Vestibular Physiotherapy Vancouver | Vertigo & BPPV

Do Any of These Sound Familiar?

Dizziness feels different depending on what's causing it. These are the patterns we see most often in our Vancouver clinics, and the conditions usually behind them.

"The room spins when I roll over in bed"

Often linked to: BPPV

Short bursts of spinning when you lie down, roll over, look up, or bend forward. Usually very treatable, often in just a few sessions.

"I've been dizzy since I had a virus"

Often linked to: vestibular neuritis or labyrinthitis

Severe vertigo that came on suddenly, followed by days or weeks of feeling off balance, especially when you turn your head.

"I've felt foggy and off balance since a concussion"

Often linked to: post-concussion vestibular dysfunction

Dizziness, trouble focusing your eyes, or feeling worse in busy places after a head injury. Learn more about our concussion physiotherapy.

"I feel like I'm rocking or swaying all the time"

Often linked to: PPPD

A constant sense of unsteadiness that's worse when standing, walking, or around busy patterns like grocery store aisles and screens.

"My dizziness comes with migraines"

Often linked to: vestibular migraine

Episodes of vertigo or imbalance, with or without headache, often alongside light or motion sensitivity.

"I'm unsteady and worried about falling"

Often linked to: age-related imbalance or Meniere's disease

Feeling less sure on your feet, especially on stairs or uneven ground. Balance training and active rehabilitation help rebuild confidence.

When to get emergency care: sudden dizziness with a severe headache, double vision, trouble speaking, facial drooping, weakness or numbness, or sudden hearing loss needs urgent medical attention. Call 911 or go to your nearest emergency department.

BPPV: The Most Common Cause of Vertigo

Benign paroxysmal positional vertigo (BPPV) happens when tiny calcium crystals in your inner ear shift out of place and drift into one of the balance canals. When you move your head, the loose crystals send false signals to your brain, causing a brief but intense spinning sensation, usually lasting less than a minute. The good news: BPPV is one of the most treatable causes of dizziness.

Assessment

Your physiotherapist confirms BPPV and pinpoints which ear and canal are affected. The main tests are the Dix-Hallpike test, where you move from sitting to lying with your head turned, and the supine roll test, where your head is turned side to side while lying down. We watch your eye movements during each position, since the pattern tells us exactly where the crystals are.

Repositioning

Once we know the affected canal, we guide your head and body through a series of positions to move the crystals back where they belong. The Epley manoeuvre is used for the most common type, and the Semont, BBQ roll, or Gufoni manoeuvres are used for other canals. Each position is held briefly, and you may feel dizzy during the process.

Follow up

Many people feel a big improvement right away, and BPPV typically resolves within 1 to 3 sessions. You may feel slightly off balance for a day or two afterwards. We retest at your next visit, and if any unsteadiness remains, add balance exercises to help you fully recover.

Why not just try the Epley at home?

Home videos assume you have the most common type of BPPV in a particular ear. If the crystals are in a different canal, or the dizziness has another cause, the wrong manoeuvre won't help and can leave you feeling worse. A proper assessment makes sure you get the right treatment the first time, and we'll teach you what to watch for if BPPV ever comes back.

Comprehensive Vestibular Physiotherapy Assessment

Your initial evaluation includes:

Detailed symptom history

Onset and triggers
Description of dizziness (spinning, lightheadedness, imbalance)
Duration and frequency of episodes
Associated symptoms (nausea, hearing changes, headaches)
Impact on daily function

Vestibular function testing

Head impulse test (assesses vestibular-ocular reflex)
Gaze stability assessment
Positional testing for BPPV
Vestibular-ocular reflex
Post-head-shake testing

Sensation during treatment

Static balance
Dynamic balance (tandem walking, single-leg stance)
Functional balance scales
Fall risk assessment

Cervical spine examination

Neck dysfunction often coexists with vestibular disorders and can contribute to dizziness.

Visual system assessment

Evaluating eye movement control and visual dependence, which affect balance.This comprehensive assessment identifies the specific vestibular pathology and guides treatment selection.

testimonials

Results that speak for themselves

Vestibular Physiotherapy Vancouver: Patient Success Stories

I wanted to take a moment to write you a note of gratitude for your time and efforts during my recovery.

Your attitude, depth of knowledge, and commitment really helped me through one of the roughest times in my life.

— M. Goddard

VanCity Physio has played a pivotal role in my journey to healing my back after a car accident in 2017. Their positive attitude and ability to build instant rapport with each of his clients constantly amazes me.

Their dedication to solving the mystery behind my injury and constant support in advocating for my health has been a necessary component to the success I've had treating this injury.

I trust VanCity Physio fully with this injury and I will undoubtedly be visiting any time I need to see a physiotherapist in the future. Do yourself a favour and book in now!

— Dr. Neda R

Frequently Asked Questions About Vestibular Physiotherapy in Vancouver

What is vestibular physiotherapy?

Vestibular physiotherapy is a specialized type of physiotherapy for dizziness, vertigo, and balance problems caused by the inner ear or the way your brain processes balance information. Treatment combines hands-on techniques, like repositioning for BPPV, with targeted exercises that retrain your balance system.

Can physiotherapy help vertigo?

Yes. Physiotherapy is a first-line treatment for many types of vertigo. BPPV, the most common cause, often resolves in 1 to 3 sessions with repositioning. Other conditions, such as vestibular neuritis or post-concussion dizziness, improve with a structured exercise program over several weeks.

What is BPPV and how is it treated?

BPPV (benign paroxysmal positional vertigo) happens when small calcium crystals in the inner ear move into one of the balance canals, causing brief spinning when you change head position. Your physiotherapist identifies the affected ear and canal with positional tests, then uses a repositioning manoeuvre to guide the crystals back into place.

What is the Epley manoeuvre?

The Epley manoeuvre is a series of head and body positions used to treat the most common type of BPPV. Each position moves the loose crystals step by step out of the balance canal. It works best when a physiotherapist first confirms which ear and canal are affected, since other types of BPPV need different manoeuvres.

How many vestibular physiotherapy sessions will I need?

BPPV typically needs 1 to 3 sessions. Other vestibular conditions usually take 6 to 12 sessions over 8 to 16 weeks, with check-ins every 4 to 6 weeks once you're progressing well. Your physiotherapist will outline a plan after your 60 minute initial assessment.

Will vestibular exercises make my dizziness worse?

At first, they may, briefly. Vestibular exercises gently provoke symptoms so your brain can adapt, and mild dizziness for 30 to 60 minutes afterwards is normal. As your balance system recovers, the same exercises become easier. Contact your physiotherapist if symptoms last more than a few hours or get significantly worse.

When should I see a doctor instead of a physiotherapist for dizziness?

Get emergency care right away if dizziness comes on suddenly with a severe headache, double vision, trouble speaking, facial drooping, weakness, numbness, or sudden hearing loss. For ongoing or recurring dizziness without these warning signs, a vestibular physiotherapy assessment is a good place to start, and we'll refer you to your doctor if anything needs further investigation.

Do I need a referral, and is vestibular physiotherapy covered?

No referral is needed to book. Vestibular physiotherapy is billed as physiotherapy, so most extended health plans cover it under physiotherapy benefits, though some plans require a doctor's referral for reimbursement. VanCity Physio offers direct billing for eligible plans at our Downtown and Fairview clinics.

Vestibular Physiotherapy
Vancouver

Specialized Care for Vestibular Disorders

Do Any of These Sound Familiar?

"The room spins when I roll over in bed"

"I've been dizzy since I had a virus"

"I've felt foggy and off balance since a concussion"

"I feel like I'm rocking or swaying all the time"

"My dizziness comes with migraines"

"I'm unsteady and worried about falling"

BPPV: The Most Common Cause of Vertigo

Assessment

Repositioning

Follow up

Why not just try the Epley at home?

Comprehensive Vestibular Physiotherapy Assessment

Detailed symptom history

Vestibular function testing

Sensation during treatment

Cervical spine examination

Visual system assessment

What to Expect During Treatment

Initial sessions

Progression

Realistic expectations

Preparing for Your Assessment

Preparing for Your Sports Physiotherapy Assessment

Normal responses

Self-care

Between sessions

Home Exercise Program Requirements

Vestibular Physiotherapy Treatment Investment

Vestibular Physiotherapy at Two Vancouver Clinics

Downtown Vancouver

Fairview

Results that speak for themselves

Frequently Asked Questions About Vestibular Physiotherapy in Vancouver

Restore Your Balance and Confidence