Vestibular and Balance Physical Therapy
Vestibular Physical Therapy for Dizziness, Vertigo, and Balance Disorders in The Triangle
If you are living with spinning sensations, persistent dizziness, or a feeling of unsteadiness that is affecting your daily life, vestibular physical therapy can help. Dr. Sara Roberts is certified in vestibular rehabilitation and specializes in finding the specific cause of your symptoms and treating it directly, not managing it indefinitely.
Certified
Vestibular rehab specialist on staff
1st
Treatment starts on Day 1
60
Minute 1-on-1 sessions
19
Years of clinical experience
What is Vestibular Physical Therapy?
The vestibular system is your body's internal sense of balance and spatial orientation. It lives in your inner ear and communicates constantly with your eyes, muscles, and brain to keep you steady and oriented in space. When something disrupts that system, the effects can be severe: a spinning sensation that comes on without warning, persistent dizziness that makes it hard to drive or work, difficulty focusing your vision when your head moves, or a constant feeling that the ground is not quite where you expect it to be.
Vestibular physical therapy is a specialized form of PT that assesses and treats the cause of those symptoms directly. Unlike general balance training, vestibular PT targets the specific mechanism of your dysfunction, whether that is displaced crystals in your inner ear, a mismatch in how your brain processes sensory signals, or reduced function in one vestibular nerve. Treatment is evidence-based, often rapid, and when delivered by a trained specialist it is one of the most effective interventions available for vestibular conditions.
Many People Live with Vestibular Symptoms for Months or Years Without Knowing Treatment is Available
Dizziness is one of the most common reasons adults visit their doctor, yet it is frequently undertreated because it is difficult to diagnose without a thorough vestibular-specific evaluation. A certified vestibular PT can often identify the cause of your symptoms in a single session and begin treatment the same day.
Vestibular Conditions We Treat
Vestibular PT addresses a wide range of conditions involving the inner ear, brain, and balance system. Below are the most common conditions we treat in Holly Springs and throughout the Triangle. If your condition is not listed, call or text us. If a vestibular component is involved, there is a good chance we can help.
BPPV (Benign Paroxysmal Positional Vertigo)
The most common vestibular condition and the most commonly missed. BPPV occurs when tiny calcium crystals in the inner ear become dislodged and move into the wrong canal, triggering a brief but intense spinning sensation triggered by head position changes. Rolling over in bed, looking up, or bending forward are classic triggers. It responds quickly to a specific hands-on technique called a canalith repositioning maneuver, which can often resolve symptoms in one to three sessions.
Vestibular Neuritis and Labyrinthitis
A viral or inflammatory event affecting the vestibular nerve or inner ear can cause sudden, severe dizziness, nausea, and a feeling of the world spinning or tilting. The acute phase resolves on its own, but many patients are left with lingering dizziness, unsteadiness, and sensitivity to movement that does not fully recover without rehabilitation.
Post-Concussion Dizziness and Imbalance
Dizziness, difficulty with visual tracking, sensitivity to busy environments, and persistent unsteadiness are common after a concussion and can linger for weeks or months. Vestibular PT is one of the most effective components of concussion rehabilitation, with evidence showing it speeds recovery compared to rest alone.
PPPD (Persistent Postural-Perceptual Dizziness)
A chronic functional vestibular disorder characterized by ongoing dizziness, unsteadiness, or non-spinning vertigo that is worsened by upright posture, movement, and visually stimulating environments. PPPD often develops after an acute vestibular event and is one of the most common yet least recognized causes of chronic dizziness.
Balance Disorder and Fall Risk
Difficulty walking on uneven surfaces, feeling unsteady in the dark, frequent near-falls or actual falls, and a general sense of insecurity while moving are all indicators of a balance system that needs rehabilitation. We assess the specific sensory systems contributing to your instability and build a targeted plan.
Gaze Instability and Visual Vertigo
Difficulty keeping your vision clear when your head is moving, reading in a car, tracking moving objects, or navigating busy visual environments like grocery stores or crowded rooms often points to a gaze stabilization problem rooted in the vestibular system. We address this with specific gaze stabilization exercises.
Meniere's Disease
Meniere's causes episodes of severe spinning vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. While we cannot cure Meniere's, vestibular PT plays an important role in managing the balance and dizziness symptoms between episodes and helping the brain adapt to changes in vestibular function over time.
Dizziness with No Clear Diagnosis
Many patients arrive having seen multiple providers without a clear explanation for their symptoms. A thorough vestibular evaluation often reveals patterns that other assessments miss. We take your symptoms seriously and take the time to investigate properly, rather than attributing dizziness to anxiety or aging without a proper assessment.
Do These Symptoms Sound Familiar?
Vestibular symptoms are often described in very personal, sometimes confusing ways. If any of the following sound like your experience, vestibular PT may be the answer you have been looking for.
Spinning When You Roll Over in Bed or Look Up
Brief but intense spinning triggered by position changes is a hallmark of BPPV and responds very well to treatment.
Blurry or Jumpy Vision When Your Head Moves
Motion sensitivity that has developed or worsened following an inner ear event is a classic sign of vestibular dysfunction rather than ordinary motion sickness.
Nausea or Dizziness in the Car as a Passenger
Motion sensitivity that has developed or worsened following an inner ear event is a classic sign of vestibular dysfunction rather than ordinary motion sickness.
Persistent Feeling of Unsteadiness or Floating
A constant sense that the floor is moving, you are on a boat, or your legs are not quite right underneath you often indicates a vestibular compensation problem.
Dizziness in Busy or Visually Complex Environments
Post-concussion vestibular symptoms are extremely common and respond well to targeted vestibular rehabilitation when addressed properly.
Dizziness or Fogginess After a Concussion
Post-concussion vestibular symptoms are extremely common and respond well to targeted vestibular rehabilitation when addressed properly.
How We Treat Vestibular and Balance Conditions
Vestibular treatment is not generic balance training. Each technique below targets a specific mechanism of vestibular dysfunction and is selected based on the findings of your evaluation. All treatment is included in your session fee.
Canalith Repositioning
A series of precise head and body position changes designed to move displaced inner ear crystals (otoconia) back into their correct position. The Epley, Gufoni, and other repositioning maneuvers are highly effective for BPPV and can often resolve symptoms in one to three sessions.
Balance and Gait Retraining
Progressive exercises that challenge the balance system across a range of surfaces, lighting conditions, and movement demands, building stability and confidence for real-world environments like uneven ground, crowded spaces, and darkness.
Gaze Stabilization Exercises
Exercises that train the vestibulo-ocular reflex to maintain clear, stable vision during head movement. Particularly effective for patients with unilateral vestibular hypofunction, post-viral dizziness, or post-concussion visual symptoms.
Vestibular Substitution
For patients with permanent vestibular loss or reduced function, we train the brain to rely more heavily on visual and proprioceptive inputs to compensate. This central adaptation process can significantly reduce symptoms over time even when the underlying vestibular damage cannot be reversed.
Habituation Training
A graded exposure approach that reduces symptom sensitivity by systematically and safely challenging the vestibular system with movements and environments that currently trigger dizziness. Used for PPPD, visual motion sensitivity, and chronic dizziness.
Education and Activity Management
Understanding your condition, what triggers your symptoms, and how to manage activity during recovery is an essential part of vestibular rehab. We equip you with strategies to continue progressing safely between sessions.
What to Expect At Your Vestibular Evalutaion
A vestibular evaluation at Carolina Elite is more comprehensive than a standard PT intake. Because vestibular symptoms are complex and can have multiple contributing causes, your first session is a thorough clinical investigation. Here is what it looks like.
1
Detailed Symptom History
We begin by taking a thorough history of your symptoms: when they started, what triggers them, how long they last, and how they have changed over time. This information alone guides the direction of the physical assessment. Prior medical records, imaging, or ENT notes are welcome but not required.
2
Eye Movement and Vestibular Reflex Testing
Your PT assesses how your eyes move in response to specific stimuli and head movements. These tests reveal how well the vestibular system is communicating with the brain and eyes, and often point directly to the cause of your symptoms. You do not need any special equipment or preparation for these tests.
3
Positional Testing
We test specific head and body positions to identify whether BPPV is present and, if so, which canal is affected. Some of these tests may temporarily provoke your symptoms. This is normal, expected, and diagnostic. Your PT will tell you what to expect before each test and will support you throughout.
4
Balance and Gait Assessment
We assess how your balance system performs across different sensory conditions: with eyes open and closed, on stable and unstable surfaces, and during movement. This tells us which sensory inputs your brain is relying on and where the gaps are.
5
Diagnosis, Plan, and Treatment Start
Based on your evaluation, your PT identifies the most likely cause of your symptoms and begins treatment in the same session. For BPPV patients, a canalith repositioning maneuver is often performed at the first visit. For other conditions, your treatment plan and goals are outlined and initial techniques are introduced.
Orthopedic PT
FAQs
Can physical therapy actually cure vertigo and dizziness?
For many vestibular conditions, yes. BPPV in particular is highly curable with the right repositioning maneuver. Studies consistently show resolution rates of 80 to 95 percent with appropriate treatment. For conditions like vestibular neuritis or unilateral hypofunction, PT cannot reverse the underlying nerve damage, but it trains the brain to compensate so effectively that most patients achieve significant or complete symptom resolution. For chronic conditions like PPPD or Meniere's disease, PT manages and reduces symptoms rather than curing them, but the improvement in quality of life can be substantial.
How many sessions will I need?
It depends on your specific condition. BPPV can often be resolved in one to three sessions. Post-viral vestibular hypofunction typically requires 6 to 12 weeks of treatment. Post-concussion vestibular symptoms vary widely based on severity. Chronic balance disorders may require ongoing maintenance. What we can promise is that you will have a clear picture of your expected timeline after your evaluation and we will track your progress and adjust the plan at every session.
I have already seen an ENT. Why do I need a vestibular PT?
ENT physicians are essential for ruling out serious pathology, managing medication, and performing procedures like ear canal procedures. What they are typically not trained to do is the functional vestibular rehabilitation that helps your brain adapt, compensate, and recover after a vestibular event. PT and ENT care are complementary. Many patients see excellent results from vestibular PT after an ENT has confirmed the diagnosis or ruled out other causes.
Will the exercises make my dizziness worse?
Some vestibular exercises intentionally provoke mild dizziness as part of the treatment. This is normal, expected, and a sign the exercises are working. The dizziness provoked by therapeutic exercises is brief and controlled, and your PT calibrates the intensity so it is challenging but manageable. The goal is for your brain to experience that stimulus repeatedly so it learns to process it without generating symptoms. Your comfort and tolerance are always monitored throughout every session.
Do I need a referral to start vestibular physical therapy?
No. North Carolina is a direct access state, meaning you can begin vestibular PT without a referral from your physician or ENT. You can book directly online or call and text us. If you have already seen a provider and have imaging or test results, bring those along. They are helpful context but not required to get started.