Balance and Vestibular Rehabilitation

The Body Compass

So, what do I mean by balance problems? 

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We rely on our balance in every activity we do and good balance comes from the integration of complex systems in our body. Balance problems may often be referred to loosely as having vertigo, or being dizzy, light headed, unsteady, woozy or wobbly. It’s often frightening and disorientating to lose your balance, to not know whether you or the world is moving and can often be associated with a wide range of other symptoms including nausea and headaches.

So when your balance is ‘off’, it’s often an indication to explore further beyond the initial symptoms in order to provide an effective and individualised course of exercises and treatment, which is also known as vestibular rehabilitation.

Control of your balance is brought about through the integration of three systems: your inner ear semicircular canals, your visual system and feedback from your joints and muscles in your body. Balance problems happen when any one of these systems doesn’t work properly either on their own, or in the way that they communicate with each other in the brain. At The Body Compass my aim is to firstly find out why your balance is ‘off’.  I take a functional approach to assess which parts of your nervous system and body are involved and then work out what can be done to improve it.

This is a three stage process:

Stage One

Diagnosis, Trial and Relief. The focus here is to find the cause of the problem. This involves taking your history, a physical and neurological examination and further test to look at your balance and visual system. If appropriate you will start a course of treatment to create a change in your neurology, improve your function and relieve your symptoms.

Stage Two

Correction and Rehabilitation. Once we know what is causing the problem, a specific tailored programme is made for you, which includes regular exercises for you to do at home, and is supported by visits.

Stage Three

Stability and beyond. Your balance is an integral and vital part of your overall health. Once you have regained your balance and health, regular checks not only help your balance but all the other systems in your body.

Types of Balance Problems

There are four general categories of balance problems that I see depending on which systems in the body are affected. There is a list with more specific explanations of commonly diagnosed conditions for balance problems below this.

1. Poor Balance in Association with Musculoskeletal Problems

You may come with issues that are more traditionally related to Chiropractic care that affect balance. As part of the treatment and rehabilitation, this area is regularly assessed. Equally, if you have poor balance due to a functional problem in the way that your brain processes balance, then you may well have problems with your back and neck.  This can be either because your brain doesn’t know where you are in space, or where your head is in relation to your body. This sensory mismatch can then lead to tight muscles, joint dysfunction and pain.

2. Known Conditions with Balance Problems

In this case you may already have a known problem, such as Parkinson’s Disease, Multiple Sclerosis or Cerebellar Ataxia. These are diagnosed conditions that are not going to go away, so treatment is aimed at maintaining, improving and supporting your balance as much as possible. It is just as important, for someone with a degenerative neurological disease to maintain and optimise their neurological function.

3. Intermittent Balance Problems

Many of these problems come from problematic episodes involving the systems that help us balance. This may be as a result of a head injury causing concussion or mild traumatic brain injury, a neck injury from a road traffic accident or surgery to the head or neck. It can also be due to problems with the balance centres in your ear, resulting in Benign Paroxsymal Postural Vertigo (BPPV) or labyrinthitis. In some cases it can also be due to poor movement in, or injury, to the feet and ankles which can have a profound effect on balance. The diagnosis of Persistent Postural-Perceptual Dizziness also fits in here, this is the   Lastly, rehabilitation for balance in the case of post operative benign brain tumours, especially in the cerebellum, and cervical spine decompression.

4. Performance

At the high end of function, balance is essential for both performance and injury prevention. Here testing and assessment are taken to the next level, involving more challenging scenarios and finer tuning. This is taking neurological function to it’s highest level of peak performance.

“Many people also choose The Body Compass for overall wellness – understanding that health is about their active involvement in being well and staying well, rather than just the absence of illness.”

Common Diagnoses for Balance Problems

Balance problems can be caused by a number of different conditions. In most cases my work is to diagnose, provide support, rehabilitation and to improve function, helping gain and maintain balance for people who already know they have a problem. In some cases I will refer you for imaging such as an MRI or X-ray, or to another specialist such as an Neurologist, ENT Consultant, Audiologist, Optmetrist or a Counsellor or Psychotherapist if that is appropriate.

Benign Postural Paroxysmal Vertigo - BPPV

The inner ear, which constantly provides information to your brain about where you are in space, can become irritated by floating calcium crystals. These crystals can cause acute vertigo with certain head movements which are often associated with turning in bed or laying down. This usually responds well to treatment with the Epley Manouvre, followed by rehabilitation and home exercises.

Menieres Disease

Menieres disease has a number of different symptoms, including hearing loss, tinnitus, and vertigo. The vertigo usually presents as acute episodes, due to irreversible damage to the hair cells in the inner ear. This can often lead to deafness and balance problems on one side.


This is often an acute attack of vertigo or dizzyness, nausea often with vomiting and tinnitus. The cause is usually an inner ear infection, causing inflammation of the balance structures, leading to the wrong signals being sent to the brain. In acute episodes, it responds well to medication to manage the debilitating symptoms. The recovery phase includes the important phase of rehabilitation for the balance centres in the brain.

Vestibular Neuritis

Vestibular Neuritis is caused by inflammation of the vestibular nerve, thought to be due to viral infection, and is similar to Labyrinthitis except that there is no change to your hearing in Vestibular Neuritis. Acute episodes are often managed with medication and any lingering symptoms usually respond well to vestibular rehabilitation.

Persistent Postural-Perceptual Vertigo - PPPV

This is a functional diagnosis made for people have a persistent sensation of non-rotational dizziness or unsteadiness, as well as a hypersensitivity to motion, lasting at least 3 months. It is the most common cause of chronic dizziness in 30-50 year olds, often following an event that caused acute vertigo or dizziness, such as labyrinthitis, vestibular neuritis or a panic attack. Typically, patients recover from the initial acute disease, but the feeling of dizziness persists. Vestibular rehabilitation, with a focus on how balance is processed centrally in the brain as well as therapy to help with anxiety can help here.

Multiple Sclerosis

Multiple Sclerosis has a variety of different ways in which it affects the nervous system and balance. The problems are caused by the loss of fat around the nerves that usually provides insulation and allows the signals to travel both quickly and clearly around the brain and the body. The symptoms will depend on which nerves are affected and amongst other things, can lead to problems with balance and co-ordination.


Parkinsons disease is a degenerative neurological disease of a specific part of the brain that plays an important role in co-ordinating movement. It classically has three elements to it, tremor, rigidity and slowness of movement, all of which have an impact on balance.

Vestibular Migraine

Migraines can often cause problems with balance, especially if the migraine is associated with movement.

Concussion or Mild Traumatic Brain Injury

Concussion can lead to problems with balance, often with the onset in the very early stages after an injury has been sustained. Although the injury may not necessarily be a direct blow to the head, it is the resultant movement of the head and neck that causes damage to the brain tissue. In most cases recovery from concussion is usually within 2 weeks for adults, or 3 weeks for children and adolescents

Joint and Muscle Problems

An old sprained ankle, a weak knee, a stiff hip, back or neck, all of these can affect your balance. Usually we are distracted by the discomfort that is associated with these problems which is the main cause to seek help, however any joint that has a restriction in it’s movement will also have a bearing on your balance.

Visual problems

Problems with eye movement and co-ordination of the eyes can lead to either blurred vision or double vision, both of which will have an impact on balance.

Cardiovascular Disease and Hypotension

An abnormal heart beat, and narrowing of the blood vessels to the heart can make it hard for enough oxygen to be supplied to the brain. This can lead to a sensation of light headedness, especially in response to movement or exercise. Very low blood pressure or hypotension, can also result in a lack of oxygen getting to the brain which will also lead to light headedness.


Lightheadedness and dizziness can also be an indication that there is a problem with your medication, which if you are taking it should be reviewed regularly by your pharmacist.

Stress and Anxiety

Many people experience dizziness or vertigo as a result of stress. Roughly a third of people with dizziness have anxiety and a third of people with anxiety have dizziness.

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