NE A P OR 229-8064 (800) 837-8428 Balance Retraining

5018 NE 15TH AVE · PORTLAND, OR 97211 · FAX: (503) 229-8064 · (800) 837-8428 · INFO@VESTIBULAR.ORG · VESTIBULAR.ORGBalance RetrainingExercises Which Speed Recovery from Dizziness & UnsteadinessBy Professor Lucy YardleyDISCLAIMERThis booklet includes exercises that aresuitable for people suffering from balanceproblems and dizziness. They are typicalof the sort of exercises that are providedin physiotherapy rehabilitation programs.These exercises can be used for a rangeof balance problems and/or dizziness.However, they are not effective for allkinds of dizziness. It is important tocheck with your doctor to see if theseexercises are suitable for you BEFOREyou try any of the exercises on your own.If you have access to a vestibularrehabilitation center, it is preferable toexplore treatment under the supervisionof a trained physical or occupationaltherapist.Exercises such as these take many weeksto start recalibrating the balance systemand they are hard work. Initially theymay make general balance and/orgiddiness seem worse. If you are unsurewhether to do them, discuss it withsomeone within your healthcare teamwho has an understanding of yoursymptoms.In supplying this information theVestibular Disorders Association acceptsno responsibility for the response to, oroutcome from, undertaking suchexercises.Supplement for people with ChronicDizzinessCan balance retraining exercises helpsomeone with chronic dizziness?‘Balance retraining’ is a therapy whichcan speed recovery from any change inbalance system function - includingchanges caused by chronic dizziness. Butif you have chronic dizziness, you need tounderstand the difference betweenattacks of vertigo (which the exercisescannot help) and long-lasting dizzinessand imbalance (which the exercises canhelp).Attack of vertigo. This is a strongsensation of spinning which happenssuddenly, lasts several hours, and usuallycauses you to be sick, and to be unableto stand up, walk or drive. In chronicdizziness, attacks of vertigo are causedby changes in the inner ear. Theexercises cannot prevent theseattacks - but they cannot cause themeither. If you are currently having thesekinds of attacks very frequently (everysix weeks, or more often) then theexercises cannot help you just now, as Vestibular Disorders Association vestibular.org Page 1 of 10

recovery takes at least six weeks evenwith the exercises.quickly, using the exercises to help toclear up symptoms.Long-lasting dizziness andimbalance. The changes in the inner earwhich cause an attack of vertigo result ina change in the signals given out by thefaulty balance organ. Over time, yourbrain adjusts to these new signals (thebooklet explains how this happens), andso you become less dizzy. Balanceretraining exercises can speed thisprocess of recovery.Common Questions About DizzinessAttacks of vertigo do not normally occurvery often - usually there are manymonths or even years between attacks,although there are sometimes periodswhen the attacks occur frequently. Butyou may find that in between the attacksof vertigo you have long-lastingsymptoms, such as dizziness, nausea,unsteadiness, tiredness, or a ‘hangover’feeling. These symptoms often becomeworse when you are physically active,tired, stressed, or when you travel. Theexercises can help you to clear up thesesymptoms during the period in betweenattacks of vertigo.Of course, after you have cleared up thelong-lasting symptoms, you may haveanother attack of vertigo. In this case,you will have to start all over again, usingthe exercises to speed recovery. Butpeople with Chronic dizziness who havetried these exercises say that they givethem confidence that they will be able toget over their next attack of vertigo moreWhy do I feel dizzy, disoriented orunsteady?The balance system relies on threedifferent senses. Using your eyes youcan see where you are and where you aregoing. Using the sensors in your bodyyou can feel where you are and how youare moving. And the balance organ inyour inner ear (which doctors sometimesrefer to as the vestibular organ orlabyrinth) senses whenever your headmoves.Your brain acts like a computer,combining signals from these threesenses to give you a stable picture of theworld and control your head, body andeye movements. If any part of thisbalance system is giving out unusual orfaulty information then you may feeldizzy, disoriented or unsteady.What causes dizziness andimbalance?The balance system can be affected bymany different medical problems, and soit is important to see your doctor andcheck which part of the balance system isnot working normally. If your symptomsseem to be caused by your balance organyour doctor may tell you that you havevertigo, or vestibular imbalance. This canresult from a mild virus or ear infection,or sometimes just wear and tear on thebalance organ. Sometimes your doctor Vestibular Disorders Association vestibular.org Page 2 of 10

will not be able to discover why thedizziness started, but balanceretraining can still help to speedrecovery even when the cause for thedizziness is not known.If your balance system is not workingnormally, then you may find that youbecome dizzy whenever you make quickor unusual movements, such as reachingup or looking behind you. You may alsobecome dizzy when you are moved (e.g.in cars or lifts), or when you are in asituation with a lot of moving lights,objects or people (e.g. in busy traffic).Is dizziness abnormal or harmful?If your balance system is not workingnormally, it is very rare for this to bebecause of a dangerous medicalcondition. But although dizziness is notusually a sign of a dangerous illness, it isvery unpleasant and frightening and cancause other symptoms and nausea,tiredness and difficulty concentrating.Often people who are dizzy avoid physicalactivity and quick movements, and thiscan lead to other health problems such asa stiff neck and headaches, and becomingunfit. Because of dizziness peoplesometimes end up avoiding even vitalactivities, such as working, travelling orgoing out alone. You need to have goodbalance as you get older, to reduce therisk of falling and hurting yourself. Soeven though dizziness is not usuallydue to serious illness, it is stillimportant to speed recovery from it.What can I do to speed recovery?The bad news is that there is nomedicine which can make the balancesystem work normally. Your doctor maybe able to give you tablets to ease thedizziness and nausea, but these will notcure the problem. Sometimes thedizziness will clear up over a month ortwo, if you keep up your normal activities(see next section). If this has nothappened, then the good news is thatyou can speed this natural recoveryprocess using the exercises in thisbooklet.How do balance retraining exercisesspeed recovery?Recovering from dizziness is exactly thesame as getting your sea legs. At firstbeing at sea makes people unsteady andsick, but if you stay at sea then graduallythe brain learns to cope with the newbalance signals from the eyes, body andbalance organs, and the sicknessdisappears. In the same way, the braincan gradually overcome dizziness andimbalance due to a change in the way thebalance system is working, followinginjury or illness. But your system canonly learn to cope with the newbalance signals if you practice theactivities which cause dizziness.Balance retraining exercises give yourbalance system all the practice it needs,at a time and place where you will not bedistracted or put at risk.How can I tell if these exercises willhelp me?In scientific studies, 75%-80% (four outof five people) who were taught these Vestibular Disorders Association vestibular.org Page 3 of 10

exercises reported feeling better within afew months. A comparison group ofpeople who were not taught the exercisesdid not get any improvement in theirdizziness.To find out whether these exercises areright for you, simply try out the exerciseson the next pages. If they do not makeyou dizzy, even when you carry them outat top speed, then they will not help you.If they make you dizzy then this is asign that your system needs practicewith these activities. Until your systemhas learned to cope with thesemovements, you will become dizzywhenever you have to carry out thesemovements as part of your normal dailyactivities.Can these exercises do me any harm?The exercises are based on normal headmovements that you should be able tomake during your daily life, and so theywill be totally safe unless you have beentold you should avoid these headmovements. If you feel a bit more dizzywhen you start the exercises this justmeans that they are working – theycannot cause any damage to thebalance system – but you may want topractice them more slowly at first. If youhave a stiff neck, you will also need tomake the movements gently to startwith, but the exercises should graduallyhelp to ease the stiffness. If the exercisesseem to bring on any of the symptomslisted below (which is very unlikely), or ifyou have these symptoms already, youshould not carry on with the exercisesuntil your doctor has said it is safe foryou to do them.Avoid doing the exercises if doingthem seems to cause any of thesesymptoms: sharp, severe or prolongedpain in your neck, head or ear; a feelingof fullness in the ear; deafness or noisesin the ear; fainting with loss ofconsciousness or blacking out; doublevision; numbness, weakness or tingling inyour arms and legs.If doing this makes you begin to blackout, visit your doctor.Carrying out the exercisesHow to design the right exerciseprogram for youEveryone’s lifestyle is different, anddifferent movements make differentpeople dizzy. This page shows you how todesign an exercise programme which willsuit you. Vestibular Disorders Association vestibular.org Page 4 of 10

1. The first vital step is to find a goodtime to carry out the exercises. Theytake less than 10 minutes, and it isvery important that you practicethem every day – even better, twicea day. Decide now on two times whenyou will try to do them, and writethem times down on the exercisesheet at the back of this book.2. Next choose a place to do them –somewhere that you can sit down andwalk about safely without trippingover things or knocking on hardobjects (e.g. beside your bed or thesofa).3. Now you need to choose whichexercises to do this week, using thetimed exercise scoring test. Forthis, you may find it helpful to ask arelative or friend to help you time howfast you do the exercises – and toencourage you!Timed exercise scoring test First carry out the shaking exercise onthe next page sitting down After you have finished, wait 10seconds, and then write down howdizzy you feel on the exercise sheet,on the line labeled shaking, underWeek 1 using the following symptomscoring: 0 none, 1 very slight, 2 mild, 3 strong Put an S by each score to show youdid the exercise sitting down Do the same for each of the 6 basicexercises on the next pageUse the scores on your exercises sheet todecide which exercises to do for the nextweek:If you have written 0 by an exercise, youdo not need to do it (as it causes nosymptoms)If you have written 1 or 2 by an exercise,you need to practice it daily.If you have written 3 by an exercise, youneed to practice it more slowly at first,every day.Week12Shake1S 1SNod0S 1STShake EC2S 1SNod EC0S 2STShake/stare2S 2SNod/stare1S 0SIn week 3, this person will need topractice the nod exercises standing upand the shake exercises sitting down.The basic exercisesIt helps to breathe slowly if you feel dizzy– no more than one breath every four tosix seconds. To loosen up before starting,gently shrug your shoulders and circlethem around a few times.1. Shake: Turn your head from right toleft and back again 10 times in 10seconds. Twist your head round as faras it will go comfortably when you do Vestibular Disorders Association vestibular.org Page 5 of 10