Vestibular Rehabilitation Exercises

The gold-standard repositioning technique for posterior semicircular canal BPPV. Moves dislodged otoconia back into the utricle. Achieves 80–90% resolution — often in a single clinic session.

• 1Sit upright on a bed, legs extended. Turn your head 45° toward the affected ear (the side that triggers vertigo).
• 2Quickly lie back with head still turned 45°, allowing the head to hang slightly beyond the bed edge. Wait 30–60 seconds until vertigo stops.
• 3Without lifting your head, rotate it 90° to the opposite side (now facing 45° away from affected ear). Wait 30 seconds.
• 4Roll your entire body onto the unaffected side, keeping the head position (face now angled downward at 45°). Wait 30 seconds.
• 5Slowly return to sitting. Remain seated for 5 minutes. Avoid bending forward or tilting the head back for 24 hours.

Used when the patient cannot extend the neck for the Epley, or as an alternative technique. Uses rapid side-to-side swinging movement. Effective in 70–80% of cases.

• 1Sit upright in the centre of the bed. Turn head 45° toward the unaffected ear.
• 2Rapidly lie down onto the affected side (nose pointing upward). Wait 3 minutes.
• 3Without changing head position, swing rapidly to the opposite side in one movement — nose now pointing toward the floor. Wait 3 minutes.
• 4Slowly return to sitting. Remain still for 5 minutes.

Specifically for horizontal (lateral) canal BPPV, diagnosed by a positive Supine Roll Test with direction-changing horizontal nystagmus. The patient rolls 360° in four 90° stages.

• 1Lie flat on your back. Turn head toward the affected ear. Wait 30 seconds.
• 2Roll head and body 90° onto the affected side. Wait 30 seconds.
• 3Roll 90° further to the prone position (face down). Wait 30 seconds.
• 4Roll 90° further onto the unaffected side. Wait 30 seconds.
• 5Roll 90° back to lying on your back. Slowly sit up.

Used after successful repositioning to manage residual dizziness, or when canal type is unclear. Works through habituation — repeated exposure progressively reduces the vestibular response to the provoking position.

• 1Sit upright on the edge of the bed.
• 2Turn head 45° to the left. Quickly lie down on your right side. Hold 30 seconds (or until dizziness fully stops).
• 3Return to sitting. Wait 30 seconds.
• 4Turn head 45° to the right. Quickly lie down on your left side. Hold 30 seconds.
• 5Return to sitting. This is one repetition.

Trains the Vestibulo-Ocular Reflex (VOR) to keep vision stable during horizontal head movement. Begin slowly and increase speed only as dizziness reduces over days.

• 1Hold a small target (business card, thumb) at arm’s length, at eye level.
• 2Fix your gaze on the target. Slowly move your head left and right while keeping the target in focus — it must not blur.
• 3Start at 1 cycle per 2 seconds. Progress to 1 cycle per second over 1–2 weeks.
• 4If the target blurs at any speed, slow down — do not push through blurring, only through mild dizziness.

Same principle as horizontal, but for vertical head movement. Important for real-life tasks: nodding during conversation, looking up at shelves, navigating stairs.

• 1Hold target at eye level, arm’s length.
• 2Fix eyes on target. Move head up and down (nodding motion) keeping the target in focus throughout.
• 3Begin slow (1 cycle per 2 seconds). Increase speed as tolerated over 1–2 weeks.

Progressive standing balance training that reduces dependence on vision and strengthens proprioceptive and vestibular inputs. Always stand near a wall or hold a chair for safety.

• 1Level 1: Feet together, eyes open. Hold 30 seconds × 3 reps.
• 2Level 2: Feet together, eyes closed. Hold 30 seconds × 3 reps. Begin only when Level 1 is stable.
• 3Level 3: Tandem stance (heel-to-toe), eyes open. Hold 30 seconds × 3 reps.
• 4Level 4: Tandem stance, eyes closed. Hold 30 seconds × 3 reps.
• 5Level 5: Single leg stance, eyes open × 20 seconds per leg. Only when cleared by your doctor.

Trains the vestibular system during a functional, daily activity. Reduces dizziness when walking through a market, scanning a room, or turning to respond to someone.

• 1Walk at a comfortable pace in a straight line (5–10 metres).
• 2While walking, slowly turn your head left, then right, repeatedly.
• 3Progress to looking up and down while walking.
• 4Progress to walking on uneven surfaces (grass, soft mat) as symptoms improve.

VRT alone is insufficient for Menière’s. These lifestyle modifications must run alongside the exercise programme to reduce endolymphatic pressure and attack frequency.

• 🧂Low-sodium diet: Target less than 1,500 mg sodium per day. Avoid processed foods, pickles, papad, packaged snacks.
• 💧Consistent hydration: 2–2.5 litres of water daily. Avoid caffeine and alcohol — both disrupt endolymphatic fluid regulation.
• 😴Regular sleep: Irregular sleep worsens attack frequency. Target 7–8 hours with a fixed wake time.
• 🧘Stress management: Stress is a major trigger. Meditation, pranayama, or yoga are evidence-supported adjuncts.
• 💊Medications as prescribed: Betahistine, diuretics, vestibular suppressants for acute attacks. Do not self-medicate.

The first exercise to begin once you can sit upright without vomiting. Gently activates the vestibular system and initiates compensation from the very first day.

• 1Sit in a stable chair with back support. Fix a small target at eye level (pen, sticker on wall).
• 2Fix your gaze on the target. Slowly move your head left and right while keeping the target in clear focus. If it blurs, slow down.
• 3Repeat for vertical direction (up and down head movement).
• 4Begin with 30 seconds. Build to 2 minutes over 3–4 days as tolerated.

Deliberately provokes mild dizziness to drive compensation. Dizziness during these exercises is expected and therapeutic — it signals the brain is being challenged to adapt. Do not avoid the dizziness; avoid only vomiting.

• 1Sit comfortably. Eyes open. Move head slowly side to side (horizontal). 20 repetitions.
• 2Move head up and down (vertical). 20 repetitions.
• 3Repeat with eyes closed once you can tolerate it — typically Day 3–5.
• 4Gradually increase speed over the week as dizziness reduces with each session.

Restores postural reflexes through progressive standing challenges. Always exercise near a wall or with a sturdy chair within reach.

• 1Week 2: Feet shoulder-width apart, eyes open × 1 minute; eyes closed × 30 seconds. × 3 sets.
• 2Week 3: Feet together, eyes open × 1 minute; eyes closed × 30 seconds. × 3 sets.
• 3Weeks 3–4: Tandem stance (heel-to-toe), eyes open × 30 seconds; progress to eyes closed.
• 4Week 4+: Single leg stance, eyes open × 20 seconds per leg — only if cleared by Dr. Pranshu Mehta.

Upgrades gaze stabilisation by moving head and target simultaneously in opposite directions — a more demanding VOR challenge that mimics real-life scanning (watching traffic, scanning a room, reading while moving).

• 1Hold target at arm’s length. Move target slowly to the right while simultaneously moving head to the left. Keep target in focus.
• 2Reverse: move target left, head right.
• 3Begin slow (1 cycle per 2 seconds). Progress to 1 cycle per second over 2 weeks.
• 4Add vertical movement once horizontal is comfortable.

Walking is one of the most powerful drivers of vestibular compensation. The rhythmic movement and changing visual environment provide strong multi-sensory stimuli for the brain to recalibrate.

• 1Week 2: 5–10 minutes on flat ground with a companion. Add horizontal head turns while walking.
• 2Week 3: 15–20 minutes outdoors in a familiar open area. Add vertical head movements.
• 3Week 4: 20–30 minutes on mildly uneven ground (grass, gravel). Gradually reduce companion support.
• 4Week 5+: Busier environments — markets, staircases, crowds — as confidence and stability improve.