepare yourself that you may feel a little worse before you feel better. It can feel dispiriting, but I always try and remember that VRT is a longer-term therapy rather than a quick fix. So be kind to yourself, adjust other plans if need be and keep in communication with your therapist either in person or by phone.
6. Schedule when to do the exercises
Rushing to catch a train? Off to get the weekly groceries in half an hour? Nope, these are not good times to do your therapy exercises! And believe me, I have tried both and regretted it . . .
It will depend on how your day is and other commitments you have, but it is best to find a time when you can rest sufficiently afterwards. VRT can initially cause an increase in symptoms, so having to rush to do something afterwards is never a good idea, and particularly if it involves a lot of walking or being in a car or in transport as they can be a trigger for many people anyway.
When my symptoms were at their worst I couldn't do anything after my VRT exercises, even watching TV was out the question. So I turned to listening to podcasts or audio books instead. Or just having a cup of herbal tea.
7. And actually do the exercises at home . . .
Am I perfect at doing my VRT every single day? Nope, because life gets in the way. But consistency really is key to seeing improvements and, as my therapist says, if you only do them at your appointment then you aren't going to get any progress. VRT is a commitment, and you have to be willing to put the time and effort in - and it's worth it when you do!
8. Do your exercises in a safe environment
This should be one of the first things your therapist explains to you, and it's important. Have a chair or piece of furniture in front of you if you are doing standing exercises, or be in the corner of a room so you can hold onto the wall if you have problems with your balance.
9. Wear comfortable clothes
Skin tight jeans to do an exercise that involves walking? Perhaps it would work for you, but personally I find it constricting and they don't let my body move in the right way. Comfortable always wins in my book!
10. Congratulate yourself!
And . . . don't forget to congratulate yourself for sticking to your vestibular rehabilitation therapy and celebrate when you see improvements in your dizziness and other symptoms!
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Please follow the advice of your doctor as to all medical treatments, supplements and dietary choices, as set out in my disclaimer. I am not a medical professional, and this post, as well as all other posts on this blog, are for informational purposes only.