What is vestibular physiotherapy?

The vestibular system — located in the inner ear — is responsible for your sense of balance, spatial orientation and gaze stability during movement. When it malfunctions, the result can be vertigo (a spinning sensation), chronic dizziness, nausea, visual disturbance during movement and unsteadiness that significantly affects daily life.

Vestibular physiotherapy is a specialised area of physiotherapy that assesses and treats these conditions using specific clinical tests, repositioning manoeuvres and exercise-based rehabilitation programs. It is not the same as general balance training — it requires a precise diagnosis of which part of the vestibular system is affected and treatment that addresses that specific deficit.

BPPV — the most common cause of vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is the single most common cause of vertigo in adults. It occurs when calcium carbonate crystals (otoconia) that normally sit on the utricle of the inner ear become displaced and migrate into one of the semicircular canals. When the head moves into certain positions, these crystals shift and create an abnormal fluid movement that the brain interprets as spinning.

Classic BPPV presents as brief (typically under a minute) but intense spinning triggered by rolling over in bed, getting up quickly, tilting the head back, or bending forward. It is often misdiagnosed or left untreated for months.

BPPV is highly treatable. Canalith repositioning manoeuvres — the Epley manoeuvre for posterior canal BPPV and the Gufoni or barbecue roll for horizontal canal BPPV — physically move the crystals back to where they belong. Most patients experience significant improvement within one to three sessions. The diagnosis must be confirmed with positional testing (Dix-Hallpike and roll tests) before the correct repositioning manoeuvre can be applied — which is why accurate assessment matters before treatment begins.

Vestibular hypofunction

When one or both vestibular organs are damaged or underperforming — from conditions such as vestibular neuritis, labyrinthitis, acoustic neuroma treatment or age-related decline — the result is chronic dizziness, visual instability during head movement and balance impairment rather than positional vertigo.

Vestibular rehabilitation for hypofunction works by promoting central compensation — training the brain to use alternative sensory inputs (visual and somatosensory) to substitute for the reduced vestibular input. Programs include gaze stabilisation exercises, habituation exercises and progressive balance training. Outcomes are strongly correlated with the consistency and progression of the exercise program.

Post-whiplash and post-concussion dizziness

Dizziness following whiplash or concussion is common and often persists well beyond the expected recovery period. The mechanisms may involve cervicogenic contributions (from the upper cervical spine), central sensitisation, or residual peripheral vestibular damage. Assessment distinguishes between these contributors so that treatment addresses the right source. Cervical physiotherapy and vestibular rehabilitation are often combined in these presentations.

What does a vestibular assessment involve?

A vestibular assessment at our clinic typically includes:

  • Detailed history of the dizziness — onset, triggers, duration, associated symptoms
  • Dix-Hallpike and roll tests to assess for BPPV
  • Head impulse test and dynamic visual acuity testing
  • Balance and gait assessment
  • Cervical assessment where cervicogenic contributions are suspected

Following assessment, you will receive a clear explanation of what is causing your symptoms and what the treatment plan involves. Where the presentation suggests a cause that is outside the scope of physiotherapy management — such as a central neurological cause — we will refer appropriately. Full clinic details and online booking are available at absolutehealth.net.au.

Common questions

Do I need a GP referral?

No. You can book directly. If your GP has already investigated your dizziness and ruled out serious causes, that information is useful but not required to start.

How quickly does BPPV resolve?

Most posterior canal BPPV cases resolve significantly within one to three sessions. Horizontal canal BPPV can take a little longer. Recurrence is possible — approximately 15–30% of patients experience a recurrence within a year — but it is equally treatable when it does.

Is vestibular physio covered by private health insurance?

Yes — vestibular physiotherapy is claimed as a standard physiotherapy consultation under extras cover with most major health funds. HICAPS is available on-site for instant claiming.