7 Exercises for Vertigo to Help Regain Your Balance
Key takeaways:
The cause of vertigo — peripheral or central — determines the best approach to treatment and exercise.
The most common type of vertigo is benign paroxysmal positional vertigo (BPPV), which is a peripheral vertigo. Central vertigo is less common and is caused by conditions like strokes, multiple sclerosis, or migraines.
Exercises including the Epley maneuver, Semont maneuver, and Brandt-Daroff maneuvers help treat BPPV. Balance and coordination exercises, such as Cawthorne and gaze stabilization exercises, can help treat other types of vertigo.
Table of contents
Vertigo describes an uncomfortable sensation of movement. It feels like your surroundings are spinning around you. It’s different from dizziness, which just makes you feel lightheaded. Vertigo can be associated with nausea and vomiting, problems with balance, and difficulty focusing your eyes.
Vertigo is a symptom of a condition, not a diagnosis. There are two types of vertigo, which help to determine the cause:
Peripheral: Around 80% of people have peripheral vertigo. This is caused by an issue with your inner ear or vestibular nerve. The most common type of peripheral vertigo is benign paroxysmal positional vertigo (BPPV). This condition causes symptoms when you change positions or quickly turn your head. Acute vestibular neuronitis and Ménière’s disease are other common causes of peripheral vertigo.
Central: This type is less common and is due to issues affecting your brain or brain stem. Multiple sclerosis, stroke, brain tumors, and even migraines can cause central vertigo.
Depending on the type of vertigo you have, exercises can help treat and prevent this condition.
What are the best exercises for vertigo?
An exercise-based treatment program, called vestibular rehabilitation therapy (VRT), can help treat vertigo. The type of exercises you do depends on the type of vertigo you have.
Exercises for BPPV focus on the small calcium carbonate crystals (called canaliths) in the inner ear. These can become loose and move out of place. Exercises called canalith repositioning procedures help to move those crystals back to their proper place. Other types of peripheral vertigo don’t improve with repositioning exercises and may benefit from other types of eye and head exercises.
Vertigo or dizziness? Learn about the difference, and why it matters.
What causes vertigo? There are actually many possible causes, some more common than others.
Vertigo can be more serious in older adults. Know when to get medical attention.
Treatment for central vertigo focuses more on balance, gait, and coordination exercises. The idea is to train the brain to adapt and compensate. The repositioning exercises referred to above will not help those with central vertigo because the cause is different.
Consult a healthcare professional or a physical therapist before starting to help determine the best exercise(s) for your condition. And use caution: Don’t do all of these exercises for vertigo in one day. They’re designed to be done for a week or longer to gauge effectiveness. If one exercise isn’t working after a trial period, wait a day or two before trying a different exercise.
Know that you may experience temporary dizziness. If you do, wait for it to pass before continuing, and don’t stand up until you feel better.
1. Epley maneuver
The Epley maneuver is a type of canalith repositioning exercise. This exercise is very effective
for those with BPPV but not for people with other types of vertigo. Research suggests that treating BPPV vertigo with the Epley maneuver and medication can be more effective than medication alone.
This exercise is intended for those with a problem with the right ear. If your problem is with the left ear, turn your head in the opposite position of what is written below. If you aren’t sure which ear is affected, talk with a healthcare professional or watch this video.
Step 1: Sit on a bed with your legs extended in front of you.
Step 2: Turn your head 45 degrees to the right.
Step 3: Lie back quickly, with a pillow under your shoulders so your head hangs down slightly (about 20 to 30 degrees). Your head should stay in the 45-degree turn to the right.
Step 4: Hold in this position for 30-60 seconds.
Step 5: Turn your head to the left 90 degrees, until it’s at a 45-degree angle to the left.
Step 6: Hold for another 30-60 seconds.
Step 7: Roll to your left side and move your head to look left (down toward the bed/floor). Hold for 30-60 seconds.
Step 8: Sit up and stay still for 15 minutes before moving.
Step 9: Repeat once a day until symptoms resolve.
2. Semont maneuver
The Semont maneuver is another type of repositioning exercise to treat BPPV vertigo. It works in a similar way as the Epley maneuver. It helps to move the calcium crystals back to the correct place in the ear. Research has found it to be up to 90% effective after four sessions. A 2021 study comparing the Semont to the Epley maneuver found them both effective in treating BPPV. However, the Epley reduced dizziness slightly more. You can try both to see which you prefer.
This is designed for those with their right ear affected. If it’s your left ear that’s affected, do the opposite of what is written.
Step 1: Sit on the edge of a bed and turn your head 45 degrees to the left.
Step 2: Quickly lay down on your right side, keeping your head in that same position. You’ll be looking diagonally up at the ceiling.
Step 3: Hold for 1 minute.
Step 4: Quickly switch to lie on your left side, keeping your head in that same position. You’ll be looking diagonally down at the floor.
Step 5: Hold for 1 minute.
Step 6: Slowly return to the sitting position and return your head to a neutral, forward-looking position.
Step 7: Sit for 10 minutes before moving.
Step 8: Repeat once a day until symptoms have resolved.
3. Foster maneuver
The Foster maneuver is a good option for those with BPPV who experience dizziness while doing other exercises for vertigo. Also called the half somersault, the Foster maneuver doesn’t work as quickly in reducing vertigo symptoms as the Epley maneuver, according to research. But it results in less dizziness afterward.
This exercise is meant for people whose right ear is affected. If your left ear is affected, do the opposite of what is written.
Step 1: Start kneeling and place both hands on the floor.
Step 2: Tilt your head back. Hold in this position for 15-30 seconds or until dizziness passes.
Step 3: Bend forward, place your forehead on the floor, and tuck your chin.
Step 4: Turn your head 45 degrees to face your right elbow. Hold for 30 seconds or until the dizziness passes.
Step 5: Keeping your head turned in the same direction, quickly raise your trunk until your head is level with your body (parallel to the floor). Your hands will stay on the floor. Hold for 30 seconds.
Step 6: Raise up to the starting kneeling position.
Step 7: Wait 15 minutes before repeating.
Step 8: You may need to repeat 4-5 times before experiencing symptom relief.
4. Brandt-Daroff exercise
The Brandt-Daroff exercise is another move that can help move the calcium crystals in the ear to the correct position for those with BPPV. Research suggests it’s less effective than the other maneuvers mentioned here. This move may be good for those with back issues as it is a slower sequence.
Step 1: Sit upright on your bed or the sofa.
Step 2: Turn your head 45 degrees to the right.
Step 3: Keeping your head in this position, quickly lie down on your left side. Stay until your dizziness goes away, and then wait an additional 30 seconds. If there’s no dizziness, wait 30 seconds.
Step 4: Sit up quickly. Hold for 30 seconds.
Step 5: Turn your head 45 degrees to the left.
Step 6: Quickly lie down on your right side, keeping your head in the same position. Stay until your dizziness disappears, and then wait an additional 30 seconds. If there’s no dizziness, wait 30 seconds.
Step 7: Sit up quickly. Wait 30 seconds.
Step 8: Do this sequence 5 more times, twice a day.
5. Cawthorne exercises
Cawthorne exercises are a set of moves that may help improve balance and equilibrium, as well as reduce dizziness. Moving the head and eyes in specific sequences may help retrain the brain, which decreases symptoms. These exercises can be used for both peripheral and central vertigo.
Cawthorne exercise 1: Eye exercise
Step 1: Sit in a chair with both feet flat on the floor.
Step 2: Hold your head still as you look up toward the ceiling and then down to the ground.
Step 3: Start slowly, and then move more quickly. Repeat 20 times.
Step 4: Repeat twice a day.
Cawthorne exercise 2: Head exercise
Step 1: Sit in a chair with both feet flat on the floor.
Step 2: Turn your head from one side to the other.
Step 3: Start slowly, and then move more quickly.
Step 4: Repeat 20 times.
Step 5: If there’s no dizziness, repeat the steps with your eyes closed.
Step 6: Repeat twice a day.
6. Gaze stabilization exercise: Near-far focusing
Gaze stabilization exercises help your brain adapt to visual signals, which affect your proprioception (the sense of where your body is in space). The exercises train your eyes to shift focus quickly, which is essential for maintaining balance and mobility.
Step 1: Sit in a chair with your feet on the floor.
Step 2: Hold your thumb about 10 inches from your face. Focus on it for several seconds.
Step 3: Quickly shift your focus to another object about 10 ft away.
Step 4: Continue to alternate your focus between your thumb and the other object for 3-5 minutes.
7. Romberg exercise
Like gaze stabilization, posture stabilization like the Romberg exercise helps improve balance and proprioception. This is helpful for people with vertigo who have trouble with standing balance.
Step 1: Stand with a wall behind you and a chair in front of you. This gives you support in case you fall.
Step 2: Stand with your feet close together and your arms down at your side.
Step 3: Hold for 30 seconds, maintaining balance.
Step 4: If you can do this easily, repeat with your eyes closed.
Step 5: Hold onto the chair for support as needed. The goal is you can do this without swaying or holding onto the chair.
Step 6: Repeat twice a day.
Frequently asked questions
The most effective exercise depends on the type of vertigo you have. Research found that those with the most common type of vertigo, benign paroxysmal positional vertigo (BPPV), had 90% improvement with the Epley maneuver, around 73% with the Semont maneuver, and 50% improvement with the Brandt-Daroff exercises. For those with central vertigo, balance and coordination exercises are best.
If you have BPPV, exercises such as the Epley maneuver can reduce or alleviate symptoms of vertigo quickly. Medications, such as antihistamines and motion sickness medication, can also quickly relieve vertigo symptoms. Vertigo symptoms due to central causes respond more slowly to treatment.
For those with BPPV, sudden changes in position or quick head movements can trigger an attack. Lifestyle factors, such as lack of sleep, diet (like alcohol, caffeine, high-sodium foods), and dehydration, can increase symptoms. Stress and anxiety can also lead to an increase in vertigo symptoms.
The bottom line
Vertigo makes you feel like your surroundings are spinning. It’s a symptom of an underlying condition. So, it’s important to find the cause (peripheral or central) to know the best treatment and exercises for vertigo. The most common type of peripheral vertigo is benign paroxysmal positional vertigo (BPPV), which responds quickly to a few different exercises (Epley maneuver, Semont maneuver, and Brandt-Daroff exercises). Central vertigo is less common and can be more difficult to treat. For both types, balance and coordination exercises, medications, and lifestyle strategies can also help reduce vertigo symptoms.
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References
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