What is vestibular physiotherapy & vertigo rehabilitation?
The vestibular system contributes to balance and clear vision during head movement. Problems affecting it can cause vertigo, unsteadiness or movement-related symptoms. Dizziness has many possible causes, however, including conditions outside the inner ear. Assessment and appropriate referral are important before choosing a treatment.
The assessment and treatment options below explain this area of care. Contact the clinic to discuss your symptoms, confirm suitability and arrange the appropriate appointment.
Conditions and symptoms
- Benign paroxysmal positional vertigo (BPPV), when confirmed by assessment
- Peripheral vestibular hypofunction affecting balance or gaze stability
- Ongoing movement-related symptoms after selected vestibular illnesses
- Balance difficulty associated with an identified vestibular problem
- Selected visually provoked dizziness presentations requiring tailored care
- Residual functional limitations after appropriate medical assessment
How it can affect your day
Some people describe brief spinning with a change in head position; others feel unsteady while walking or have trouble keeping vision clear during movement. Tell the clinician whether symptoms are spinning, light-headedness or imbalance, how long episodes last and whether hearing changes, headache or other symptoms occur. These distinctions help guide the assessment.
Assessment tools and testing techniques
A focused assessment combines your history with selected clinical tests and outcome measures. The examples below are chosen according to the condition, safety and clinician’s training; not every test or device is needed or available at every appointment.
Dix–Hallpike positional testing
What it assessesSelected positional vertigo presentations
When the history suggests appropriate positional vertigo, the clinician may use this test and observe the resulting eye movement pattern. Medical and neck-related precautions are checked first. Symptom reproduction alone is insufficient to identify every cause of dizziness.
Supine Roll Test
What it assessesPossible horizontal-canal BPPV
This positional test helps assess suspected horizontal-canal BPPV. The eye movement pattern and history guide interpretation and treatment selection. It differs from the Dix–Hallpike test; the two should not be treated as interchangeable tests for all dizziness.
Oculomotor and gaze-stability examination
What it assessesEye and head movement responses
Selected tasks examine eye tracking, gaze and responses to head movement. Findings contribute to a broader assessment and can indicate a need for medical referral. This is not a substitute for a complete neurological or specialist vestibular investigation.
Dynamic Visual Acuity
What it assessesVision during head movement
Comparing visual performance with the head still and during appropriate head movement can help assess functional gaze stability. The protocol and suitability matter. Reduced performance can have several contributors and does not by itself establish the diagnosis.
Balance and Functional Gait Assessment
What it assessesBalance during daily movement
Standing and walking tasks may explore the effect of head movement and changing task demands on stability. A structured gait assessment can help track functional limitations where appropriate. Assistance and safe support are matched to the person’s risk.
Dizziness Handicap Inventory and symptom history
What it assessesThe everyday effect of dizziness
A symptom-impact questionnaire can record how dizziness affects activities and participation. Combined with onset, duration and trigger history, it helps set relevant goals. A high score describes burden; it does not prove an inner-ear cause.
Understanding your assessment findings
An explanation should distinguish suspected BPPV, reduced vestibular function and other possible contributors. Different causes require different management. Persistent uncertainty, new hearing symptoms or findings outside the clinician's scope may lead to referral to a physician, audiologist or specialist.
Treatment techniques and rehabilitation
Each technique has a purpose within a wider rehabilitation plan. Selection depends on assessment findings, your preferences and how you respond to care.
Canalith repositioning for confirmed BPPV
A selected maneuver, such as an Epley maneuver for an appropriate BPPV presentation, aims to reposition displaced inner-ear particles. The affected canal and test findings guide selection; one maneuver is not suitable for every type of dizziness.
When it may be considered
A BPPV presentation supported by the clinical assessment and appropriate positional findings.
What a session may involve
The maneuver is selected for the affected canal and clinical context. Response is reassessed; repeating a generic maneuver for unexplained dizziness is not a substitute for diagnosis.
Gaze-stabilization exercises
For selected vestibular deficits, exercises practise maintaining a visual target during head movement. The starting dose and progression should be individualized rather than copied from a generic routine.
When it may be considered
Selected vestibular deficits affecting clear vision with head movement.
What a session may involve
Practice starts with a clinician-selected target, speed and duration. Symptom response guides adjustment; more provocation is not automatically a better exercise.
Habituation and graded exposure
Carefully selected exposure to provoking movements or environments may be used for suitable presentations. The clinician should explain the intended symptom response and when practice needs adjustment.
When it may be considered
A suitable presentation with symptoms linked to particular movements or environments.
What a session may involve
The clinician selects a manageable exposure and explains acceptable response and recovery. The program is modified if symptoms do not settle as expected.
Balance and walking rehabilitation
Exercises may address steadiness while standing, turning or walking. Support and supervision are matched to risk, with progression towards relevant daily situations.
When it may be considered
Instability or reduced confidence during standing, turning and walking.
What a session may involve
Tasks are practised with support appropriate to fall risk. The plan progresses towards real activities while clearly identifying what should not be attempted alone.
A rehabilitation plan built around your goals
A useful goal might be turning in bed more comfortably, walking while looking around or managing a familiar shop. The plan depends on the cause of symptoms and may involve repositioning, exercise or referral rather than all three. Review is important if the initial approach does not fit the response.
More about this service
For clinic-specific information, visit Vestibular Physiotherapy & Vertigo Rehabilitation page ↗. You can also meet the team or book an appointment with the clinic.
What to expect at your first appointment
Bring a medication list and relevant medical or hearing reports. Explain any neck limitations or difficulty lying back before testing. Because examination may provoke dizziness, consider arranging a companion or transport if symptoms could affect your ability to travel safely. Ask the clinician about preparation rather than stopping medication yourself.
How progress is measured
Progress may include fewer episodes, better tolerance of head movement, improved balance or greater confidence outside the home. Questionnaires and repeat functional tests can help track change. A reduction in one symptom does not necessarily mean every balance problem has resolved.
Home care and day-to-day support
Only practise the exercises or maneuvers selected for your assessed condition. Ask about dose, support, expected symptoms and stopping rules. Avoid attempting positional maneuvers from a video before suitability and the likely cause have been established, particularly when you have neck or other medical limitations.
When to seek medical care
Call 911 for sudden dizziness with new weakness, facial droop, speech difficulty, double vision, severe headache or inability to stand or walk. Sudden hearing loss requires urgent medical assessment. New severe or unexplained dizziness should not be assumed to be BPPV or postponed until a routine rehabilitation visit.
Choosing the right physiotherapist
Ask about the clinician’s registration, relevant training and experience with your particular concerns. Explain any communication, privacy, accessibility or assistance needs before booking. A suitable appointment should leave room for questions and a clear discussion of your choices.
Frequently asked questions
Is all dizziness caused by the inner ear?
No. Dizziness can arise from several medical conditions. The history, examination and any required medical investigations guide management.
What is BPPV?
It is an inner-ear condition that can cause brief episodes of spinning with particular head positions. Positional testing helps determine whether the pattern fits BPPV.
Does everyone need an Epley maneuver?
No. It is used for an appropriate confirmed BPPV presentation. Other canals and other causes of dizziness require different approaches.
Will testing make me dizzy?
Some tests can temporarily reproduce symptoms. The clinician should explain what to expect, check suitability and obtain your consent before proceeding.
How quickly will I improve?
Response varies with the diagnosis and individual circumstances. Some positional symptoms respond differently from longer-term balance difficulties; a fixed timeline should not be promised.
Can I drive after an appointment?
Do not drive while dizzy or when vision or balance makes it unsafe. Discuss travel arrangements and any medical restrictions with the clinician before your visit.
Further readingProfessional resources to explore at your own pace5 resources
- 01APTA: BPPV (opens in a new tab)
- 02ANPT: Vestibular rehabilitation guidance (opens in a new tab)
- 03AAO-HNS: BPPV guideline (opens in a new tab)
- 04NHS: Sudden hearing loss (opens in a new tab)
- 05RehabMeasures: Dynamic Visual Acuity (opens in a new tab)
General information to help you understand your options. An individual assessment is needed for advice about your own health.