Vestibular Rehabilitation — Dizziness & Vertigo Treatment

When the Room Spins — and Nobody Can Tell You Why

Dizziness is one of the most common reasons people visit a doctor, and one of the most commonly mismanaged. If you have been told your labs look fine, your MRI is normal, and there is nothing wrong — but you are still dizzy, unsteady, or afraid to turn your head — you are not imagining it. The vestibular system is a specific structure in your inner ear that controls balance, spatial orientation, and gaze stability. When it malfunctions, the symptoms are real, measurable, and treatable.

Vestibular rehabilitation is a specialized form of physical therapy that identifies the source of your dizziness or imbalance and treats it directly. We use standardized clinical testing to determine exactly which part of the vestibular system is involved, and we apply targeted interventions based on what the testing reveals. Most patients see meaningful improvement within their first few visits.

BPPV — The Most Common Cause of Vertigo

Benign paroxysmal positional vertigo (BPPV) accounts for roughly half of all peripheral vestibular disorders. It occurs when tiny calcium carbonate crystals become dislodged and migrate into one of the semicircular canals. When you move your head into certain positions — rolling over in bed, looking up, bending forward — these displaced crystals send a false rotational signal to your brain, causing intense, brief vertigo.

We diagnose BPPV through positional testing, watching your eye movements for a characteristic pattern called nystagmus. The direction and timing tells us exactly which canal is involved. Treatment is a canalith repositioning maneuver — a precise sequence of head and body movements that guides the crystals back where they belong. The Epley maneuver resolves most posterior canal BPPV in a single session. Horizontal and anterior canal variants require different maneuvers, but the principle is the same: identify the canal, reposition the crystals, resolve the vertigo. Medications like meclizine only mask the symptom without addressing the mechanical cause.

Vestibular Neuritis, Labyrinthitis, and Concussion

Vestibular neuritis is an inflammation of the vestibular nerve, typically following a viral infection. It causes sudden, severe vertigo lasting days, along with nausea and difficulty walking. Labyrinthitis involves both the vestibular nerve and the cochlea, so it may also include hearing changes or tinnitus. In both conditions, the acute vertigo typically subsides as the brain compensates — but compensation is often incomplete without targeted rehabilitation, leaving residual dizziness, motion sensitivity, and balance deficits.

The vestibular system is also frequently affected after concussion. Up to 80% of concussion patients report dizziness, and vestibulo-ocular dysfunction is one of the most common post-concussion findings. We work with concussion patients as part of a comprehensive concussion rehabilitation program, applying the same evidence-based vestibular interventions adapted to brain injury recovery.

What a Vestibular Evaluation Looks Like

We do not start treatment until we understand exactly what is causing your symptoms. The evaluation includes:

• Detailed symptom history — onset, triggers, duration, associated symptoms, and functional impact
• Oculomotor testing — smooth pursuits, saccades, and convergence to assess central eye movement control
• Positional testing — Dix-Hallpike and Roll tests for BPPV, with careful observation of nystagmus direction, latency, and duration
• Head impulse testing — rapid head turns to assess the vestibulo-ocular reflex (VOR) and identify side-specific vestibular loss
• Dynamic visual acuity — comparing visual clarity with the head still versus moving to quantify VOR impairment
• Balance assessment — progressively challenging conditions (eyes open/closed, firm/foam surfaces, head turns during gait)
• Cervicogenic screening — ruling out whether neck dysfunction is contributing to or mimicking vestibular symptoms

When we finish, you will know what is causing your dizziness, which structures are involved, and exactly what the treatment plan looks like.

How We Treat Vestibular Conditions

Vestibular rehabilitation is a framework of evidence-based interventions matched to the specific diagnosis. Everything starts with what the evaluation reveals:

Canalith repositioning — for BPPV, we perform the appropriate maneuver for the involved canal (Epley, BBQ roll, or canal-specific techniques), verify resolution with repeat testing, and provide post-treatment positioning guidance.

Gaze stabilization exercises — for vestibular hypofunction, these retrain the vestibulo-ocular reflex. You maintain visual focus on a target while moving your head at progressively faster speeds, driving neuroplastic adaptation in the brainstem pathways that stabilize vision during movement.

Habituation exercises — for motion sensitivity and visual vertigo, habituation involves controlled, repeated exposure to the movements and environments that provoke symptoms. This is particularly important for persistent postural-perceptual dizziness (PPPD) and post-concussion vestibular dysfunction.

Balance retraining — we use progressively challenging balance activities — altering surface stability, visual input, head position, and task complexity — targeting the specific sensory strategy (vestibular, visual, or somatosensory) that needs retraining based on your evaluation.

Functional integration — walking in busy environments, navigating uneven terrain, returning to exercise and sport, driving comfortably, and managing daily life without symptom flare-ups.

Conditions We Treat

• Benign paroxysmal positional vertigo (BPPV) — all canal variants
• Vestibular neuritis and labyrinthitis
• Unilateral and bilateral vestibular hypofunction
• Concussion-related vestibular and vestibulo-ocular dysfunction
• Persistent postural-perceptual dizziness (PPPD)
• Meniere’s disease (vestibular rehabilitation component)
• Cervicogenic dizziness
• Motion sensitivity and visual vertigo
• Age-related balance decline with vestibular involvement

Locations

We provide vestibular rehabilitation at both our Fitchburg and Edgerton locations. Every session is one-on-one with your physical therapist for the full visit — no aides, no rotating between patients. If you have been dizzy and nobody has been able to help, call us. This is what we do.

No Referral Needed

Wisconsin’s direct access law means you can see a physical therapist without a physician referral. Call us today and be seen within 24-48 hours.

We are in-network with Anthem BlueCross BlueShield, Medicare, Humana, The Alliance, UMR, Cigna, and all Workers’ Compensation carriers. HSA/FSA accepted. Competitive self-pay rates available. We verify your benefits before your first visit.

Two Locations

Fitchburg — 6250 Nesbitt Rd, Suite 500, Fitchburg, WI 53719
Edgerton — 102 W Fulton St, Edgerton, WI 53534
Phone: (608) 561-7733

Serving Fitchburg, Madison, Verona, Oregon, Middleton, Edgerton, Milton, Janesville, Stoughton, and surrounding communities.