The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult concussion specialists and treating providers before starting any new therapy. Vestibular therapy helps post-concussion syndrome patients with dizziness, imbalance, and vertigo (Silverberg et al., 2020). Vestibular dysfunction affects 30-65% of PCS patients. Randomized controlled trials support vestibular rehabilitation for concussion-related dizziness, imbalance, and vertigo. Vestibular therapy programs include gaze stabilization, habituation exercises, balance retraining, and gait training. Symptom improvement common within 4-12 weeks. Vestibular-trained physical therapist referral recommended for PCS with dizziness, imbalance, motion sensitivity, or vertigo. Vestibular therapy safe when guided by trained clinician. Vestibular therapy reduces dizziness in PCS. Evidence supports vestibular rehabilitation. Vestibular dysfunction common in PCS. 30-65% of PCS patients affected. Referral to vestibular-trained PT recommended. Specialized training required. What Vestibular Therapy Addresses in PCS Dizziness reduction. Dizziness reduction primary goal. Vertigo reduction. Vertigo reduction goal. Imbalance improvement. Imbalance improvement goal. Motion sensitivity reduction. Motion sensitivity reduction. Visual motion sensitivity reduction. Visual motion sensitivity reduction. Gaze stability improvement. Gaze stability improvement. Postural control improvement. Postural control improvement. Gait normalization. Gait normalization. Fall risk reduction. Fall risk reduction. Return to activity support. Return to activity support. Vestibular Therapy Techniques Gaze stabilization exercises (VOR training). Gaze stabilization retrains vestibulo-ocular reflex. Habituation exercises. Habituation exercises reduce motion sensitivity. Balance retraining. Balance retraining improves postural control. Gait training. Gait training normalizes walking pattern. Canalith repositioning (Epley maneuver). Epley maneuver for BPPV. Cervicogenic dizziness treatment. Cervicogenic dizziness treatment. Visual motion desensitization. Visual motion desensitization. Substitution exercises. Substitution exercises for vestibular loss. Adaptation exercises. Adaptation exercises for vestibular hypofunction. Vestibular Dysfunction Types After Concussion Peripheral vestibular dysfunction. Peripheral vestibular dysfunction common. Central vestibular dysfunction. Central vestibular dysfunction common. Benign paroxysmal positional vertigo (BPPV). BPPV common after head injury. Vestibular migraine. Vestibular migraine common in PCS. Cervicogenic dizziness. Cervicogenic dizziness common. Visual vertigo. Visual vertigo common. Persistent postural-perceptual dizziness (PPPD). PPPD common in chronic PCS. Vestibular hypofunction. Vestibular hypofunction possible. Evidence Supporting Vestibular Therapy for PCS Randomized controlled trials support. RCTs support vestibular rehab. Schneider et al. (2014) landmark trial. Cervicovestibular rehab reduced symptom persistence. Buffalo Concussion Treadmill Test integration. BCTT integration common. Symptom improvement within 4-12 weeks. Improvement within 4-12 weeks. Reduced concussion symptom persistence. Reduced symptom persistence. Faster return to activity. Faster return to activity. Reduced dizziness scores. Reduced Dizziness Handicap Inventory scores. Assessment Before Vestibular Therapy VOMS (Vestibular/Ocular Motor Screening). VOMS screens vestibular and ocular dysfunction. Dix-Hallpike test for BPPV. Dix-Hallpike for BPPV. Head impulse test. Head impulse tests vestibular function. Head shake test. Head shake tests asymmetry. Dynamic visual acuity. Dynamic visual acuity tests VOR. Balance testing (BESS, mCTSIB). Balance testing assesses postural control. Gait analysis. Gait analysis assesses walking. Videonystagmography (VNG) if available. VNG at specialized centers. Vestibular Therapy Program Structure Initial evaluation 60-90 minutes. Initial evaluation 60-90 minutes. Home exercise program essential. Home exercise program essential. Sessions 1-3 times per week. Sessions 1-3 times per week. Program duration 4-12 weeks common. Duration 4-12 weeks common. Progression based on symptom response. Progression based on symptom response. Symptom exacerbation expected initially. Symptom exacerbation expected initially. Symptom improvement over weeks. Improvement over weeks expected. Vestibular Therapy Safety Considerations Symptom exacerbation expected initially. Initial symptom flare-up common. Nausea common during exercises. Nausea common. Dizziness during exercises expected. Dizziness expected. Vestibular-trained PT essential. Vestibular-trained PT essential. Not appropriate for acute concussion in first 24-48 hours. Not appropriate in acute period. Cervical instability contraindication. Cervical instability contraindication. Red flag symptoms warrant medical evaluation. Red flag symptoms warrant evaluation. Finding a Vestibular Therapist Vestibular Disorders Association (VeDA) directory. VeDA directory for vestibular therapists. APTA Neurology Section directory. APTA Neurology Section directory. Ask about concussion experience. Ask about concussion experience. Ask about VOMS training. Ask about VOMS training. Ask about vestibular certification. Ask about vestibular certification. Concussion clinic referral. Concussion clinic referral. Neurologist referral. Neurologist referral. Supporting Mobility Routine These exercises support vestibular rehabilitation through cervical and nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. Common Mistakes About Vestibular Therapy Avoiding vestibular therapy due to symptom fear. Symptom exacerbation expected. Not completing home exercise program. Home program essential. Stopping therapy after initial improvement. Complete program. Seeing non-vestibular-trained PT. Vestibular training essential. Expecting immediate resolution. Improvement over weeks. How long does vestibular therapy take for PCS? Vestibular therapy for PCS commonly takes 4-12 weeks. Symptom improvement often begins within 2-4 weeks. Full program completion supports lasting improvement. Home exercise program essential. Duration varies based on symptom severity, vestibular dysfunction type, and adherence to home program. Is vestibular therapy safe after concussion? Yes, vestibular therapy safe after concussion when guided by vestibular-trained physical therapist. Initial symptom exacerbation expected as vestibular system challenged. Nausea and dizziness common during exercises. Symptoms should improve over weeks. Not appropriate in acute period (first 24-48 hours). Cervical instability contraindication. Will insurance cover vestibular therapy for concussion? Most insurance covers vestibular therapy with concussion diagnosis and physician referral. Coverage varies by plan. Prior authorization sometimes required. Some plans limit number of visits. Verify coverage with insurance and physical therapy clinic. Concussion clinic and neurologist referrals support authorization. Can vestibular therapy make me feel worse before better? Yes. Initial symptom exacerbation expected during vestibular therapy. Dizziness, nausea, and imbalance often worsen during first 1-2 weeks. Symptoms should improve over weeks as vestibular system adapts. Symptom exacerbation part of habituation process. Persistent worsening warrants therapist evaluation and program adjustment. What is the difference between vestibular therapy and general physical therapy? Vestibular therapy requires specialized training in vestibular rehabilitation techniques including gaze stabilization, habituation, balance retraining, canalith repositioning, and VOMS assessment. General physical therapy may not include vestibular-specific techniques. Vestibular-trained PT with concussion experience essential for PCS. Ask about vestibular certification and concussion experience before starting. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed