Vertigo Physiotherapy
Supported positional testing can help identify BPPV and other causes of vertigo.
Vertigo physiotherapy assesses spinning, dizziness and balance problems. Treatment may include BPPV repositioning manoeuvres, eye and head exercises, balance training and a gradual return to normal movement.
Vertigo is a symptom rather than a diagnosis. It can feel as though you or the room is spinning, tilting or moving. Some episodes last only seconds. Others continue for hours or return over several weeks.
The timing, triggers and other symptoms help identify the likely cause. They also help determine whether physiotherapy, medical care or both may be appropriate.
For broader information, visit our vestibular physiotherapy hub or compare the four main types of dizziness.
Vertigo: Quick Answer
- Vertigo usually feels like spinning, tilting or movement when you are still.
- Brief spinning when rolling in bed or looking up often occurs with BPPV.
- Physiotherapy may include testing, repositioning manoeuvres and movement-based exercises.
- Not every episode comes from the inner ear.
- Sudden neurological symptoms or sudden hearing loss need urgent medical care.
Who May Benefit From Vertigo Physiotherapy?
An assessment may help if you have:
- brief spinning when rolling in bed, lying down or looking up
- dizziness after moving your head
- poor balance or unsteady walking
- blurred or bouncing vision with head movement
- motion or visual sensitivity
- ongoing unsteadiness after an inner-ear illness
- neck pain with non-spinning dizziness
- recurrent symptoms that have not followed a clear pattern
A physiotherapist can assess movement-related causes and screen for warning signs. Medical review may be needed when symptoms suggest a hearing, heart, circulation or neurological problem.
What Can Cause Vertigo?
Vertigo has several possible causes. The most useful clues often come from what triggers it, how long it lasts and whether other symptoms occur.
- BPPV: often causes brief spinning after rolling in bed, lying down, looking up or bending forward.
- Vestibular neuritis: may cause sudden, longer-lasting vertigo, nausea and poor balance.
- Vestibular migraine: may cause vertigo, motion sensitivity or visual sensitivity, with or without a headache.
- Ménière’s disease: may cause vertigo attacks with hearing changes, tinnitus or pressure in one ear.
- PPPD: more often causes rocking, swaying or ongoing unsteadiness than short bursts of spinning.
- Cervicogenic dizziness: may cause non-spinning dizziness linked with neck pain or restricted neck movement.
Other medical conditions and some medicines can cause similar symptoms. Treatment should follow an assessment rather than the spinning sensation alone.
Why Does Vertigo Happen When You Move Your Head?
Your inner ears, eyes and neck send information to your brain. Your brain uses these signals to keep your vision clear and your body balanced.
In BPPV, tiny calcium crystals move into one of the inner ear’s balance canals. Certain head positions then produce an incorrect movement signal. This can cause a short burst of vertigo and involuntary eye movements called nystagmus.
However, head movement can also trigger symptoms from migraine, reduced inner-ear function, PPPD and neck problems. The length of each episode and the assessment findings help distinguish these patterns.
How Can Vertigo Physiotherapy Help?
Treatment aims to reduce symptoms, improve balance and help you move with more confidence. The plan should match the likely cause.
Treatment may include:
- repositioning manoeuvres for confirmed BPPV
- vestibular rehabilitation therapy
- eye and head exercises to improve visual control
- gradual practice of movements that trigger symptoms
- balance and walking retraining
- falls-risk assessment and practical safety advice
- neck assessment when neck symptoms are relevant
- medical referral when the findings need further investigation
A repositioning manoeuvre can help BPPV, but it does not treat every cause of vertigo. General balance exercises may improve steadiness, but they will not move misplaced inner-ear crystals. An assessment guides the safest option.
How Does a Physiotherapist Assess Vertigo?
Your physiotherapist will ask what the sensation feels like, when it started and how long each episode lasts. They may also ask about:
- head-position triggers
- nausea or vomiting
- falls or severe imbalance
- migraine or headaches
- neck pain
- hearing changes, tinnitus or ear pressure
- medicines and other health conditions
- weakness, numbness, vision changes or speech problems
Testing will depend on your symptoms and safety needs. It may include observation of eye movements, BPPV positional tests, head and eye coordination, neck movement, standing balance, walking and a neurological screen.
If the findings do not fit a condition suitable for physiotherapy, your physiotherapist may recommend medical assessment before starting treatment.
Eye, head and gaze-stability testing helps guide vestibular rehabilitation.
Assessment Helps Answer Three Questions
- Is this likely to be BPPV? Positional testing may reproduce the symptoms and reveal a typical eye-movement pattern.
- Is balance affected? Eye, walking and balance tests help identify areas that may need training.
- Is medical care needed? Hearing, neurological or heart-related symptoms may change the safest next step.
Advanced Vestibular Assessment at Clayfield
Some cases are recurrent, persistent or unusual. In these situations, standard observation may not provide enough information.
Our Clayfield physiotherapy clinic offers advanced testing using infrared goggles. The goggles allow the physiotherapist to observe eye movements while removing visual fixation. This may reveal subtle nystagmus and help clarify a complex pattern.
Infrared-goggle testing may be useful when:
- vertigo keeps returning
- symptoms do not follow a typical BPPV pattern
- more than one balance canal may be involved
- previous manoeuvres have not resolved the symptoms
- another inner-ear condition may be contributing
Not everyone needs infrared-goggle testing. Your history and initial findings will guide whether it is likely to help.
How Long Does Vertigo Last?
The expected duration depends on the cause.
- BPPV usually causes spinning that lasts for seconds.
- Vestibular neuritis may cause severe symptoms for hours or days.
- Vestibular migraine and Ménière’s disease can cause repeat attacks.
- Ongoing balance or motion sensitivity may continue for weeks or months.
Recovery can also be affected by general health, falls risk, migraine, neck problems, medicines, activity levels and how long the symptoms have been present.
When Does Vertigo Need Urgent Medical Care?
Most vertigo is not caused by an emergency. However, sudden vertigo can occur with a stroke or another serious condition.
Call Triple Zero (000)
Call 000 if sudden vertigo occurs with:
- face drooping
- new weakness or numbness
- difficulty speaking, understanding or swallowing
- double vision or sudden loss of vision
- a sudden severe or unusual headache
- new severe difficulty walking or standing
- collapse, fainting or chest pain
- new loss of coordination
Sudden hearing loss also needs urgent medical care. Seek assessment as soon as possible, ideally within 24 hours, if hearing falls suddenly over several hours or days. This is especially important when it affects one ear or occurs with tinnitus, ear pressure or vertigo.
What Should You Do While Waiting for Assessment?
Reduce activities where a sudden episode could cause injury. Do not drive, climb ladders, work at unprotected heights or operate machinery while symptoms remain unpredictable.
Move carefully when getting out of bed. Use a stable support if needed and keep walking areas well lit.
Avoid repeatedly trying online repositioning manoeuvres when the cause is unclear. The correct manoeuvre depends on the affected ear and balance canal. An unsuitable manoeuvre may make symptoms worse or delay the right assessment.
Walking and balance rehabilitation can help restore confidence after vertigo.
Related Vertigo and Dizziness Information
- Vestibular Physiotherapy
- BPPV
- Vertigo and Dizziness
- Vestibular Migraine
- Ménière’s Disease
- Persistent Postural-Perceptual Dizziness
- Cervicogenic Dizziness
- Vestibular Rehabilitation Therapy
Vertigo Physiotherapy FAQs
Can vertigo physiotherapy reduce spinning?
It may reduce spinning when treatment matches the cause. Repositioning manoeuvres can help confirmed BPPV. Other exercises may help reduced inner-ear function, motion sensitivity and poor balance.
What causes vertigo when lying down or rolling in bed?
BPPV often causes brief vertigo when lying down, rolling in bed, looking up or bending forward. Other conditions can also react to head movement, so an assessment may be needed before choosing treatment.
How many physiotherapy sessions are usually needed?
The number of sessions depends on the cause, how long symptoms have been present, falls risk and response to treatment. Some BPPV cases improve quickly. Ongoing dizziness or balance problems may need a staged program.
Is vertigo always caused by the inner ear?
No. Inner-ear conditions are common, but migraine, neurological conditions, medicine effects and other health problems can cause similar symptoms. Neck problems more often cause non-spinning dizziness or unsteadiness.
Can I perform an Epley manoeuvre at home?
An Epley manoeuvre may help one form of BPPV. The correct technique depends on the affected ear and balance canal. Seek advice if the diagnosis is unclear, symptoms are severe or recurrent, or you have significant neck, blood-vessel or mobility problems.
When should vertigo be assessed urgently?
Call 000 when sudden vertigo occurs with weakness, facial drooping, speech or swallowing difficulty, double vision, severe headache, collapse, chest pain or a new inability to walk. Sudden hearing loss also needs urgent medical care.
Book a Vertigo Physiotherapy Assessment
If vertigo, dizziness or poor balance affects walking, work, driving, exercise or confidence, an assessment can help clarify the safest next step.
Choose your preferred PhysioWorks clinic below. If symptoms are persistent, recurrent or unusual, call reception so we can help match you with the most suitable physiotherapist and location.
Choose your clinic and appointment pathway
Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.
References
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.
- Hall CD, Herdman SJ, Whitney SL, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline. J Neurol Phys Ther. 2022;46(2):118-177.
- Stroke Foundation. Signs of Stroke. Accessed July 2026.
- National Institute for Health and Care Excellence. Hearing Loss in Adults: Assessment and Management. NICE guideline NG98. Accessed July 2026.
