What Are VOR Exercises and Why Do They Matter?
VOR exercises are an essential part of any rehabilitation program focused on treating dizziness, vertigo, and vestibular-based symptoms. The vestibulo-ocular reflex (VOR) acts like your brain’s steady camera, helping keep your vision clear as your head moves. VOR exercises train this reflex. If dizziness makes daily life difficult, these gaze stabilization exercises can help reduce blurry vision (oscillopsia), improve balance, and help you get back to your usual activities.
Problems with your vestibular system can cause blurred vision and dizziness while walking, turning, or riding in a car. Fortunately, the VOR can adjust to new challenges, when trained and treated properly.
A key part of VOR exercises is called “retinal slip.” This means there is a small, controlled movement of the image on your retina when your head moves. The goal is to challenge your system enough to help it adapt, but not so much that it overwhelms you.
Who Should Use VOR Exercises for Dizziness?
VOR exercises are primarily used for patients experiencing dizziness and blurred vision due to unilateral or bilateral vestibular hypofunction, vestibular neuritis, or persistent post-concussion symptoms. These exercises are a fundamental part of vestibular physical therapy to help the brain compensate for an underperforming inner ear.
According to clinical practice guidelines, gaze stabilization is highly effective for patients recovering from vestibular neuritis or labyrinthitis.
These exercises are often included as part of a larger rehab plan for people with ongoing concussion symptoms. Instead of using a single exercise, a comprehensive approach is needed to support your nervous system’s recovery.
Dealing with Dizziness or Vertigo? We Can Help!
If you’re dealing with dizziness, vertigo, motion sensitivity, or “bouncy vision,” it’s common to feel unsure where to start. Or worse, always feeling worried you’ll make symptoms worse.
At The Neural Connection, we help people who feel stuck by taking time to listen, validating what you’re experiencing, and building a plan that fits your body and your life.
A vestibular-focused visit and examination at our clinic typically looks beyond just “one exercise” or even “one system.” We assess your symptom triggers, eye movements, balance and walking, and whether issues like neck strain, visual overload, or BPPV patterns might be part of the picture. It’s a comprehensive structural and neurological assessment that you won’t find at many other clinics.
Then we create personalized treatment plans, which often include gaze stabilization progressions (like VOR x1 and VOR x2), balance therapy strategies, pacing guidance, and home practice that’s scaled to your current tolerance.
Best of all?
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If you’re still struggling with symptoms and not sure where to go, you’re just a free phone consultation away from potentially finding answers…
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When Should You Avoid Starting VOR Exercises?
Do not start VOR exercises on your own if you have sudden hearing loss, severe vertigo that lasts more than 24 hours, or a recent serious neck injury. These “red flag” symptoms require immediate medical assessment to rule out urgent neurological conditions, such as a stroke.
Any medical situation in which rapid head movement isn’t safe means you must pause and seek professional help. For instance, sudden ringing in the ears accompanied by severe vertigo requires immediate attention.
Neck problems (cervicogenic dizziness) can also play a big role in your symptoms. A clinician should check your neck before you start gaze stabilization exercises to make sure these movements are safe for you.
How Do You Start VOR Exercises Safely?
To start VOR exercises safely, pay attention to your “dose.” This means how long, how fast, and how often you do the head and eye movements. Clinical guidelines recommend gradually building up to 12-20 minutes of daily practice, split into multiple short sessions throughout the day.
Research shows that the details of your exercise routine are important. Since everyone’s tolerance is different, clinicians usually start you off slowly and adjust the intensity based on how your body responds.
For peripheral vestibular hypofunction (low function), the goal is usually about 12 minutes a day at first, increasing to around 20 minutes for long-term cases. Don’t start with 20 minutes right away. The most important thing is to progress slowly and safely, while managing symptoms.
How Do You Perform x1 VOR Exercises?
VOR x1 is the usual starting exercise. In this drill, your head moves while your eyes stay focused on a still target. This helps train your brain to keep your vision steady when you move your head
Step-by-Step Setup
- Put a sticky note with one letter (like “A”) at eye level.
- Stand about an arm’s length away.
- Start in a sitting position if your balance feels unsteady.
How to Do It (Horizontal Gaze Stabilization)
Keep your eyes focused on the letter and turn your head left and right (like saying “no-no”). Ensure the letter stays mostly clear. When you are ready, you can add vertical movements by moving your head up and down (like saying “yes-yes”).
Beginner Dosage
• Position: Sitting (progress to standing near a counter).
• Sets: 3–5 sets.
• Time: 20–30 seconds per set (build toward 45–60 seconds).
• Frequency: 2–3 times/day.
Progress Rule: Change only one thing at a time, such as duration, speed, position, or how busy the background is, to avoid flaring symptoms or moving too quickly through care.
How Do You Progress to x2 VOR Exercises?
VOR x2 is a more advanced version of VOR exercises. In this exercise, you move the visual target in the opposite direction of your head. This counter-movement drastically increases retinal slip demands, providing a stronger signal to adapt.
Setup and Execution
Hold a card with a letter on it at arm’s length, keeping it at eye level (you can also use your thumb). Keep your eyes focused on the target.
Move your head and the target in opposite directions:
• Move your head left while the target moves right.
• Move your head right while the target moves left.
Starter Dosage
• Position: Sitting first.
• Sets: 3 sets.
• Time: 15–20 seconds per set (build toward 30 seconds).
• Frequency: 1–2 times/day (only if VOR x1 is going well).
If doing VOR x2 makes your symptoms much worse for the rest of the day, it might be too hard for your nervous system at this time, so consult with your provider.
What Are the Normal Symptoms and Red Flags During VOR Exercises?
A mild increase in dizziness or nausea is a normal, expected symptom during VOR exercises because the drills are intended to challenge your vestibular system. However, sudden hearing loss, fainting, or new neurological symptoms like weakness are red flags that require you to stop immediately and seek medical attention.
Expected Symptoms
Mild symptom increases during vestibular rehab are common. These short-term side effects typically settle within minutes to a day after a session.
• Mild dizziness or motion sensitivity during or briefly after the drill.
• Mild nausea or eye fatigue that settles quickly.
• Feeling a bit “off” but returning to normal later that day.
Red Flags (Not Expected, But Always On The Look For It)
Pause your exercises and get medical guidance immediately if you experience:
• Symptoms that stay significantly worse into the next day, repeatedly.
• Fainting, chest pain, or feeling like you might pass out.
• Sudden hearing loss, with or without vertigo.
• New neurologic symptoms such as new weakness, numbness, trouble speaking, or severe new headaches.
Frequently Asked Questions (FAQ)
How long should I do VOR exercises each day?
When performing VOR exercises, aim to build up to a daily total of 12 to 20 minutes of gaze stabilization practice. This total time should be split into multiple short sessions throughout the day, guided by clinical practice guidelines and your personal tolerance.
Should VOR exercises make me dizzy?
Yes, a mild, temporary increase in symptoms and dizziness can be expected because VOR exercises are designed to challenge your vestibular system deliberately. However, this symptom spike should not consistently wipe out the rest of your day or worsen into the next day.
What’s the difference between VOR x1 and VOR x2?
The main difference is that in VOR x1, your head moves while the target stays still. In VOR x2, both your head and the target move in opposite directions. This makes VOR x2 much more challenging for your brain.
Can I do VOR exercises if I think I have BPPV?
You should exercise caution, as BPPV (Benign Paroxysmal Positional Vertigo) often requires specific repositioning maneuvers and positional testing before starting general VOR exercises. This is especially critical if your vertigo is triggered by specific movements, such as rolling over in bed or looking up.
When should I seek urgent care for dizziness?
As we’ve previously discussed, seek urgent medical help if your dizziness comes with new neurological symptoms, severe headaches, fainting, chest pain, or sudden hearing loss. If you have sudden, ongoing severe vertigo, you also need immediate care to rule out serious conditions like stroke.
How We Treat Dizziness and Vertigo at The Neural Connection
If you’re trying VOR exercises and still feel stuck, or you’re not sure whether you’re doing the right version, at the right speed, for the right amount of time. You don’t have to figure it out alone…
At The Neural Connection, we help people with dizziness, vertigo, and vestibular issues by identifying what’s driving symptoms (like gaze instability, motion sensitivity, balance problems, BPPV patterns, or neck/visual contributors) and building a personalized plan that progresses at a pace your nervous system can handle.
Many patients tell us the most helpful part is having a calm, clear roadmap, paired with a team that listens closely and adjusts the plan if symptoms flare. If you want a confident starting point and a practical progression for VOR x1 and VOR x2, we’d be glad to help…
If you’re ready to schedule your vestibular evaluation at The Neural Connection, click the link below!
Click here for a FREE 30-Minute Consultation
*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.
