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Cawthorne-Cooksey exercises

How do the balance organs work?

The balance organs of the two ears work together to send signals to the brain which maintains the balance of the head and body.

What symptoms may I have?

If one or both balance organs are not working well, you will feel off balance. This may present as vertigo or a spinning sensation. Other people describe the sensation of giddiness or of being drunk. They may also feel sick (have nausea) or are sick (vomit).

These symptoms can feel quite scary, and some people may lose their confidence. Please be reassured that, although scary, this condition is not life threatening.

What are Cawthorne Cooksey's exercises?

These are a set of balance retraining exercises. The aim of these exercises is to build your tolerance to these abnormal balance signals in the brain.

The more you do these exercises and try and get back to your normal activities, the sooner the symptoms will disappear.

What do I expect to see after doing these exercises?

Your symptoms will not disappear overnight. It is important to persist with the exercises. You will notice the following over time:

The neck and shoulder muscles no longer feel tense.
The movements that provoke vertigo will cause less and less vertigo over time.
You will be able to move your eyes without moving your head or body.
Your symptoms and coordination will improve.
You will be practicing good posture and balance in everyday life.

How quickly your symptoms improve will vary from person to person. Be patient!

How often should I do these exercises?

It is generally recommended to do these exercises three times every day in three sets of five. It works out at around 10 minutes each time.

You may wish to grade the severity of your symptoms before and as you do the exercises to help you keep track of your improvement. You can use the following scale:

0 - no symptom at all

1 - mild symptoms

2 - moderate symptoms

3 - severe symptoms

The exercises

Begin with exercise 1. Only when the symptoms clear, or after two weeks, move on to the next exercise.

If you have been prescribed medication to ease your symptoms, then continue taking them while on this exercise programme. Please consult your GP or ENT doctor if in any doubt.

Tips for Success

Make sure you are in a safe environment before you start any exercises to reduce the risk of injury.
When you first start the exercises, you may wish to have someone else around to help you and to give you reassurance.
You should perform the exercises daily for maximal benefit.
Begin with exercise 1. Work your way down the list of exercises.
All exercises should be performed slowly to begin with and gradually progress to faster movements.
Perform the exercises as directed. Do not proceed with the other exercises until you are able to comfortably do the exercise in question without symptoms.
Should an exercise make you feel off balance, dizzy or unstable, practice this exercise for the remainder of the 10 minutes.
Do not overdo the exercises. If your symptoms become too severe, take a break.
Make a conscious effort to put your head in positions and do movements that cause your symptoms as far as you can tolerate. This is to encourage the brain to compensate more quickly.
Follow the advice given until you are able to perform all exercises and keep active in the long term.
Try to incorporate some of the principles in your everyday life if possible.
You could restart exercises if your symptoms ever return.

Exercise 1 - Eye movements

This exercise can be done whilst you are sitting in bed or sitting on a chair.

Exercise 1(A)

Hold your head still and look up and down as far as you can

Do the eye movements slowly around 20 times.
Once you get used to them and your symptoms are better or stable, then do the eye movements quickly.

Exercise 1(B)

Hold your head still and look side to side as far as you can

Do the eye movements slowly around 20 times.
Once you get used to them and your symptoms are better or stable, then do the eye movements quickly.

Exercise 1(C)

Stretch one arm out straight
hold the thumb up and focus on it
While continuing to focus on the thumb, bring it in until about a foot (30cm) from the nose

Do the eye movements slowly around 20 times.
Once you get used to them and your symptoms are better or stable, then do the eye movements quickly.

Exercise 2 – Head movements

This second set of exercises can be done whilst you are sitting in bed or sitting on a chair.

Exercise 2(A)

With your eyes open, bend your head back as far as possible, then forward to touch your chin to the chest.

Do this 20 times slowly, then 20 times quickly.
When vertigo improves, repeat this exercise (slowly and then quickly) with your eyes closed.

Exercise 2(B) Head turns

With your eyes open, turn your head to the right side and then to the left side as far as possible 20 times slowly.

Once you are happy you can do this without any symptoms, turn your head for 2 slow turns followed by 1 rapid turn. Do this exercise 20 times.
Repeat the above exercises with your eyes closed 20 times.

Exercise 3 - Shoulder movements

This exercise can be done whilst you are sitting.

Exercise 3(A)

Shrug your shoulders up and down 20 times.

Exercise 3(B)

Circle your shoulders forward and backward 20 times.

Exercise 4 - Movement of the torso

This exercise can be done whilst you are sitting down.

Exercise 4(A)

Bend forward to pick up a small object, such as a cup, from the floor in front of you, and then return to a sitting position.

Do this exercise 20 times slowly.
Repeat this movement quickly 20 times.
Repeat the exercise slowly and then quickly with your eyes closed.

Exercise 4(B)

Turn your body at the waist to the right then to the left side as far as you can.

Do this exercise 20 times slowly.
Repeat this movement quickly 20 times.
Repeat the exercise with your eyes closed.

Exercise 5 – Standing exercises

Do the eye, head, and shoulder movements as before while standing.

Exercise 5(A)

Sit down and stand back up slowly 20 times with your eyes open.

Repeat this exercise quickly 20 times.
Once your symptoms improve, sit down, and stand up with your eyes closed, again slowly first then quickly 20 times.

Exercise 5(B)

Whilst standing and with your eyes open, throw a small ball from hand to hand (throw the ball above your eye level so that you must look up).

Repeat this 20 times.

Exercise 5(C)

Pass a small ball from hand to hand behind your knee.

Do this exercise whilst standing, gently bending forward at the waist, with legs slightly apart and one foot slightly forward.
Repeat this 20 times.

Exercise 5(D)

Turning in circles

From a sitting position, stand up and turn in a complete circle, then sit back down.
Alternate the turning direction (clockwise then anticlockwise).
Stand in place when you turn around.
Do this exercise slowly, 20 times, then quickly.

Exercise 6 – Moving about

The exercises start to get more challenging. Do this exercise in an open area free of obstacles with a partner or friend(s).

Exercise 6(A)

Throwing and catching a ball while walking

Walk around a person in a large circle.
This person will throw a large ball at you.
Catch the ball then throw it back to the person.
Keep walking around the person in a circle whilst doing this exercise.
Alternate the direction (clockwise then anticlockwise).

Exercise 6(B)

Walking around a room

Walk across and around a room first with your eyes open.
When your vertigo improves, walk around the room with your eyes closed.

Exercise 6(C)

Walking on a slope

Walk up and down a gentle slope first with your eyes open.
When your vertigo improves, walk with your eyes closed.

Exercise 6(D)

Sports/normal activity

Participate in games involving stooping, stretching, and aiming, such as bowling, tennis, golf, table tennis, and basketball.

Reference: ENTUK adaptation from Dix and Hood, 1984; and Herdman, 1994 and 2000

Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice

Date Published: 22/05/2024 Review Date: 22/05/2027