Dizziness, vertigo, imbalance, or motion sensitivity can make everyday activities feel unpredictable and frustrating.
Vestibular physiotherapy is a specialized area of physiotherapy that assesses and treats problems affecting the vestibular system—the inner-ear and brain pathways that help control balance, spatial orientation, and gaze stability.
At painPRO, our physiotherapists use individualized, evidence-informed assessment and rehabilitation to help you understand what's contributing to your symptoms and develop a treatment plan based on your goals.
What Is Vestibular Physiotherapy?
Your vestibular system plays an important role in helping your brain understand where your body is in space and how you're moving.
When this system isn't working properly, you may experience:
- Dizziness or lightheadedness
- Vertigo or a spinning sensation
- Feeling unsteady or off-balance
- Motion sensitivity
- Nausea
- Difficulty walking or changing direction
- Symptoms when turning your head
- Difficulty focusing while moving
- Visual sensitivity
- Problems with balance in low-light environments
- Difficulty returning to sports, exercise, work, or everyday activities
Vestibular physiotherapy uses targeted assessment and rehabilitation to address the specific impairments contributing to your symptoms. Evidence supports vestibular rehabilitation for people with peripheral vestibular hypofunction, with improvements reported in symptoms, gaze and postural stability, function, and quality of life.
What Conditions Can Vestibular Physiotherapy Help With?
Vestibular physiotherapy may be appropriate for a range of conditions, including:
BPPV
Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of brief episodes of vertigo triggered by changes in head position, such as rolling over in bed, lying down, sitting up, or looking up.
Specific assessment and canalith repositioning manoeuvres can be used when BPPV is identified. Clinical guidelines strongly recommend appropriate repositioning procedures for diagnosed BPPV.
Vestibular Hypofunction
Reduced function of one or both sides of the vestibular system can contribute to dizziness, imbalance, difficulty stabilizing your vision while moving, and problems with walking or navigating your environment.
Vestibular rehabilitation is strongly supported for appropriate individuals with unilateral or bilateral peripheral vestibular hypofunction.
Post-Concussion Dizziness
Dizziness, balance problems, visual motion sensitivity, and difficulty tolerating movement can occur following a concussion.
Vestibular physiotherapy may form part of a broader concussion rehabilitation plan when vestibular or balance impairments are contributing to symptoms.
Balance & Gait Problems
If you feel unsteady when walking, turning, standing, or moving through busy environments, vestibular rehabilitation may help address the underlying balance and movement impairments.
Motion Sensitivity
Some people experience dizziness or nausea when moving their head, walking through busy environments, using escalators, scrolling on screens, or travelling in a vehicle.
Other Vestibular Disorders
Vestibular physiotherapy may also be appropriate for people experiencing symptoms associated with other peripheral or central vestibular conditions. Your physiotherapist can determine whether vestibular rehabilitation is appropriate or whether further medical assessment is recommended.
What Happens During a Vestibular Physiotherapy Assessment?
Your first appointment is designed to understand what you're experiencing, when it happens, and why it may be happening.
Your physiotherapist may assess:
- Your symptoms and history
We'll discuss when your symptoms started, what brings them on, how long they last, and how they affect your daily activities. - Eye and head movement
Your physiotherapist may assess how your eyes and head work together during movement. - Balance and stability
This may include different standing, walking, and balance tasks. - Positional symptoms
If your symptoms suggest BPPV, specific positional testing may be performed. - Gait and movement
Your physiotherapist may assess how your balance changes while walking or moving your head. - Functional goals
Most importantly, we'll look at what you want to get back to—whether that's working, exercising, driving, playing sports, walking outdoors, or simply moving around your home with more confidence.
Your treatment plan is then tailored to the findings from your assessment.
What Does Vestibular Physiotherapy Treatment Involve?
There isn't a single exercise or treatment that works for everyone.
Depending on your assessment, treatment may include:
- Canalith repositioning manoeuvres for BPPV
- Gaze stabilization exercises
- Habituation exercises
- Balance and postural control exercises
- Walking and gait training
- Head and eye movement exercises
- Visual-motion exercises
- Functional movement training
- Education and strategies for managing symptoms
- A personalized home exercise program
The goal isn't simply to make you better at performing exercises in the clinic, the goal is to help you feel more confident and capable in the activities that matter to you.
Vestibular rehabilitation is generally active and progressive, with exercises selected according to the individual's impairments, symptoms, goals, and tolerance.
Is Vestibular Physiotherapy Right For Me?
You don't necessarily need to know what's causing your dizziness before booking.
If you're experiencing dizziness, vertigo, balance problems, motion sensitivity, or difficulty tolerating movement, a vestibular physiotherapy assessment can help determine whether vestibular rehabilitation may be appropriate.
Your physiotherapist can also identify situations where further medical investigation or referral is warranted.
You may want to consider an assessment if:
- Your symptoms are affecting your daily activities
- You feel unsteady or worried about falling
- You experience spinning when changing positions
- You avoid certain movements because they make you dizzy
- You're having difficulty returning to exercise after a concussion
- You feel dizzy in busy environments
- Your vision feels unstable when you move your head
- You're having difficulty returning to work, sport, or other activities
Why Choose painPRO for Vestibular Physiotherapy?
Evidence-Informed Care
Our approach is grounded in current clinical evidence and individualized to your presentation rather than relying on a one-size-fits-all treatment plan.
One-on-One Attention
Your physiotherapist will work directly with you to assess your symptoms, explain what's happening, and progress your rehabilitation.
Integrated Care
Vestibular symptoms don't always exist in isolation. When appropriate, your physiotherapist can collaborate with other painPRO professionals, including kinesiologists, chiropractors, registered massage therapists, acupuncturists, occupational therapists, and counsellors.
painPRO is a multidisciplinary organization with six locations across Metro Vancouver, making it easier to access coordinated care when you need it.
Personalized Rehabilitation
Your treatment plan is based on your symptoms, assessment findings, lifestyle, and goals—not simply a diagnosis.
Vestibular Physiotherapy FAQ
What is the difference between dizziness and vertigo?
Dizziness is a broad term used to describe sensations such as lightheadedness, unsteadiness, or feeling off-balance.
Vertigo specifically refers to the sensation that you or your surroundings are moving or spinning.
They can have different causes, which is why a proper assessment is important.
What is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo. It occurs when tiny calcium carbonate crystals in the inner ear become displaced and move into one of the semicircular canals.
This can cause brief episodes of vertigo when changing the position of your head—for example, rolling over in bed, lying down, sitting up, or looking up.
BPPV can often be effectively treated with specific repositioning manoeuvres when the appropriate type of BPPV is identified.
Can physiotherapy treat vertigo?
Yes, in many cases. Physiotherapy can be an effective treatment for certain causes of vertigo, including BPPV and some forms of vestibular hypofunction.
However, vertigo has many possible causes. A vestibular physiotherapist will assess your symptoms and determine whether physiotherapy is appropriate or whether another healthcare professional should be involved.
Can vestibular physiotherapy help with dizziness after a concussion?
It can. Some people experience dizziness, balance difficulties, visual sensitivity, or difficulty tolerating head movement following a concussion.
When vestibular or balance impairments are contributing to symptoms, vestibular physiotherapy may be incorporated into a broader concussion rehabilitation program.
Will vestibular exercises make me dizzy?
They can temporarily increase symptoms, and that's not necessarily a sign that something is wrong.
Some vestibular exercises intentionally challenge the systems responsible for balance and visual stability. Your physiotherapist will determine an appropriate level of challenge and progressively adjust your exercises based on your response.
If an exercise consistently causes significant or prolonged symptoms, let your physiotherapist know so your program can be modified.
How many vestibular physiotherapy sessions will I need?
There isn't one standard number of sessions.
The amount of treatment depends on the cause and severity of your symptoms, how long you've been experiencing them, your goals, and how you respond to treatment.
Some straightforward cases may require only a small number of appointments, while more complex vestibular conditions may require a longer rehabilitation program.
Do I need a doctor's referral?
No. You can book directly with a physiotherapist at painPRO.
However, some extended health insurance plans or specific funding programs may have their own requirements, so we recommend checking your coverage before your appointment.
Is vestibular physiotherapy covered by extended health benefits?
Many extended health plans include physiotherapy coverage, but the amount and requirements vary between plans.
painPRO offers direct billing to many extended health providers, although coverage should always be confirmed with your insurer.
Can vestibular physiotherapy help with balance problems even if I don't have vertigo?
Yes. Vestibular problems don't always cause a spinning sensation. Some people primarily experience unsteadiness, difficulty walking, visual instability, or problems maintaining balance.
A vestibular assessment can help determine whether your symptoms may be related to vestibular dysfunction or another cause.
Can vestibular physiotherapy help older adults?
Yes. Vestibular rehabilitation can be appropriate for older adults experiencing dizziness, imbalance, vestibular hypofunction, or increased fall risk.
Treatment can be adapted to the individual's abilities, environment, and goals. Evidence supports vestibular rehabilitation for appropriate adults with peripheral vestibular hypofunction.
What should I bring to my first appointment?
Bring any relevant medical information, including:
- A list of medications
- Relevant medical or diagnostic reports
- Information about previous treatment
- Details about when your symptoms started
- Any questions or concerns you have
Most importantly, be prepared to describe what movements or situations trigger your symptoms.
When should I see a doctor instead of a physiotherapist?
Dizziness and vertigo can have many different causes. Vestibular physiotherapy is appropriate for many musculoskeletal and vestibular presentations, but some symptoms require medical assessment.
If you experience new or severe neurological symptoms, fainting, chest pain, severe headache, sudden hearing loss, significant difficulty speaking, new weakness or numbness, or other concerning symptoms, seek urgent medical attention rather than waiting for a physiotherapy appointment.