Balance Training To Help Prevent Falls: A Structured Plan for Vestibular Rehabilitation Therapy (VRT)

Jaime Hernandez
1 day ago
4 min read

Educational only—not medical advice, diagnosis, or treatment.

Balance Training To Help Prevent Falls, A Structured Plan for Vestibular Rehabilitation Therapy (VRT)

Retraining Balance, Stability, and Confidence Through Evidence-Based Movement

Writer: Jaime Hernandez, LMT, MES, CPT

Founder, Health and Exercise Prescriptions®www.healthandexerciseprescriptions.com

Thorne Store: https://www.thorne.com/u/HealthAndExercisePrescriptions

When Balance Changes, Everything Changes

Balance is one of those abilities we take for granted—until it’s gone.

Standing up from a chair. Turning your head while walking. Stepping off a curb. Rolling over in bed. These movements are automatic—until dizziness, vertigo, or instability suddenly make them feel unpredictable.

When balance falters, people don’t just move less—they think differently. Confidence drops. Movement becomes cautious. Daily life quietly shrinks.

This is not weakness.

It’s a nervous system problem—and the good news is, the nervous system is adaptable.

That adaptability is the foundation of Vestibular Rehabilitation Therapy (VRT).

The Science of Falls: Why Balance Training Matters

Falls are not rare accidents. They are a predictable outcome of untreated balance and vestibular decline.

Current population research shows:

Ages 65–74: approximately 25% (1 in 4) experience at least one fall each year
Ages 75–84: fall rates increase significantly beyond earlier senior years
Ages 85+: 40% or more fall annually
Overall, about 1 in 3 adults over 65 fall each year

More importantly, fall severity increases sharply with age. Hospitalization, loss of independence, and long-term disability are far more common after age 75.

Vestibular dysfunction—inner ear and balance system impairment—is present in over half of older adults who fall, and dizziness itself is a major predictor of future falls.

This means balance loss is not random. It is measurable, trainable, and—when addressed early—often reversible.

Why Vestibular Rehabilitation Works

Balance depends on three integrated systems:

Vestibular system – inner ear sensors detecting head motion and orientation
Visual system – eye input stabilizing the horizon
Proprioceptive system – joint and muscle feedback informing body position

When one system degrades, the brain must learn to rely more effectively on the others. VRT is the structured process that teaches the brain how to do that.

PHASE 1 — Reset, Safety, and Nervous System Orientation

Clinical Intake & Baseline

Every vestibular plan begins with assessment:

Symptom intensity (0–10 scale)
Static and dynamic balance testing
Cervical range of motion
Eye-tracking and oculomotor screening
Gait observation
Blood pressure and orthostatic response

Early Reset Strategies

Diaphragmatic breathing to reduce sympathetic overdrive
Gentle cervical and thoracic mobility
Grounded seated and standing postures
Hydration and electrolyte support for inner-ear fluid balance

If BPPV is present: Canalith repositioning (such as the Epley maneuver) is used to relocate displaced otolith crystals—often producing rapid symptom relief when properly applied.

PHASE 2 — Gaze Stabilization & Eye–Head Coordination

A properly functioning vestibulo-ocular reflex (VOR) keeps vision clear during head movement. When this reflex weakens, everyday motion causes blur, dizziness, or nausea.

VOR x1

Eyes fixed on a target
Head moves side-to-side
30–60 seconds per set

VOR x2

Head and target move in opposite directions
Trains advanced visual-motor coordination

Smooth Pursuit

Eyes track a moving object without head movement.

Saccades

Rapid eye shifts between two points to improve visual processing speed.

These drills are foundational and performed daily with controlled progression.

PHASE 3 — Balance Retraining

Static Balance

Feet together → semi-tandem → tandem
Eyes open → eyes closed
Stable surface → foam pad

Dynamic Balance

Marching in place
Lateral stepping
Controlled turns
Head movement integration

Functional Balance

Sit-to-stand
Step-downs
Reaching tasks
Light carries

This phase restores trust in upright posture.

PHASE 4 — Gait & Coordination

Walking is dynamic balance under load.

Gait Progressions

Heel-to-toe walking
Backward walking (controlled)
Obstacle navigation
Walking while performing gaze stabilization

The goal is smooth, rhythmic, confident movement.

PHASE 5 — Habituation Training

Certain movements provoke dizziness—rolling over, looking up, quick turns.

Habituation uses controlled exposure:

Select 1–3 mildly provoking movements
Repeat slowly and consistently
Symptoms should settle within ~15 minutes

Over time, the nervous system learns these movements are safe.

PHASE 6 — Strength for Stability

Muscular support makes vestibular gains durable.

Key Areas

Hip abductors and extensors
Core stabilizers
Calf complex and tibialis anterior
Postural musculature

Strength training reduces fall risk by improving reaction time and postural control.

PHASE 7 — Return to Daily Life and Activity

Outdoor walking
Uneven terrain
Stairs and curbs
Busy visual environments
Screen tolerance
Recreational movement

This is where rehabilitation becomes life again.

Training Frequency

Phase	Frequency	Duration
Early	3–5 days/week	10–15 min
Mid	5–6 days/week	15–25 min
Integration	3–4 days/week	20–30 min

Typical recovery spans 4–12 weeks, depending on condition and consistency.

Supporting the Nervous System

Reducing inflammation, supporting mitochondrial function, and stabilizing nervous-system signaling can enhance recovery.

Explore professional-grade supplements: https://www.thorne.com/u/HealthAndExercisePrescriptions

Thank you for your time and energy… Be well.

— Jaime Hernandez

Health and Exercise Prescriptions®

Legal Disclaimer

This content is for educational purposes only and does not constitute medical or rehabilitation advice. Consult your physician or qualified healthcare provider before starting or changing an exercise program—especially if you have pain, injuries, cardiovascular, metabolic, or other medical conditions. Stop any activity that causes sharp pain, dizziness, chest discomfort, or unusual shortness of breath.