Vestibular Dysfunction

Dizziness remains one of the most common complaints in the general population¹ and can place a significant health burden on patients and reduce their quality of life.² The underlying cause of dizziness stems from a variety of sources including a neurogenic (e.g. neuropathy), metabolic (e.g. dehydration or hypoglycemia), or cardiac nature.³ In the athletic population, the majority of literature on dizziness is directed toward athletic concussion injury and cardiac and/or metabolic causes. While these causes are justifiably a primary focus for medical professionals who evaluate patients presenting with dizziness, it is also important to recognize other potential sources of dizziness that can affect athletic and non-athletic populations – in particular dizziness that arises from a vestibular source. Vestibular dysfunction can be of a central (e.g. cerebellum) or peripheral (e.g. inner ear) nature, with symptoms ranging from the aforementioned dizziness to a more severe presentation (e.g., tinnitus, inner ear pressure, or vertigo).⁴ Though often thought to be associated with advanced age,⁵ vestibular conditions have been shown to occur throughout the lifespan⁶ and can be a common source of dizziness. For example, vertigo has been reported to affect up to 25% of patients complaining of dizziness,⁷ and vertigo itself often arises spontaneously among an otherwise healthy population. While dizziness brought on by concussion is often the focus in an athletic setting, athletic trainers and other health professionals must also be skilled in identifying vestibular conditions to pinpoint the true source of a patient’s dizziness.

"Vestibular Well-Being Benefits of a Single Session of Functional Neurology Intervention on Saccadic Stimuli Dysfunction" Escribano-Colmena et al, 2025. The study found that a single session of functional neurology intervention focusing in the areas of what the authors noted as “proprioceptive reflexes, trigger point desensitization, and a holistic, systemic approach” provided notable improvement in vestibular function, particularly in patients with saccadic stimuli dysfunction. Treated participants could tolerate substantially more rapid visual-vestibular stimulation, suggesting greater resilience of the vestibular system to challenging inputs without triggering dizziness, nausea, or imbalance. This improvement likely reflects enhanced sensory-motor integration, allowing the brain to coordinate visual, vestibular, and proprioceptive signals more efficiently. The authors propose these changes result from neuroplastic adaptations that fine-tune the vestibulo-ocular reflexes, postural control, and spatial orientation circuits. 

"Unsteady Ground: Understanding the Problem of BPPV in the World of sports" Nowak et al, 2025. Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders and can occur in response to head trauma such as what often occurs in competitive sports. This review article investigates the prevalence, etiology, and risk factors of BPPV among athletes, acknowledging that dizziness and vertigo are common presentations and may stem from BPPV triggered by specific movements or impacts associated with physical activity. The authors highlight that while knowledge of BPPV’s underlying causes has progressed, more than half of BPPV-related cases remain idiopathic. This article consolidates diagnostic considerations and treatment strategies for BPPV in athletic populations, highlighting the need for greater awareness of BPPV in sports medicine.

"Athletes Who Test Positive on Multiple Domains of the Vestibular-Ocular Motor Screen Take Longer to Return to Play" Lee et al, 2025. Though focused on the perspective of return-to-play after concussion, this article highlights the utility of the Vestibular-Ocular Motor Screen (VOMS) in evaluating ocular motor assessments including smooth pursuits, saccades, and convergence, all of which can be negatively affected in patients with a vestibular disorder.  

Research is ever-improving within the realm of vestibular disorders. This article provides a summary of key information including differential diagnoses, associated symptoms for the most common vestibular disorders, diagnostic criteria for the most common vestibular disorders, and an introduction to vestibular testing.

Evaluating the dizzy patient can be challenging. Though written for a medical practice, this article provides an evidence-based process for screening the dizzy patient and provides tips for obtaining a beneficial medical history, adequate components of a dizziness questionnaire, evaluation tips, and referral suggestions.

The diagnosis of any vestibular disorder relies in part on accurate and valid diagnostic testing. This article provides a summary of the most common clinical tests used in the diagnosis of vestibular disorders.

NATA educATe: The Vestibular System - A Clinical Focus for Athletic Trainers and Healthcare Providers
This webinar, offered by the National Athletic Trainers’ Association and presented by the author of this article, provides an overview of both the peripheral vestibular system (i.e. ‘inner ear’) and a description of the symptoms and treatments for the most common vestibular disorders.  

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