Condition
Vertigo.How we help.
Vertigo is dizziness with a sense of movement, usually a spinning feeling, when nothing around you is actually moving. For some people it comes in short bursts: turning over in bed, sitting up in the morning, or tipping the head back to reach the top shelf of an almirah. For others it is a steadier unsteadiness that makes a crowded bazaar lane in Jaipur harder to walk through than it used to be. It can be unsettling even when nothing hurts.
How we help
- A detailed assessment of your symptoms, your balance and how your eyes and head respond to movement
- A record of the specific movements and positional changes that set the dizziness off
- Repositioning manoeuvres performed by a trained physiotherapist, where the assessment indicates they are suitable
- A graded programme of gaze-stability, balance and walking work, reviewed as your response changes
What to expect
Your first visit is mostly questions and testing. Your physiotherapist asks what the dizziness feels like, how long an episode lasts, which movements and positions set it off, and what you have stopped doing because of it. Then comes the examination: balance, walking, and how your eyes respond when your head moves, along with positional testing where that is appropriate. What follows depends on what the assessment shows. Repositioning manoeuvres, gaze-stability work, balance training and graded movement are among the treatments the physiotherapist may add to support progress, and each one is talked through with you first, including what you may feel while it is being done.
What vertigo actually is
Vertigo is a particular kind of dizziness. It is an illusion of movement: a sense that you are spinning, or that the room is turning around you, when nothing is moving at all. It is not the same thing as dizziness in general, or as imbalance, and the difference matters, because those descriptions point in different directions.
Your sense of balance is not one system. It is assembled from several sources working together:
- The vestibular system within the inner ear
- Vision
- Sensory information from the muscles and joints
- The brain's ability to bring those signals together and interpret them
When those sources give conflicting or abnormal information, you may experience vertigo, dizziness or imbalance. One of the most common causes is Benign Paroxysmal Positional Vertigo, usually shortened to BPPV. In BPPV, small calcium-carbonate particles within the inner ear become displaced and stimulate the balance sensors abnormally during certain head movements. That typically produces brief episodes of vertigo when the head changes position.
Other vestibular conditions can cause longer-lasting dizziness, imbalance, or difficulty stabilising vision during movement. Two things are worth carrying through the rest of this page: not all dizziness is vertigo, and not all vertigo starts in the inner ear.
What can lie behind it
Vertigo has many possible causes. Some are related to the vestibular system, while others require medical or neurological evaluation. The causes commonly listed include:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Inner-ear vestibular disorders
- Vestibular hypofunction
- Vestibular neuritis
- Labyrinthitis
- Meniere's disease
- Vestibular migraine
- Head or neck trauma, in some cases
- Certain neurological disorders
BPPV is particularly associated with short episodes of vertigo triggered by movements such as rolling over in bed, looking up, looking down, getting into or out of bed, or turning the head quickly. Vestibular hypofunction behaves differently. When one or both sides of the vestibular system function below normal levels, the brain may receive less reliable balance information, and that can contribute to dizziness, to blurred or bouncing vision during head movement, and to difficulty maintaining balance.
This page cannot tell you which of them applies to you, and it would be wrong to try. The list above crosses several areas of medicine, and because vertigo can also occur with neurological, cardiovascular or other medical conditions, not every case is suitable for physiotherapy. Vestibular rehabilitation is used for selected peripheral vestibular disorders, so correct identification of the likely cause is an important part of assessment.
How it shows up day to day
Vertigo can present differently depending on its underlying cause. The symptoms people describe include:
- A spinning sensation, or a feeling that the surroundings are moving
- A sensation of being pulled or tilted
- Dizziness when the head moves
- Loss of balance, and unsteadiness while walking
- Nausea or vomiting
- Difficulty walking in visually busy environments
- Blurred or unstable vision during head movement
- Fear of falling, and reduced confidence with movement
- Difficulty changing positions, and difficulty performing everyday activities
People with vestibular dysfunction may also notice symptoms when turning the head while walking, moving quickly, looking around a crowded environment, or changing direction. Some forms of vertigo are brief and depend on position, while others can produce more persistent dizziness or imbalance.
A few things fall outside that range and need medical assessment rather than a physiotherapy appointment. New, severe or unexplained vertigo is one. So is vertigo arriving alongside symptoms such as new weakness or numbness, difficulty speaking, double vision, severe headache, fainting, significant difficulty walking, or any other sudden neurological change.
What vestibular rehabilitation involves
Vestibular rehabilitation is a programme of exercise and graded exposure to movement, and it sits within physiotherapy scope. What it contains is decided by the assessment rather than by the word vertigo, which is why two people given the same label can end up doing quite different exercises.
An assessment may consider:
- The nature and duration of your symptoms
- The specific movements that trigger dizziness
- Positional changes
- Balance and walking
- Eye and head movement responses
- Vestibular function
- Previous episodes
- The effect on your work and your daily activities
- Fear of movement, or fear of falling
Where appropriate, rehabilitation may include repositioning manoeuvres, gaze-stability exercises, balance training, movement-based exercises and progressive functional activities. The shape of it differs by presentation. For someone with BPPV, treatment may focus primarily on identifying the affected canal and performing the appropriate repositioning technique. For someone with vestibular hypofunction, rehabilitation may involve a longer programme focused on gaze stability, balance, walking and adaptation. Progression is guided by how you respond, not by a fixed number of weeks, and the movements you are asked to practise are the ones your own day requires.
Diagnosis, any scan or medical investigation, medication, and any decision about onward specialist care for dizziness sit with a doctor rather than with a physiotherapist. Physiotherapy works alongside that, not in front of it.
Common questions
When should I see a physiotherapist about vertigo?
If dizziness or spinning keeps coming back, is set off by movement, or is affecting your balance and your daily activities, a physiotherapy assessment can examine what your balance system is doing and whether vestibular rehabilitation is appropriate. Sudden or severe neurological symptoms are different. New weakness or numbness, difficulty speaking, double vision, severe headache or fainting alongside vertigo need urgent medical assessment instead.
What does physiotherapy for BPPV involve?
Where an assessment points to BPPV, physiotherapy involves identifying which canal is affected and performing the appropriate repositioning manoeuvre, carried out by a trained physiotherapist. A repositioning manoeuvre is a guided sequence of head positions intended to move the displaced inner-ear particles back into position. Your physiotherapist will explain the sequence, and what you may feel during it, before starting.
What is the best treatment for vertigo?
No single treatment is established as the best one, and the question does not really have one answer. Vertigo is a symptom with several possible causes rather than a single condition, so what is appropriate follows from the cause, and the cause cannot be settled from the sensation alone. Where the picture points to a peripheral vestibular problem, the physiotherapy options include repositioning manoeuvres, and balance, gaze-stability and movement-based rehabilitation.
What does vestibular rehabilitation involve?
It is a programme of exercises built around gaze stability, balance, eye and head coordination, and graded exposure to the movements that provoke your symptoms. It is set up after an assessment and adjusted as your response changes, rather than worked from a standard sheet, so the exercises you are given may look nothing like someone else's.
Why do I feel dizzy when I turn my head?
Head movement can trigger dizziness when the inner-ear balance system is irritated or not working normally, and BPPV is one common cause of position-related dizziness. It is not the only one, which is why the pattern, how long each episode lasts, and what else happens alongside it are all recorded at an assessment rather than assumed.
Why does the spinning start when I get out of bed?
Spinning while rolling over, sitting up or getting out of bed is commonly associated with BPPV, where a change in head position briefly disturbs the inner-ear balance system. Other causes can produce something that feels much the same, so what the sensation feels like does not settle the question on its own.
Related treatments
Related conditions
This page is educational and does not replace a proper assessment. Outcomes vary by individual; Trivayu Physio Center makes no guarantee of specific results.
Related videos
Filmed at our centre in Vaishali Nagar. These are general demonstrations, not a plan for your particular problem. Always follow the plan your own physiotherapist gives you.
Shoulder exercises using a wall
Assisted shoulder work with overhead resistance
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