Which kinds of dizziness respond
Physiotherapy helps when the problem sits in the vestibular system: the inner ear, the nerve connecting it to the brain, or the way the brain processes balance signals. That covers BPPV, the lingering imbalance after vestibular neuritis or labyrinthitis, persistent dizziness after concussion, the periods between attacks in Meniere's disease and vestibular migraine, age-related balance decline and persistent postural-perceptual dizziness. It also helps when neck stiffness or tension is feeding into the sense of unsteadiness.
Which kinds do not
Light-headedness from low blood pressure, anaemia or medication side effects, dizziness during a migraine attack, and dizziness from heart rhythm problems need medical management rather than exercises. A good vestibular physiotherapist screens for these and refers on rather than treating.
What does a vertigo physiotherapist do?
A physiotherapist treating vertigo starts with a detailed history and tests of your eye movements, balance and the head positions that bring on symptoms. That shows whether the cause is BPPV, an inner ear problem, the way the brain is processing balance signals, or something that needs a doctor. Treatment often starts in the same appointment, and you leave with exercises to do at home. See what happens at a vestibular assessment.
What the treatment consists of
For BPPV, a repositioning manoeuvre such as the Epley, which usually resolves the vertigo in one to three sessions. For other vestibular conditions, a programme of exercises: gaze stabilisation, where you keep your eyes fixed on a target while moving your head; habituation, where you repeat the movements that provoke mild symptoms until the brain stops reacting; and balance retraining on progressively harder surfaces and with head movement. The exercises are done daily at home and progressed at review appointments every one to two weeks.
Why exercises work when tablets do not
Dizziness medication dampens the balance system, which can help during an acute attack but slows the brain's recalibration if taken for longer. Exercises do the opposite: they give the brain the input it needs to adapt. NHS and international guidelines recommend vestibular rehabilitation as first-line treatment for persistent vestibular dizziness for that reason.
Vestibular neuritis: NHS care and physiotherapy
Vestibular neuritis and labyrinthitis usually settle on their own within a few weeks. A GP may prescribe medicine for a few days to ease severe dizziness and sickness. If you still feel dizzy or off balance after that, vestibular rehabilitation exercises help the brain adapt; your GP can refer you, or you can see a vestibular physiotherapist privately.
How long it takes
BPPV is often resolved within a session or two. Other conditions usually need six to twelve weeks of consistent home exercises. Symptoms sometimes rise slightly in the first week or two as the exercises deliberately provoke them, then fall. Improvement depends heavily on doing the exercises as prescribed.
When dizziness needs urgent help
Call 999 or go to A&E if dizziness comes with double vision or loss of vision, hearing loss, trouble speaking, weakness, numbness or tingling in an arm or leg, a sudden severe headache or chest pain. See a GP if vertigo will not go away or keeps coming back.
At Omnia
Vestibular First, our vertigo and dizziness service in Chiswick, is delivered by physiotherapists trained in vestibular assessment and rehabilitation. Tai chi classes and manual therapy for the neck are available in the same clinic where they support recovery. A vertigo and BPPV assessment with treatment is £50; book through our booking page or call 020 4515 0000. Omnia Lifestyle is at 8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking.
See also: vestibular neuritis symptoms, recovery and treatment, is my dizziness BPPV?, the Epley manoeuvre for BPPV, what vestibular rehabilitation is and why you might feel dizzy.