Vestibular Therapy

If you have vertigo or other vestibular conditions, we can help!  Vestibular conditions we treat include benign paroxysmal positional vertigo (BPPV), Meniere’s Disease, Vestibular neuritis, and more.

Do you have vertigo?  Vertigo is the sensation that everything around you is spinning, even though it's not.  It's caused by an imbalance in your vestibular system, which is located in your inner ear.(1)

Vertigo is different than dizziness, which is a more general term for feeling unsteady. Dizziness can have many causes, including vision issues, hypothyroidism, urinary tract and other infections, pneumonia, heart disease, migraines, osteoarthritis, medication side-effects, intoxication... the list of things that can make you dizzy is long.(2)

We Treat BPPV

Benign Paroxysmal Positional Vertigo (BPPV) is a condition of your vestibular system. It is the most common cause of vertigo.

If you do have BPPV, our physiotherapy treatment can stop your vertigo in as little as one visit - although it often takes two or three.  Patients report near immediate relief following our treatment for BPPV (learn more about treatment techniques below).  

How To Tell If BPPV or Something Else is Causing your Dizziness

Since there are so many potential causes for dizziness, we first need to figure out what your cause is.  Your doctor and physiotherapist can help with this.

Tell your doctor about your symptoms, and if they suspect BPPV is the cause, book a vestibular physiotherapy appointment with us.

You can also work with your physiotherapist to help you figure out what's going on.  If they don't think it's a vestibular condition treatable with physiotherapy, they can refer you to another healthcare specialist to ensure you get the care you need.

Here are some of the questions we'll likely ask you:

  • Have you been diagnosed with BPPV, positional vertigo, Meniere's Disease, Vestibular Neuritis or another vestibular condition?
  • Does rolling in bed make you dizzy?
  • Does turning your head make you dizzy?
  • Does lying on one side make you dizzy?

If your answers to these questions are yes, give us a call.  If you're not sure, call us to set up a FREE 15-minute phone conversation with a physiotherapist, to make sure physiotherapy for BPPV is right for you.

Your Vestibular System

Your vestibular system includes parts of your inner ear, plus the nerves that send signals from your inner ear to your brain. 

Your vestibular system helps control your balance and eye movements. If it is damaged by disease, aging, or injury, you can get vestibular disorders like BPPV.  

In addition to vertigo, common symptoms of vestibular system damage can include imbalance, spatial disorientation (not being able to tell where things are), and vision disturbance (not seeing clearly).  

Among older adults, vestibular issues are actually the most common cause of dizziness.(3)  Vestibular disorders are also common among people who have suffered a traumatic brain injury, such as a concussion.(4)  With a traumatic brain injury, there are commonly other symptoms too, such as tinnitus (ringing in the ears), headache, and blurred vision.

Below is an image of your inner ear. The vestibular system is made up of the semicircular canals (item 12), the utricle (13) and saccule (not pictured), plus the nerves that connect them to the brain (such as the vestibular nerve, item 15). Your semicircular canals have crystals in them, called otoconia.  

About BPPV: Benign Paroxysmal Positional Vertigo

BPPV means:

  • Benign: it is not life threatening
  • Paroxysmal: it comes in sudden, brief spells
  • Positional: it gets triggered by certain head positions or movements
  • Vertigo: a false sense of rotational movement

In BPPV, the crystals (otoconia) in your inner ear have fallen out of place.  This happens either because of degeneration related to aging or from a traumatic blow to the head. The crystals move to other parts of the semicircular canals.

When enough of these crystals accumulate in one of the canals, they interfere with the normal movement of fluid through the canals. That causes the nerves to send false signals to the brain, and these false signals cause vertigo.

When you have BPPV, you will feel vertigo but the vertigo will not be constant.  Rather, the vertigo will come on with certain movements, and then subside soon after you stop moving.  It is commonly triggered by movements like rolling over in bed, getting in and out of bed, tipping the head to look upward, bending over, and quick head movements.  

Treating BPPV

In the vast majority of cases, vertigo from BPPV can be stopped with a series of head movements called Canal Repositioning Maneuvers.  

First your physiotherapist will do an assessment to figure out which canal your crystals have moved in to.  Then they do the treatment maneuver, to get them back to the chamber they are supposed to be in.  The maneuvers use gravity to guide the crystals through your canals.

Depending on your form of BPPV, maneuvers your physiotherapist will use include the Epley Maneuver, the Barbeque Roll, or the Semont (Liberatory) Maneuver. All these maneuvers will involve your physiotherapist guiding you to move your head and body through a series of positions. 

These treatment techniques are relatively safe, non-invasive, and often provide quick relief from BPPV.  Keep in mind, however, your physiotherapist may have to trigger your vertigo as part of their assessment, to figure out which treatment technique is right for you.  

Not sure if vestibular physiotherapy is right for you?  Call us to book a FREE 15-minute phone conversation with a physiotherapist, to discuss your dizziness, your vestibular system and your symptoms.


(1) Lo AX, Harada CN. Geriatric Dizziness: Evolving Diagnostic and Therapeutic Approaches for the Emergency
Department. Clin Geriatr Med 2013, 29: 181 204.

(2) Hansson EE. Vestibular rehabilitation For whom and how? A systematic review. Adv Physiother , 2007; 9:106

(3) Iwasake S, Tamasoba T. Dizziness and Imbalance in the Elderly: Age related Decline in the Vestibular System.
Aging & Disease, 2015. 6(1): 38 47.

(4) McLeod TC, Hale TD. Vestibular and balance issues following sports related concussions. Brain Injury, 2015. 29(2): 175 184.

(3) McLeod TC, Hale TD. Vestibular and balance issues following sports related concussions. Brain Injury, 2015. 29(2): 175 184.

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