The Hidden Role of Vestibular Therapy in MS Balance Problems
If you or someone you love with MS struggles with dizziness, imbalance, “spaciness,” or feeling off when moving, you might assume it’s “just MS.” But often, there’s more going on - particularly in the vestibular system (inner-ear + brain integration for balance, spatial orientation, and visual-motion control). Vestibular problems are common in MS, and proper vestibular therapy can make a huge difference.
Why Vestibular Issues Are Common in MS
Research shows vestibular dysfunction occurs in 30% to 70% of people with MS (Mardsen, 2025)
MS-related demyelination or lesions can impact not just limbs or spinal tracts, but also central vestibular pathways: brainstem vestibular nuclei, oculomotor tracts, cerebellar connections — all of which are critical for balance, eye-movement control, and spatial orientation.
Because vestibular symptoms often overlap with "just fatigue" or "just MS-balance problems," they can be overlooked or misattributed, but identifying vestibular dysfunction can open up effective treatment avenues.
What I Often See in MS Patients: Eye Movement + Vestibular Clues
In my clinical/rehab work, I frequently uncover vestibular signs that help explain “why balance feels off” or dizziness in clients living with MS:
Abnormal functional eye movements: issues with saccades (fast eye-jumps), smooth pursuits (tracking), or eye-motion stability.
Sometimes nystagmus, involuntary, rhythmic eye movements, especially when doing head turns or positional changes.
Complaints of visual motion sensitivity: difficulty when moving through busy visual environments (crowded grocery aisles, scrolling on a screen, busy traffic), or dizziness with visual motion... a sign that visual-vestibular integration may be impaired.
Episodes of vertigo or positional dizziness, especially when changing head positions or lying down, raising suspicion for coexisting vestibular disorders like BPPV.
These are more than “just feeling wobbly.” They point to vestibular system involvement - either central (due to MS) or peripheral (inner-ear) - both of which may respond very differently to therapy.
What About BPPV & Inner-Ear Issues (Yes - It Happens, Even With MS)
It’s not rare for people with MS to have a secondary vestibular issue - for example, inner-ear issues like BPPV, on top of central vestibular dysfunction.
BPPV results from dislodged “otoconia” (tiny calcium crystals) in the inner ear’s semicircular canals. When they shift during head movement, you get brief but intense spells of positional dizziness or vertigo (e.g. when turning in bed, looking up, bending over).
Some MS patients with dizziness benefit from workup for BPPV or other peripheral vestibular disorders, especially if their dizziness is positional or triggers with head/neck movement.
Importantly: there is a link between low Vitamin D and higher risk of BPPV with recurrent vertigo episodes.
Because people with MS also have a link to lower Vitamin D levels, this could be an additional association.
Why Vestibular Rehabilitation Therapy (VRT) Matters And How It Can Help
A 2020 systematic review concluded that vestibular rehabilitation shows promise as a safe and effective option to improve balance, reduce dizziness, and reduce fatigue in people with MS (Synnott 2020).
A randomized controlled trial comparing a customized vestibular rehab program vs. a generic home-booklet for MS with vestibulopathy found meaningful improvements, supporting the cost-effectiveness and potential benefits of tailored vestibular therapy in MS. (Ebrahim 2023)
Vestibular rehab for MS isn’t just “copy what you do for inner-ear vertigo.” Because central (brain/nerve) pathways are often involved, VR needs to be carefully adapted, combining eye-movement-training, gaze stability, head/eye coordination, balance work, visual-motion habituation, and sometimes positional maneuvers (if BPPV is present).
When done properly, vestibular therapy can lead to improvements in balance, spatial orientation, stability during walking, reduced dizziness/spinning, and less fatigue.
In short: for many people with MS, vestibular rehab may be exactly the “missing piece” that helps restore confidence in movement.... not just weaker muscles or poor conditioning.
Why Vestibular Symptoms Often Get Missed in MS And Why That’s a Problem
Vestibular issues in MS don’t always present as classic “spinning vertigo.” Many people describe “unsteadiness”, “fogginess", “off-balance feeling", “visual overload”, like their eyes are "slow", or “wobbliness” rather than dramatic spinning.
If healthcare providers treat only lower-limb weakness, spasticity, or ataxia, they may miss vestibular dysfunction entirely, leading to incomplete rehab plans.
Without vestibular rehab, central vestibular deficits may persist or worsen, inner-ear problems (like BPPV) may recur, and patients may lose confidence and avoid movement, which can accelerate deconditioning, falls, and reduced quality of life.
What People With MS Can Do — Practical Steps & What to Watch For
If you live with MS and struggle with balance, dizziness, or visual motion sensitivity:
Ask for a vestibular screening! Even if your main diagnosis is “just MS.” This may include eye-movement assessments (saccades, smooth pursuits), positional tests (for BPPV), and gaze/head-movement tests.
Check Vitamin D levels, especially if you have low sun exposure, limited mobility, or recurrent dizziness episodes. Correcting Vitamin D may help reduce the reoccurrence of BPPV.
Consider vestibular rehabilitation — ideally customized to you: combining eye-movement training, gaze stability, balance work, visual-motion tolerance, and safe positional maneuvers if needed.
Be patient but diligent: Vestibular rehab in MS may take longer than “typical” vestibular rehab because central nervous system pathways may remap slowly. Consistency and progression matter.
Integrate vestibular rehab into a broader neuro-rehab + lifestyle plan, including strength, flexibility, fatigue management, posture, hydration, sleep, and meaningful movement in daily life.
How Online Coaching / Neuro-Rehab Programs Fit — Especially for MS
One of the greatest barriers many people with MS face is access, whether due to mobility, geography, fatigue, or energy. That’s where online neuro-rehab coaching shines:
Through telehealth, we can guide eye-movement tests, positional screening (with caregiver or family member assisting, if safe), and customized vestibular/balance exercises that fit your home environment.
We can help monitor visual-motion triggers (busy rooms, screens, lights) and tailor visual-motion desensitization exposure, gradually increasing complexity in a controlled way.
We can integrate vestibular rehab with fatigue management, strength, balance, and functional mobility, providing a holistic plan that addresses both central nervous system demands and peripheral vestibular health.
Coaching also supports accountability, progression tracking, and adjustment — which are key because MS + vestibular issues require adaptive programming.
If you’ve been told “that’s just how MS is,” and you’ve already adapted life to avoid dizziness and imbalance, you might be missing the opportunity for meaningful recovery. Vestibular rehab doesn’t promise perfection. But for many people with MS, it can mean less dizziness, fewer falls, more stability, and a better quality of life.
Final Thoughts
Vestibular dysfunction in MS is more common than many realize, and often overlooked. Whether the root is central (brain/nerve), peripheral (inner ear), or both - vestibular rehabilitation represents a powerful, evidence-based, and often under-utilized tool in the neuro-rehab toolbox.
If you or your loved one experience dizziness, off-balance feelings, visual motion sensitivity, or unsteady walking, don’t automatically chalk it up to “just MS.” Reach out for vestibular assessment, ask about Vitamin D, and consider a customized vestibular rehab plan, maybe even one delivered online and tailored to your lifestyle.
Your nervous system has the capacity for change and improvement. With the right approach, balance can be retrained and life can feel steadier again.
If you’re curious if vestibular therapy + neuro rehab coaching is the right fit, let’s chat.
Sources
Marsden J, Dennett R, Gibbon A, Knight Lozano R, Freeman JA, Bamiou DE, Harris C, Hawton A, Goodwin E, Creanor S, Sorrell L, Hoskings J, Pavlou M. Vestibular Rehabilitation in Multiple Sclerosis: Randomized Controlled Trial and Cost-Effectiveness Analysis Comparing Customized With Booklet Based Vestibular Rehabilitation for Vestibulopathy. Neurorehabil Neural Repair. 2025 Sep;39(9):687-700. doi: 10.1177/15459683251345444. Epub 2025 Jun 17. PMID: 40528281; PMCID: PMC12405695.
Eoin Synnott et al. The Effectiveness of Vestibular Rehabilitation on Balance Related Impairments among Multiple Sclerosis Patients: A Systematic Review. J Mult Scler (Foster City), 2020, 7(1), 01-08.
Ebrahim, Manar & Abd-Elraouf, Soha & Ibraheem, Ola & Ibrahim, Walied & Hamdy, Mohamed. (2023). Vestibular rehabilitation therapy in Patients with Multiple Sclerosis. European Chemical Bulletin. 12. 3691-3706. 10.53555/ecb/2023.12.Si12.341.
