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How Vestibular Therapy for Concussions Can Help You Overcome Balance Problems

Active middle-aged woman working out with stability ball, participating in vestibular therapy for concussions

A concussion can cause a person to experience prolonged dizziness and balance problems. This is usually a result of damage to the vestibular system. Fortunately, vestibular therapy for concussions is an effective way to manage dizziness and imbalance.

To help you understand vestibular therapy, this article will discuss how it works and the various exercises it may involve.

Vestibular Therapy for Concussions

As its name suggests, vestibular therapy targets the vestibular system to restore a person’s balance and spatial orientation. It is one of the most effective and evidence-based methods for treating a concussion.

To better understand vestibular therapy, it will help to have some background on the way the vestibular system works.

What is the vestibular system?

The vestibular system lies in the inner ear. It’s of two main parts: the semicircular canals and the otolith organs.

The semicircular canals are three, fluid-filled tubes lined with tiny hairs that monitor head motion. When you move your head, the fluid sloshes around and moves those hairs, which allows your brain to detect motion.

Each canal detects a specific direction of movement. One for moving up or down, one for tilting to the left or right, and one for rotational movement.

The otolith organs have a similar function, except they respond more to gravitational force. The calcium carbonate crystals inside these organs detect when your body is moving up in an elevator, for example.

If a concussion disrupts any part of the vestibular system, the brain will no longer be able to tell the position of the head in relation to your body. That’s when dizziness and balance problems will arise.

Principle Methods of Vestibular Therapy

To overcome dizziness after a concussion, you will need to first be examined by a physical therapist.

A physical therapist will perform a series of tests (such as vision and balance tests) to determine if your issues are stemming from the inner ear. Based on the results, the therapist will create a customized rehabilitation plan to address your specific vestibular issue.

Below, we’ll discuss the 3 primary exercise methods that a PT may have you do as part of vestibular therapy.

1. Gaze Stabilization Exercises

How to do eye exercises for concussion

The vestibular system plays an important role in our vision. This relationship is seen most clearly in the vestibulo-ocular reflex, which is what allows you to stay focused on an object even when your head is moving.

After a concussion, this reflex can become damaged, which will cause disorientation and vertigo.

Gaze stabilization exercises, also sometimes called eye exercises, were designed to help restore that reflex. It involves several exercises of increasing difficulty. The following is a sample exercise:

  • Sit upright in a chair.
  • Draw an X in the center of a piece of paper.
  • Hold the paper in your hand at arm’s length. Keep it at eye level.
  • While focusing your eyes on the X, turn your head side to side. Move as fast as you can without the X getting blurry.
  • Do this for 2 minutes or as long as you can handle.

For optimal results, it’s ideal to practice the exercises several times a day. Ultimately, the more you exercise, the more you will activate neuroplasticity, which will allow your brain to re-establish a connection to your vestibular system.

2. Habituation Exercises

For concussion patients who mostly experience dizziness when they move around, a therapist may prescribe habituation exercises.

These exercises help reduce dizziness by gradually increasing exposure to the movements that bother them, such as bending over to pick something up off the ground. The goal is to build up a tolerance so that those movements no longer affect you.

Your therapist helps ensure that the exercise is equally challenging but manageable, to help keep you from overexertion. Some examples of habituation exercises include:

  • Moving from a sitting position to flat on your back
  • Standing up and sitting back down
  • While sitting up, bending forward until your head is between your knees

Like gaze stabilization exercises, the more you practice, the faster you will improve.

3. Balance and Exertional Training

patient practicing vestibular therapy exercises for concussions

When your dizziness has improved enough, you will graduate to practicing balance exercises and cardio to improve your endurance.

This method is particularly useful for athletes with concussions. The goal is to slowly build up the person’s stamina to the level it was before their injury.

It’s important to challenge yourself during training, but not to overdo it. If you notice your concussion symptoms flaring up while exercising, take a break. Pushing yourself too hard can cause a setback.

But if you can find the right balance between exertion and fatigue, your brain will start to repair itself and you’ll notice your symptoms fading.

Bonus Vestibular Therapy Method: The Epley Maneuver

Sometimes a concussion will cause the crystals in the otolith organs to dislodge, which will lead to severe vertigo.

The Epley maneuver was designed to push those crystals back into their proper place. It involves moving the head into four positions and staying in each position for about thirty seconds.

This maneuver must be performed by a doctor; you cannot do it on your own. It usually takes about fifteen minutes to complete and has an 80% cure rate.

If your doctor does not know how to do the Epley Maneuver, you can find a list of certified vestibular specialists here.

For a good demonstration of the Epley Maneuver, check out this video!

Vestibular Rehab for Concussion Patients

Vestibular therapy is one of the most effective treatments for balance disorders after a concussion.

However, not all dizziness is caused by inner ear issues. Some, for example, can be caused by cervical problems, such as whiplash. If that’s the case, vestibular therapy will not have any positive effects.

That’s why it is crucial to visit a specialist before trying vestibular therapy for concussion. They can help identify the source of your problems and direct you towards the best treatment methods.

And finally, for vestibular therapy to work properly, you must follow the program at home every day. Doing so will help activate neuroplasticity and reduce the time you must wait before returning to your normal life.   

Image credits: ©iStock/undrey/Antonio_Diaz

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