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Balance and Vestibular Therapy

Regaining balance in your life

Balance and Vestibular Therapy


Why Physical Therapy to Manage Balance and Vestibular Issues?

The goal of treatment is to improve your ability to safely participate in daily activities.

Specialized physical therapy can be used to address vestibular and balance problems that are the result of a variety of diagnoses. Therapy is recommended for treating the following symptoms:

  • Dizziness or vertigo
  • Motion sickness that occurs when walking in crowds or busy environments
  • Spinning sensation when looking up, bending over or lying down in bed
  • Unsteadiness or frequent falls
  • Concussion (Learn more about concussion care)

At your first appointment, your physical therapist will start with a thorough history of your symptoms then perform a non-invasive examination to assess your vestibular and balance systems. This exam will allow your provider to best understand your symptoms.

Following the assessment, your therapist will work with you to create a personalized care plan that may include hands-on treatments, exercises, or education involving lifestyle and activity modifications. Management of vestibular dysfunction or imbalance often requires a multi-disciplinary approach; collaboration with other health care providers may be recommended.

What is balance?

Balance is the ability to maintain an upright position at rest or during movement. There are three main systems that work to keep us balanced:

  • Visual system (eyes)
  • Vestibular system (inner ear)
  • Somatosensory system (touch/sensation)

These three systems receive information about body position in relation to gravity and our surroundings, allowing us to react and move freely without falling. Illness, injury, medication interactions or aging can affect these systems and lead to decreased balance and a higher risk for falls. Generalized weakness, impaired coordination or orthopedic injuries are other factors that may increase your chance of falling.

Physical therapy is a safe and effective treatment option to improve balance and decrease your fall risk.

What is the vestibular system?

The vestibular system consists of the inner ear and its connections to the brain. This system assists in keeping us balanced as well as coordinates head and eye movements. Vertigo and dizziness are common symptoms that occur when a person experiences vestibular dysfunction. Other symptoms include:

  • Blurred or shaky vision with head movements (oscillopsia)
  • Difficulty concentrating or feeling foggy headed
  • Fluctuating ear pressure, fullness or ringing (tinnitus)
  • Hearing changes
  • Imbalance, falls or lack of coordination
  • Nausea or vomiting

Vertigo versus Dizziness– what are the differences?

Vertigo is an abnormal sensation of movement and feeling described as if you or your environment are spinning. In contrast, dizziness is a general term often used when feeling lightheaded, faint or unsteady. It is helpful to differentiate between the two when talking to your health care provider about your symptoms.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign: Not malignant or damaging
Paroxysmal: Sudden onset or episodic
Positional: Triggered by movement or changes in head position
Vertigo: True rotational dizziness described as if you and/or the room are spinning1

BPPV is episodic vertigo that typically lasts less than one minute. It occurs when provoked by certain head movements or position changes such as looking up, bending over, lying down or turning from side to side in bed. Some individuals may also experience nausea or unsteadiness between episodes.

BPPV is a common condition caused by a problem of the inner ear and affects approximately 2.4% of the population.2 More commonly seen in adults, it increases in frequency with age and affects women more often than men. Possible triggers include head injury, migraine, inner ear infection, osteoporosis or diabetes. BPPV will not cause hearing loss.

What causes the spinning?

Image 1: The inner ear with displaced crystals in the posterior canal causing BPPV.

Image courtesy of Vestibular Disorders Foundation (VeDA):

Parts of the inner ear contain microscopic crystals called otoconia – often referred to as “ear crystals or rocks”. If these crystals become loose, they can end up in one of the semicircular canals (Image 1). When the head is turned into certain positions, the subsequent movement of these crystals in the canal sends a false message to the brain indicating that the head is spinning, and thus creating a sensation of vertigo. This also results in an eye movement called nystagmus which may cause your surroundings to appear as if they are moving.

How is BPPV Treated?

BPPV should be diagnosed and treated by a trained healthcare provider. Often, you may be referred to a physical therapist for treatment. During the initial assessment, your provider will move your head through a series of testing positions to observe all eye movements and determine which positions provoke vertigo. The assessment may also involve the use of video goggles to record eye movements.

An effective and non-invasive treatment for BPPV is called a canalith repositioning maneuver. The treatment works by moving the ear crystals out of the semicircular canals and back to their normal position within the inner ear.

The likelihood of experiencing BPPV again is high with an approximate 1% per month recurrence rate. If your symptoms return, contact your physical therapist to schedule an appointment. Medications will not cure BPPV.

Be Proactive

By making it a priority to discuss your balance and vertigo symptoms with your doctor, you can rule out a medication interaction or more serious condition, such as heart attack or stroke. If your doctor believes that you are at risk for falls or that your symptoms are related to your vestibular system, a referral to physical therapy may help you to improve.

Do I Need a Prescription?

Medicare, Medicaid, as well as some insurance plans require a prescription to begin therapy. If you have questions, kindly contact us. We are happy to help you obtain a prescription, as needed.

Convenient Locations

If you experience vertigo or dizziness, physical therapy is a proven treatment option for addressing symptoms. Talk to your physician about a referral to one of our vestibular therapy specialists to get the care you need.


Brown County

Aurora BayCare Rehabilitation Center
1160 Kepler Dr.
Green Bay, WI 54311

Aurora Rehabilitation Center
2253 W. Mason St.
Green Bay, WI 54303

Fond du Lac County

Aurora Sports Health
210 Wisconsin American Drive
Hwy. 23 East
Fond du Lac, WI 54935

Kenosha County

Aurora Physical Therapy
1020 35th St., #110
Kenosha, WI 53140

Aurora Sports Health
7610 Pershing Blvd.
Kenosha, WI 53142

Manitowoc County

Aurora Sports Health
3821 Dewey St.
Manitowoc, WI 54220

Aurora Sports Health
920 State St.
Manitowoc, WI 54220

Aurora Physical Therapy
1001 Service Rd.
Kiel, WI 53042

Aurora Physical Therapy
5300 Memorial Dr.
2nd Floor
Two Rivers, WI 54241

Milwaukee County

Aurora Physical Therapy
1575 N. RiverCenter Drive
Milwaukee, WI 53212

Aurora Sports Health
3003 W. Good Hope Rd.
Milwaukee, WI 53209

Aurora Physical Therapy
Aurora St. Luke's Medical Center
2900 W. Oklahoma Avenue
Milwaukee, WI 53215

Aurora Sports Health
Aurora Sinai Medical Center
1st Floor, Suite 1100
945 N. 12th St.
Milwaukee, WI 53233

Aurora Physical Therapy
Aurora Sinai Medical Center
945 N. 12th St., 4th floor
Milwaukee, WI 53233

Aurora Physical Therapy
7878 N. 76th St.
Milwaukee, WI 53223

Aurora Physical Therapy
3611 S. Chicago Ave., #120
South Milwaukee, WI 53172

Aurora Physical Therapy
Aurora St. Luke's South Shore
5900 S. Lake Dr.
Cudahy, WI 53110

Milwaukee County (cont'd)

Aurora Sports Health
9200 W. Loomis Road, Suite 107
Franklin, WI 53132

Aurora Physical Therapy
4202 W. Oakwood Park Ct., #340
Franklin, WI 53132

Aurora Sports Health
9120 W. Loomis Rd., #100
Franklin, WI 53132

Aurora Physical Therapy
4131 W. Loomis Rd., #200
Greenfield, WI 53221

Aurora Neurotology & Audiology
4448 W. Loomis Rd., #200
Greenfield, WI 53220

Aurora Sports Health
9000 W. Sura Lane, 5th floor
Greenfield, WI 53228

Aurora Sports Health
2000 E. Layton Ave., #160
St. Francis, WI 53235

Aurora Sports Health
Aurora West Allis Medical Center
8901 W. Lincoln Ave.
Ground Floor
West Allis, WI 53227

Aurora Physical Therapy
Aurora West Allis Medical Center
8901 W. Lincoln Avenue
3rd Floor
West Allis, WI 53227

Ozaukee County

Aurora Rehabilitation Center/Aurora Sports Medicine Institute
Aurora Medical Center - Grafton
975 N. Port Washington Road
Grafton, WI 53024

Aurora Physical Therapy
215 W. Washington St.
Grafton, WI 53024

Racine County

AMCB Surgery Center-Southern Lakes
709 Spring Valley Road
Burlington, WI 53105

Aurora Sports Health
1249 W. Liebau Rd.
Mequon, WI 53092

Aurora Sports Health
7300 Washington Avenue
Racine, WI 53406

Sheboygan County

Aurora Sports Health
2600 Kiley Way
Plymouth, WI 53073

Aurora Physical Therapy
2414 Kohler Memorial Dr
Sheboygan, WI 53081

Aurora Sports Health
2629 N. 7th St
Sheboygan, WI 53083

Walworth County

Aurora Physical Therapy
830 East Geneva Street
Delavan, WI 53115

Aurora Sports Health
700 Geneva Parkway N
Lake Geneva, WI 53147

Washington County

Aurora Sports Health
Aurora Health Center
1640 E. Sumner St.
Hartford, WI 53027

Aurora Sports Health
1061 E. Commerce Blvd.
Slinger, WI 53086

Aurora Rehabilitation Center/Aurora Sports Medicine Institute
1100 Gateway Ct.
West Bend, WI 53095

Aurora Sports Health
N112 W17975 Mequon Rd.
Germantown, WI 53022

Waukesha County

Aurora Sports Health
16985 W. Bluemound Rd.
Brookfield, WI 53005

Aurora Physical Therapy
N84 W16889 Menomonee Ave.
Menomonee Falls, WI 53051

Aurora Physical Therapy
S74 W16775 Janesville Rd., #120
Muskego, WI 53150

Aurora Sports Health
36500 Aurora Dr.
Summit, WI 53066

Aurora Sports Health
Aurora Health Center
W231 N1440 Corporate Ct.
Waukesha, WI 53186

Aurora Sports Health
14555 W. National Avenue, Suite 195
New Berlin, WI 53151

Winnebago County

Aurora Sports Health
1136 Westowne Dr., Suite 110
Neenah, WI 54956

1 Von Brevern, M , Radtke, A, Lezius, F, "Epidemiology of benign paroxysmal positional vertigo: a population-based study.” J Neurol Neurosurg Psychiatry 2007; 78: 710–5.
2 Ibid

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