Rolling over in bed brings on a spinning sensation. Turning your head makes you feel unsteady. Or you have started avoiding busy places because movement leaves you feeling off balance.
These experiences can have different causes. Vestibular physiotherapy may help with certain conditions affecting the inner ear and balance system, but the first step is understanding what is causing your symptoms. An assessment also helps identify when you need medical care or further investigation.
When dizziness needs urgent medical care
Call 000 if sudden dizziness or vertigo occurs with signs of a stroke, such as facial drooping, weakness or numbness on one side, or difficulty speaking. Sudden severe headache, new double vision, confusion or difficulty walking also need urgent medical assessment. Do not drive yourself or wait for a routine physiotherapy appointment.
New, persistent or unexplained dizziness should be assessed by a doctor. If you are unsure how urgently you need help, call Healthdirect on 1800 022 222. A previous diagnosis of vertigo does not mean a new or different episode has the same cause.
Dizziness and vertigo describe different sensations
Dizziness is a broad term. You might mean light-headedness, faintness, unsteadiness or a feeling that things are moving. Vertigo describes a sensation that you or your surroundings are spinning or moving when they are not.
Be as specific as you can at your appointment. An episode lasting seconds after rolling in bed is different from feeling faint when you stand up. Medicines, blood-pressure changes and other health conditions can contribute to dizziness, so symptoms should not automatically be attributed to the inner ear.
Your physiotherapist will start with your story
Expect questions about when symptoms began, how long episodes last and what seems to bring them on. Your physiotherapist may also ask about hearing changes, headaches, nausea, falls, previous illnesses or injuries, and any medical assessments you have already had.
Explain the effect on your day. Perhaps you feel unsteady walking to the shops, cannot turn your head comfortably or have stopped an activity you enjoy. These details help the clinician understand your priorities as well as your symptoms.
Bring a medicines list and relevant reports if you have them. A brief record of recent episodes can help: note the activity, the sensation, how long it lasted and any other symptoms. You do not need to work out the diagnosis yourself.
What might the physical assessment involve?
The tests depend on your symptoms and health history. They may include observing eye movements, checking how your eyes respond when your head moves, and assessing standing balance or walking. Your physiotherapist should explain each test and discuss any movement limitations before proceeding.
If your history suggests benign paroxysmal positional vertigo, or BPPV, they may consider positional testing. This involves moving into particular positions while observing your eyes and symptoms. Some tests can briefly bring on dizziness, so tell your clinician how you feel and ask to pause if needed.
Not everyone needs the same tests, and a single appointment may not answer every question. If the findings suggest a different cause or need further investigation, your physiotherapist may recommend a GP or specialist assessment.
Treatment follows the assessment findings
BPPV involves small crystals moving into the wrong part of the inner ear’s balance system. When appropriate, a trained clinician can use a repositioning manoeuvre to move them. The manoeuvre chosen depends on the assessment; it is not a general treatment for every kind of dizziness.
For other suitable vestibular conditions, rehabilitation may involve exercises for keeping vision steady during head movement, gradually becoming more comfortable with selected movements, or practising balance and walking. Education about managing activities and reducing falls risk may also form part of the plan.
The exercises and their difficulty should match your needs. A program may produce some temporary symptoms, but you should receive guidance about the expected response, how to practise safely and when to stop or seek advice. Do not copy another person’s exercises or attempt a repositioning manoeuvre simply because a video describes similar symptoms.
How to prepare and get home
- Wear comfortable clothes that allow you to move and shoes suitable for walking.
- Bring your glasses, usual walking aid and any relevant referral or test results.
- Tell the clinic about neck or back problems that might affect positioning.
- Consider arranging someone to accompany you and drive you home, as testing can temporarily provoke symptoms.
Do not stop or change prescribed medicines unless your treating clinician specifically advises you to. Ask the clinic about any preparation for your particular appointment. Avoid driving while dizzy or unsteady.
What happens after the appointment?
You should leave with an explanation of the findings, the proposed next step and any exercises or precautions relevant to you. Ask how progress will be reviewed and what to do if symptoms worsen or change.
Treatment length varies with the cause, your health and your response. Some people need a repositioning treatment and review; others need an ongoing rehabilitation program or input from another health professional. A fixed number of visits cannot guarantee recovery.
Arrange an assessment in Burleigh Heads
Burleigh Central Physiotherapy provides vestibular physiotherapy for vertigo and dizziness, including individual assessment and tailored treatment where appropriate. The clinic is at 11/109 West Burleigh Road, Burleigh Heads QLD 4220.
Call 07 5576 0747 or contact the team to ask about a vestibular assessment. Describe your symptoms when booking so the team can help you arrange the appropriate appointment.
This article provides general information and does not replace individual medical or physiotherapy advice.
Further reading
Healthdirect: Vertigo symptoms, causes and treatment
St George’s University Hospitals: Vestibular and balance rehabilitation
Kingston and Richmond NHS: Vestibular assessment and rehabilitation
