You do the recommended exercises, and afterwards the ground seems to sway more than before. Perhaps you wonder whether the training is working or you are asking too much of yourself. That question deserves a specific answer. “You have to push through” is no more a useful training plan than a blanket ban on any noticeable response.
Keep practising or pause?A slight, temporary increase in symptoms may be planned in certain supervised vestibular exercises. You should not simply overlook pronounced, unusual or persistent worsening. Stop the exercise that triggers it, protect yourself against falls and discuss the response with the professional supporting you. The training aim, dose and recovery matter, rather than just the number of repetitions.
What is the exercise actually meant to improve?
“Balance exercises” covers very different tasks. Standing on one leg, keeping a letter clear while turning your head and looking at a moving visual field are not interchangeable versions of the same exercise.
One task may challenge standing stability. Another aims at gaze stabilisation during head movements. Another supports gradual habituation to a particular trigger. The starting question is therefore: which limitation was identified, and why was this particular task selected?
There is good support for targeted vestibular rehabilitation in reduced peripheral vestibular function identified medically or therapeutically. The corresponding clinical guideline by Hall and colleagues concerns this patient group. Its exercise programmes cannot automatically be applied to every form of dizziness.
Three responses requiring different steps
Mild, familiar and within the agreed rangeThe familiar sensation increases a little and subsides within the recovery period discussed. You remain safe, and the rest of your day does not worsen. This may fit supervised habituation training. The acceptable response should be agreed with your professional beforehand.
Too strong or too prolongedYou then have to lie down for a long time, walk less well or are much more restricted the following day. In that case, continuing the current version unchanged is not a sensible standard approach. Pause the triggering task and have the selection, amount and possible need for assessment reviewed.
New or unusualNew double vision, speech disturbance, paralysis, sudden pronounced inability to walk or an unusually severe headache are not a normal exercise response: call 112 immediately. New hearing loss or a clearly changed pattern of dizziness also needs prompt medical assessment.
Why the same exercise can vary greatly in difficulty
Imagine being asked to look at a letter and move your head. The demands already change with how quickly and how far you turn. Distance, print size and background also matter. Sitting in front of a plain wall is a different task from standing with feet close together in front of a television that is on.
If several demands are increased at once, it remains unclear which was excessive. In a functional assessment, I therefore change individual conditions as specifically as possible. A smaller movement, quieter background or more stable starting position can make a large difference. This does not mean the same adjustment helps everyone.
Timing also matters: a demanding task just before driving or walking over uneven ground is unsuitable if you do not yet know its after-effects. A training plan must fit the day, rather than merely appear plausible on paper.
An example from functional training planning
The letter becomes unclear when turning the headAs a starting task, we compare a brief, tolerable head movement while looking at a stationary target. We then reduce, for example, movement speed without also changing distance and background. We record image clarity, effort and symptoms. The original task is then compared again and recovery observed. This constructed example illustrates the approach; it is not a general exercise instruction.
If a version is better tolerated, it may be a suitable starting point. The next question is how reliably it works later too. An immediately good comparison and a difficult afternoon need to be considered together. Conversely, a task that does not improve immediately does not automatically rule out a therapeutically useful learning process.
Neuroathletic work with tasks, dose and progress is different from NeuroFI testing through an indicator muscle. The suitable approach depends on the concern. For more about how the eyes and head interact, see the article on the vestibulo-ocular reflex and gaze stabilisation.
What you can note before your next discussion
A brief description is enough: which exercise was it? In what position, for how long and at what speed? How did you feel beforehand, immediately afterwards and later in the day? Could you carry on with your usual activities? This provides more to work with than “The exercise was bad”.
Do not repeat a clearly distressing task several times just to obtain an exact number. Bring the existing exercise plan to your appointment. Programmes prescribed medically or through physiotherapy should be adjusted in agreement with the responsible professionals.
Common questions about exercise dose
Does a good exercise have to help immediately?No. A training programme may work through repeated practice at an appropriate dose. Immediate relief is a useful indication, but not the only quality criterion.
How long is it acceptable to feel dizzy afterwards?There is no suitable general rule in minutes for all causes and exercises. Agree on an individual range beforehand. If the response is much stronger or lasts longer than discussed, the plan should be reviewed.
Is worsening a sign that it is working?Not automatically. Initially, it describes a response to a demand. Whether that is acceptable in the particular training depends on the aim, intensity, duration and overall course.
Should I avoid all movement?Pausing an exercise you cannot tolerate does not mean stopping every safe everyday movement. Suitable activities can be agreed individually with the professional supporting you.
A good plan also explains when it changes
An exercise needs an aim, starting position and dose. It also needs criteria for when to make it easier, harder or suspend it for now. Only then does an exercise list become an understandable training process.
Would you like to understand your functional training approach more closely?In my work with dizziness and balance in Vilshofen we consider specific tasks and how well you tolerate them. If your dizziness has been assessed, you can describe where your current approach is not getting you further in a free initial consultation.
Sources and further reading
Hall et al. (2022): Vestibular Rehabilitation for Peripheral Vestibular Hypofunction – Updated Clinical Practice Guideline. Applies to diagnosed peripheral vestibular hypofunction.
University Medical Center Hamburg-Eppendorf: Dizziness. Assessment and treatment approaches according to cause.
University Medical Center Hamburg-Eppendorf: Dizziness. Assessment and treatment approaches according to cause.
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