Have you ever rolled over in bed and suddenly felt like the entire room was spinning?
Maybe you feel dizzy when you look up, bend over, turn your head or get out of bed. Or perhaps you don’t experience spinning at all, but instead feel unsteady, off-balance or uncomfortable in busy environments.
These symptoms can be confusing—and sometimes frightening.
The good news is that many causes of dizziness and vertigo can be assessed and treated. Vestibular physiotherapy is a specialized form of rehabilitation designed to help people with certain inner-ear and balance disorders.
At Restorative Touch Physiotherapy in Hamilton, our goal is not simply to treat “dizziness.” The first step is understanding what type of dizziness you’re experiencing and what may be causing it.
This guide explains the most common causes of vertigo and dizziness, what BPPV is, how vestibular physiotherapy works, what happens during an assessment, what exercises may be used, and when dizziness requires medical attention.
What Is Vertigo?
Vertigo is the sensation that you or your surroundings are moving when they aren’t.
People often describe it as:
- The room spinning
- Feeling like you’re being pulled to one side
- Feeling like you’re on a boat
- The floor moving underneath you
- A sensation of falling
- Sudden spinning when changing position
- Feeling disoriented when moving your head
Vertigo is different from simply feeling lightheaded.
For example, feeling faint when you stand up quickly may have a cardiovascular or blood-pressure-related cause rather than a vestibular one.
This distinction matters because different types of dizziness require different approaches.
What Is the Vestibular System?
Your vestibular system is part of your body’s balance system.
It includes structures in your inner ear that detect movement and changes in head position.
Your brain combines information from three major sources:
Your inner ear
Detects head movement and acceleration.
Your eyes
Tell your brain where you are in relation to your surroundings.
Your muscles and joints
Provide information about the position of your body.
Your brain constantly combines these signals to help you stay balanced and understand where you are in space.
When these systems don’t agree, you may experience dizziness, vertigo, blurred vision, nausea or imbalance.
Vestibular rehabilitation is designed to help the nervous system adapt to certain vestibular deficits and improve gaze stability, balance and function. Strong evidence supports vestibular rehabilitation for appropriate unilateral and bilateral peripheral vestibular hypofunction. (PubMed)
What Causes Vertigo?
There are many possible causes.
Some common vestibular causes include:
- Benign paroxysmal positional vertigo (BPPV)
- Vestibular hypofunction
- Vestibular neuritis
- Labyrinthitis
- Vestibular migraine
- Ménière’s disease
- Persistent postural-perceptual dizziness (PPPD)
- Concussion-related vestibular dysfunction
Dizziness can also have causes outside the vestibular system, including:
- Certain medications
- Blood-pressure changes
- Cardiovascular problems
- Neurological conditions
- Vision problems
- Neck-related problems
- Anxiety and other psychological factors
- Dehydration
- Low blood sugar
This is why a good vestibular assessment is more than simply asking, “Are you dizzy?”
The timing, triggers, duration and characteristics of your symptoms can provide important clues.
What Is BPPV?
Benign paroxysmal positional vertigo, commonly called BPPV, is one of the most common causes of positional vertigo.
BPPV occurs when tiny calcium carbonate particles, commonly called “crystals,” become displaced within the inner ear’s semicircular canals.
These canals normally detect rotational head movement.
When displaced particles move within a canal, certain head positions can produce an abnormal signal to the brain.
The result can be a sudden episode of spinning.
BPPV often causes vertigo when you:
- Roll over in bed
- Sit up from lying down
- Lie down
- Look upward
- Bend over
- Turn your head quickly
- Get in or out of bed
A typical episode may be brief, often lasting less than a minute, although people can feel unsettled or off-balance for longer afterward.
Why Does BPPV Cause Spinning When I Turn Over in Bed?
This is one of the most characteristic features of BPPV.
When you change your head position, the displaced particles move within the affected semicircular canal.
That movement stimulates the vestibular system inappropriately.
Your brain receives information suggesting that your head is rotating even though the movement isn’t occurring in the same way.
Your eyes may respond with involuntary movements called nystagmus, and you experience vertigo.
A trained clinician can use specific positional tests to determine whether BPPV is likely and which canal may be involved.
The clinical guideline for BPPV recommends positional testing such as the Dix-Hallpike manoeuvre for suspected posterior-canal BPPV and a supine roll test when appropriate. (PubMed)
What Is the Epley Manoeuvre?
The Epley manoeuvre is a canalith-repositioning procedure commonly used to treat certain types of BPPV.
The purpose isn’t to “exercise” the vestibular system.
Instead, the manoeuvre uses a sequence of head and body positions to help move displaced particles out of the affected semicircular canal and back toward their normal location.
When the diagnosis is appropriate, repositioning manoeuvres can be highly effective.
Clinical guidelines recommend an appropriate particle-repositioning manoeuvre for posterior-canal BPPV. (PubMed)
Important:
The Epley manoeuvre isn’t appropriate for every type of dizziness.
It also isn’t necessarily the same manoeuvre for every type of BPPV.
The affected canal and side matter.
That’s why repeatedly performing an Epley manoeuvre at home without knowing whether you actually have BPPV—or which ear and canal are involved—may not be the best approach.
Can Physiotherapy Treat BPPV?
Yes.
Physiotherapists with appropriate vestibular training can assess and treat BPPV.
Treatment may involve:
- Identifying whether the symptoms are consistent with BPPV.
- Performing appropriate positional testing.
- Determining the likely affected canal and side.
- Performing the appropriate repositioning manoeuvre.
- Reassessing symptoms and positional findings.
- Providing follow-up advice if needed.
BPPV guidelines emphasize differentiating BPPV from other causes of dizziness and reassessing patients when symptoms persist or treatment doesn’t resolve the problem. (PubMed)
For some people, treatment can be remarkably quick.
For others, persistent symptoms may indicate that another vestibular problem is present or that additional treatment is needed.
What If the Epley Manoeuvre Doesn’t Work?
This is an important question.
If the Epley manoeuvre doesn’t resolve your symptoms, it doesn’t necessarily mean that “BPPV is untreatable.”
There are several possibilities.
The diagnosis may be incorrect
Not every episode of dizziness is BPPV.
A different canal may be involved
BPPV can affect different semicircular canals, requiring different repositioning strategies.
The BPPV may still be present
Sometimes additional treatment is required.
Another vestibular problem may be contributing
For example, vestibular hypofunction or vestibular migraine may produce symptoms that aren’t resolved by repositioning manoeuvres.
You may have residual imbalance
Even after the positional vertigo resolves, some people continue to feel unsteady or “off” temporarily.
This is one reason a proper assessment is more useful than simply trying random dizziness exercises.
What Is Vestibular Physiotherapy?
Vestibular physiotherapy is a specialized form of rehabilitation designed for people experiencing dizziness, vertigo, imbalance, motion sensitivity or certain vestibular disorders.
Treatment depends on the diagnosis.
It may include:
- Canalith repositioning manoeuvres
- Gaze stabilization exercises
- Balance exercises
- Habituation exercises
- Walking and mobility exercises
- Head-movement exercises
- Visual-motion exercises
- Education
- Activity modification
- Home exercise programs
The goal is not simply to eliminate a symptom temporarily.
The goal is to help you move, walk, exercise and participate in daily life with greater confidence and stability.
What Are Gaze Stabilization Exercises?
Gaze stabilization exercises are commonly used for certain vestibular conditions.
The basic idea is to challenge the vestibular system’s ability to keep your vision stable while your head moves.
A simple example is looking at a stationary target while gently moving your head from side to side.
Example
- Sit or stand safely.
- Hold your thumb or focus on a letter on the wall.
- Keep your eyes focused on the target.
- Slowly move your head side to side.
- Try to keep the target clear.
- Stop if symptoms become excessive.
The exact speed, duration, position and progression should be individualized.
These exercises aren’t appropriate for every person with dizziness.
For people with peripheral vestibular hypofunction, clinical guidelines support gaze-stability exercises as part of vestibular rehabilitation. (PubMed)
What Are Balance Exercises?
Your vestibular system is only one part of your balance system.
Your brain also relies on your vision and information from your muscles and joints.
Vestibular rehabilitation may therefore include progressively challenging balance exercises.
Examples can include:
- Standing with feet together
- Standing on a reduced base of support
- Tandem stance
- Single-leg balance
- Walking while turning the head
- Walking with visual challenges
- Changing surfaces
- Functional balance tasks
These exercises should be progressed according to your abilities.
Someone who is unsteady simply standing still requires a very different program from an athlete who becomes dizzy only when running and turning their head.
What Is Vestibular Hypofunction?
Vestibular hypofunction occurs when one or both sides of the vestibular system aren’t providing normal information to the brain.
It can result from various causes, including:
- Vestibular neuritis
- Inner-ear disorders
- Certain medications
- Surgery
- Other conditions affecting the vestibular system
Symptoms may include:
- Dizziness
- Imbalance
- Blurred vision when moving your head
- Difficulty walking
- Difficulty in dark environments
- Difficulty navigating busy environments
- Motion sensitivity
Vestibular rehabilitation can help the brain adapt to certain vestibular deficits.
Clinical practice guidelines report strong evidence supporting vestibular rehabilitation for appropriate unilateral and bilateral peripheral vestibular hypofunction. (PubMed)
What Is Vestibular Neuritis?
Vestibular neuritis is a condition involving dysfunction of the vestibular portion of the vestibular nerve.
It can cause a sudden onset of significant vertigo, dizziness and imbalance.
People may describe:
- Sudden spinning
- Severe imbalance
- Difficulty walking
- Nausea
- Symptoms that worsen with head movement
The initial symptoms can be intense.
As the acute episode settles, some people continue to experience imbalance or dizziness with movement.
Vestibular rehabilitation may be used during recovery when appropriate.
However, because sudden severe dizziness can have causes that require urgent medical attention, a new severe episode should not automatically be assumed to be vestibular neuritis.
Can a Neck Problem Cause Dizziness?
Sometimes dizziness can be associated with neck problems, but this is an area where careful assessment is important.
Some people report dizziness or disequilibrium associated with neck movement or neck pain.
However, “cervicogenic dizziness” should not simply be assumed whenever someone has both neck pain and dizziness.
Other vestibular, neurological, cardiovascular and medical causes should be considered first.
A vestibular physiotherapy assessment can help determine whether the symptoms appear consistent with a vestibular disorder, a neck-related component, or another cause that requires medical assessment.
Can Concussions Cause Dizziness?
Yes.
Dizziness and balance problems are common after concussion.
People may experience:
- Dizziness with head movement
- Motion sensitivity
- Difficulty in busy environments
- Headaches
- Visual sensitivity
- Balance problems
- Difficulty focusing
- Nausea
- Feeling “off”
- Exercise intolerance
Vestibular rehabilitation can form part of a broader concussion rehabilitation program when vestibular deficits are present.
Importantly, concussion-related dizziness isn’t necessarily BPPV.
A person can have BPPV after a head injury, vestibular dysfunction, visual motion sensitivity or several factors at the same time.
The treatment therefore needs to be based on the individual’s assessment.
What Is Vestibular Migraine?
Vestibular migraine is a condition in which migraine-related processes are associated with episodes of vertigo or dizziness.
A person doesn’t necessarily have to experience a traditional migraine headache every time.
Possible symptoms include:
- Vertigo
- Dizziness
- Motion sensitivity
- Sensitivity to visual environments
- Headache
- Light sensitivity
- Sound sensitivity
- Nausea
Physiotherapy may help address balance, movement sensitivity or other physical limitations in appropriate patients, but vestibular migraine may also require medical management.
What Happens During a Vestibular Physiotherapy Assessment?
If you’re nervous about your first appointment, here’s what you can generally expect.
Your physiotherapist will begin by asking detailed questions about your symptoms.
You may be asked:
- When did the dizziness start?
- Does the room spin?
- How long does each episode last?
- What triggers it?
- Does rolling over in bed trigger it?
- Does moving your head trigger it?
- Do you have headaches?
- Do you experience hearing changes?
- Have you recently had a concussion?
- Do you feel unsteady?
- Have you fallen?
- Do you take medications that may affect your symptoms?
The physiotherapist may then assess:
- Eye movements
- Head movement
- Positional responses
- Balance
- Walking
- Gaze stability
- Coordination
- Cervical movement
- Functional movement
Depending on your symptoms, positional testing may be used to determine whether BPPV is present.
The assessment is designed to determine what type of problem you’re dealing with before choosing treatment.
Is Vestibular Physiotherapy Supposed to Make You Dizzy?
Sometimes.
This can sound strange, but certain vestibular rehabilitation exercises intentionally expose you to movements that reproduce mild symptoms.
The goal is controlled adaptation.
For example, someone with vestibular hypofunction may become dizzy when moving their head quickly.
A rehabilitation program may gradually expose them to head movement while performing an appropriate exercise.
However, more dizziness isn’t automatically better.
The dosage needs to be appropriate.
If an exercise causes severe symptoms that remain significantly worse for a prolonged period, it may need to be modified.
Your physiotherapist should explain what level of symptoms is expected and how to progress the exercises safely.
How Long Does Vestibular Physiotherapy Take?
There is no universal timeline.
BPPV may improve very quickly following an appropriate repositioning manoeuvre.
Other vestibular disorders can require several weeks or months of rehabilitation.
For example, clinical guidelines for peripheral vestibular hypofunction describe different rehabilitation durations depending on whether the condition is acute, chronic, unilateral or bilateral. (PubMed)
Your recovery may also be influenced by:
- Age
- Duration of symptoms
- Severity of vestibular dysfunction
- Other medical conditions
- Balance ability
- Vision
- Medications
- Activity level
- Cognitive factors
- Consistency with home exercises
The goal is not to keep attending physiotherapy indefinitely.
The goal is to give you the tools and capacity to manage your condition and return to normal activities.
Can Vertigo Go Away on Its Own?
Sometimes.
Some causes of dizziness resolve naturally or improve as the nervous system adapts.
BPPV can also sometimes resolve without treatment.
However, waiting isn’t always the best option—particularly if your symptoms are affecting your ability to walk, drive, work or function safely.
More importantly, you need to know what is causing the dizziness.
A persistent or unexplained problem deserves appropriate assessment.
Can I Drive If I Have Vertigo?
Be cautious.
If you’re actively experiencing spinning, significant dizziness, visual instability or impaired balance, driving may be unsafe.
Even if your symptoms are intermittent, you need to consider whether an episode could occur while you’re driving.
If dizziness is affecting your ability to safely operate a vehicle, speak with your healthcare provider about when it is appropriate to return to driving.
Can Vertigo Cause Anxiety?
Absolutely.
Imagine suddenly feeling as though the room is spinning every time you roll over in bed.
It’s understandable that you may become worried about triggering another episode.
People with persistent dizziness can also begin avoiding:
- Driving
- Exercise
- Busy stores
- Crowded environments
- Stairs
- Walking outside
- Turning their head
- Social activities
This can create a cycle where reduced activity leads to reduced confidence and physical conditioning.
Appropriate rehabilitation can help people gradually return to activities they have been avoiding.
That doesn’t mean dizziness is “just anxiety.”
It means the physical symptoms and the emotional response to those symptoms can influence each other.
When Is Dizziness an Emergency?
This is one of the most important sections of this article.
Not every episode of dizziness should be treated by a physiotherapist.
Seek urgent medical attention for sudden dizziness or vertigo accompanied by concerning neurological or systemic symptoms, particularly if symptoms are new or severe.
Potential warning signs include:
- New weakness or numbness, particularly on one side
- Facial drooping
- Difficulty speaking or understanding speech
- New double vision or significant visual disturbance
- Severe difficulty walking or coordinating movement
- Fainting or loss of consciousness
- Severe or unusual headache
- New chest pain
- Severe shortness of breath
- Significant new hearing loss
- Persistent vomiting or severe illness
- Symptoms following significant head trauma
Stroke and other serious neurological conditions can sometimes present with dizziness or imbalance.
Do not assume that sudden severe vertigo is BPPV simply because the room is spinning.
When in doubt, seek appropriate medical evaluation.
What Is the Difference Between Vertigo and Dizziness?
Dizziness is a broad term describing sensations such as lightheadedness, unsteadiness, floating, disorientation or feeling off.
Vertigo specifically refers to the sensation of movement, often spinning, when there isn’t corresponding movement.
Someone can have dizziness without vertigo.
Someone can have vertigo as one component of a broader vestibular disorder.
That’s why the exact description of your symptoms matters.
What Is the Difference Between BPPV and Vestibular Hypofunction?
They’re different problems.
BPPV
Usually produces brief episodes of positional vertigo triggered by specific head movements.
Treatment often involves a canalith-repositioning manoeuvre when the diagnosis is confirmed.
Vestibular hypofunction
Involves reduced vestibular function on one or both sides.
Symptoms can include:
- Imbalance
- Dizziness
- Visual blurring with head movement
- Difficulty walking
- Motion sensitivity
Treatment often involves vestibular rehabilitation exercises, including gaze stabilization, balance and functional movement exercises.
Knowing the difference matters because the treatment is different.
What Exercises Help Vertigo?
There isn’t one universal “vertigo exercise.”
The correct exercise depends on the diagnosis.
Depending on the condition, vestibular rehabilitation may include:
Gaze stabilization
Training the eyes and vestibular system to maintain clear vision while the head moves.
Habituation
Repeated, controlled exposure to movements that provoke symptoms to help reduce sensitivity.
Balance training
Progressively challenging the body’s balance systems.
Walking exercises
Adding head movement, visual challenges or different surfaces.
Positional manoeuvres
Used for specific types of BPPV rather than as a general dizziness exercise.
This is why searching “best exercises for vertigo” and doing random exercises isn’t always the best approach.
The right exercise for the wrong diagnosis can be ineffective—or inappropriate.
Should I Do the Epley Manoeuvre at Home?
If you’ve previously been diagnosed with a specific type of BPPV and have been taught the correct manoeuvre, a home program may be appropriate in some circumstances.
But if you’ve never been assessed, it’s better not to assume that every episode of dizziness is BPPV.
The Epley manoeuvre is designed for specific canal involvement.
If your symptoms are caused by something else, it won’t address the underlying problem.
A vestibular physiotherapist can determine whether BPPV is likely and teach you an appropriate strategy when indicated.
Can Medication Treat Vertigo?
Medication can have a role in managing certain vestibular conditions, particularly during acute episodes, but it isn’t appropriate for every cause of dizziness.
For BPPV specifically, clinical guidelines recommend against routinely treating the condition with vestibular-suppressant medications and instead emphasize appropriate repositioning treatment. (PubMed)
Medication decisions should be discussed with your physician or prescribing healthcare professional.
What Can I Do at Home for Dizziness?
Until you have determined the cause of your dizziness, prioritize safety.
You can:
- Move slowly when changing positions.
- Use a handrail on stairs.
- Keep pathways clear.
- Avoid driving if symptoms impair you.
- Stay hydrated.
- Follow the exercise program prescribed for your specific condition.
- Keep track of what triggers your symptoms.
- Avoid suddenly stopping prescribed medications without speaking to your healthcare provider.
If you are experiencing significant balance problems, avoid performing challenging balance exercises alone.
Can Vestibular Physiotherapy Help Older Adults?
Yes.
Balance problems can become particularly important as people age because falls can have significant consequences.
Vestibular rehabilitation can address appropriate vestibular deficits while also working on:
- Balance
- Walking
- Strength
- Confidence
- Head movement
- Functional mobility
The goal is not simply to improve a test result.
It’s to help someone feel safer and more independent during everyday activities.
Can Vestibular Physiotherapy Help Athletes?
Absolutely.
Athletes may notice vestibular problems during:
- Running
- Turning quickly
- Changing direction
- Tracking a ball
- Jumping
- Contact
- Rapid head movement
- Returning to sport after concussion
A rehabilitation program can be progressed beyond basic balance exercises toward the specific demands of the athlete’s sport.
For a soccer player, that might include scanning while running and changing direction.
For a hockey player, it might involve rapid head movement and visual tracking.
For a racquet-sport athlete, it might involve tracking a moving ball while moving the head and body.
The final stage of rehabilitation should reflect the activity you’re trying to return to.
How Restorative Touch Physiotherapy Can Help With Vertigo & Vestibular Disorders
At Restorative Touch Physiotherapy, vestibular rehabilitation begins with understanding why you’re dizzy.
Depending on your presentation, your assessment may look at:
- Positional vertigo
- Eye movements
- Gaze stability
- Balance
- Walking
- Head movement
- Cervical function
- Vestibular symptoms
- Functional limitations
From there, treatment is individualized.
For someone with BPPV, treatment may involve an appropriate repositioning manoeuvre.
For someone with vestibular hypofunction, treatment may involve progressive gaze stabilization, balance and functional exercises.
For someone recovering from concussion, vestibular rehabilitation may form one part of a broader return-to-activity plan.
And if your symptoms don’t appear appropriate for physiotherapy, we’ll help identify when further medical assessment is needed.
The goal is simple:
Help you understand what’s happening, improve your confidence and function, and get you safely back to the activities that matter to you.
Frequently Asked Questions About Vertigo & Vestibular Physiotherapy
Where can I get vestibular physiotherapy in Hamilton?
Vestibular physiotherapy is available at select physiotherapy clinics in Hamilton and surrounding communities. When choosing a clinic, look for a physiotherapist with specific training and experience in vestibular rehabilitation.
Can a physiotherapist treat vertigo?
Yes, physiotherapists with appropriate vestibular training can assess and treat certain causes of vertigo, including BPPV and peripheral vestibular disorders.
How quickly can physiotherapy fix BPPV?
Some people experience substantial improvement after an appropriate repositioning manoeuvre, while others require additional assessment or treatment. The timeline depends on the type of BPPV and whether another vestibular problem is contributing.
Is BPPV dangerous?
The condition itself is generally considered benign, but the sudden vertigo and resulting imbalance can increase fall risk. It is also important to distinguish BPPV from other causes of dizziness that may require medical attention.
Does BPPV come back?
Yes. BPPV can recur after successful treatment. If symptoms return, reassessment can determine whether BPPV has returned and whether another cause should be considered.
Can vertigo be caused by my neck?
Neck-related dizziness is possible, but it shouldn’t automatically be assumed to be the cause. Vestibular, neurological and other medical causes should be considered.
Can physiotherapy help dizziness after a concussion?
Yes. Vestibular rehabilitation can be useful when vestibular or balance impairments are contributing to post-concussion symptoms.
Does vestibular physiotherapy make you dizzy?
Some exercises intentionally produce mild, controlled symptoms as part of the rehabilitation process. The program should be individualized and progressed appropriately.
How many vestibular physiotherapy sessions will I need?
It depends on the diagnosis and severity. Some BPPV cases may require very few visits, while vestibular hypofunction and more complex balance disorders can require several weeks of rehabilitation.
Can I do vestibular exercises at home?
Yes. Home exercises are an important part of many vestibular rehabilitation programs. They should be selected and progressed according to your diagnosis and individual needs.
Do I need a doctor’s referral for vestibular physiotherapy in Ontario?
You can generally access private physiotherapy without a physician referral. However, your extended health insurance provider may have specific requirements for reimbursement, so check your individual benefits.
Vertigo & Vestibular Physiotherapy in Hamilton
Dizziness can be unsettling, especially when you don’t understand why it’s happening.
You don’t have to simply live with it or assume that every episode of spinning is “just vertigo.”
A proper assessment can help determine whether you’re dealing with BPPV, vestibular hypofunction, a concussion-related vestibular problem, another vestibular disorder or a condition that requires medical assessment.
At Restorative Touch Physiotherapy on Hamilton Mountain, our physiotherapy team can assess your symptoms and develop an individualized rehabilitation plan based on your presentation and goals.
Whether you’re struggling with positional vertigo, balance problems, dizziness with movement or difficulty returning to normal activities after a concussion, the first step is understanding what’s causing your symptoms.
Book a vestibular physiotherapy assessment at Restorative Touch Physiotherapy in Hamilton.