By Kenny Merlevede

Senior Physiotherapist, Founder and Director · Registered with the AHPRA (PHY0002060505)

Kenny is a physiotherapist with over 18 years’ experience in musculoskeletal and sports rehabilitation. He specialises in identifying the underlying drivers of pain and treating complex presentations including chronic spine pain, neck and headache disorders, jaw dysfunction, and persistent sports injuries. His approach combines manual therapy, dry needling, and active rehabilitation with strong emphasis on education and long term outcomes. He is also a GEMt dry needling teacher and demonstrator. As an endurance athlete with experience in marathons, Ironman, CrossFit, basketball, and ultra endurance events, he brings a unique performance perspective to rehabilitation and load management

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Last reviewed: 22 July 2026

Dizziness, Vertigo and Vestibular Rehabilitation: What to Expect

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Dizziness and vertigo are common symptoms affecting 5 to 10% of adults, caused by problems in the inner ear or the way your brain processes balance information. Vestibular rehabilitation is a specialised form of physiotherapy that uses specific exercises and manoeuvres to reduce symptoms, improve balance and restore function. Most conditions respond well to treatment, with many patients noticing improvement within a few sessions.

Fast Facts

What is dizziness and vertigo?

Dizziness is a broad term describing sensations of light-headedness, unsteadiness or feeling off-balance. Vertigo is a specific type of dizziness where you feel like the room is spinning or moving, even when you're still. Both are symptoms, not diagnoses, and they arise from problems with the vestibular system, the network of structures in your inner ear and brain that controls balance and spatial orientation.

The most common vestibular conditions include benign paroxysmal positional vertigo (BPPV), caused by tiny crystals in the inner ear moving into the wrong place, triggering brief intense spinning when you change head position. Vestibular neuritis is inflammation of the balance nerve, usually after a viral infection, causing sudden severe vertigo, nausea and balance problems that improve over weeks. Persistent postural-perceptual dizziness (PPPD) involves chronic unsteadiness and dizziness worsened by standing, moving or busy visual environments. Vestibular migraine combines migraine features with vertigo or dizziness episodes.

Some people also experience cervicogenic dizziness, where neck problems contribute to balance symptoms, often alongside headache.

What it feels like: symptoms and signs

Most people describe vertigo as the world spinning like they're on a boat in rough seas, or the floor tilting like a funhouse. The sensation can be violent and terrifying, especially the first time. With BPPV, the spinning lasts seconds to a minute and is triggered by rolling over in bed, looking up or bending down. With vestibular neuritis, the spinning is constant and severe for days, gradually settling to a persistent unsteadiness.

Dizziness without spinning often feels like walking on a bouncy surface, being light-headed or drunk without drinking, or a sense the ground is rushing up. Many people grab walls or furniture instinctively, even when sitting.

Nausea and vomiting are common, particularly with acute vertigo. You might feel exhausted because your body is fighting to stay balanced all day. Vision can blur or bounce during head movements, making it hard to read or watch television. Some people develop anxiety about triggering symptoms, which leads to avoiding movement and makes the problem worse over time.

Headaches, neck stiffness and difficulty concentrating often accompany vestibular symptoms, particularly in vestibular migraine and cervicogenic presentations.

What causes it and who gets it

BPPV is caused by tiny calcium crystals (otoconia) that normally sit in one part of the inner ear dislodging and floating into the semicircular canals. When you move your head, these crystals move and send false signals to your brain, creating the spinning sensation. It becomes more common with age, affects around 2.4% of people at some point in their life, and is more common in women.

Vestibular neuritis is usually triggered by a viral infection that inflames the vestibular nerve. Vestibular migraine is linked to migraine pathways in the brain and affects 1 to 3% of adults, again more common in women.

Post-concussion vestibular problems can develop after a head injury. Cervicogenic dizziness arises from neck joint or muscle dysfunction, often in people with a history of neck pain, whiplash or poor posture.

Risk increases with age, particularly over 40, but vestibular problems can affect anyone. A history of migraines, previous ear infections, head injury or prolonged neck problems increases risk.

How vestibular rehabilitation works

Vestibular rehabilitation uses specific exercises and techniques to retrain your brain to process balance signals correctly. Your brain is highly adaptable, and when the vestibular system is disrupted, it can learn to compensate and restore normal function. This process is called neuroplastic adaptation.

For BPPV, treatment involves repositioning manoeuvres, physical techniques that move the displaced crystals back to where they belong. The Epley manoeuvre is the most common and involves moving your head through a series of positions whilst lying down. Research published in the Cochrane Database of Systematic Reviews (2011) found the Epley manoeuvre is significantly more effective than sham treatment, resolving symptoms in 50 to 60% of people after one session and 70 to 90% after two to three treatments.

For other vestibular conditions, rehabilitation involves three main types of exercise. Gaze stabilisation exercises train your eyes to stay focused on a target whilst you move your head, improving visual stability. Habituation exercises involve repeating movements that provoke mild symptoms, gradually reducing your brain's sensitivity to those triggers. Balance and gait training uses progressively challenging exercises to improve steadiness and reduce fall risk.

Exercise-based vestibular rehabilitation has been shown to improve vertigo symptom scores, fall risk, balance and emotional wellbeing in adults with chronic dizziness compared with usual medical care.

The American Physical Therapy Association clinical practice guideline (2016) gives a strong recommendation for vestibular rehabilitation in patients with unilateral or bilateral vestibular hypofunction, stating there is strong evidence it improves symptoms, balance and function.

"I've learned that people often live with dizziness for much longer than they need to. Most people don't know what to do about it, and many GPs don't realise that physiotherapists can assess and treat conditions like BPPV. As a result, patients often aren't referred early and can spend years living with symptoms before they reach our clinic. Once the correct diagnosis is made, the treatment can be surprisingly straightforward and effective," says Kenny Merlevede, Senior Physiotherapist and Director at Physio K.

What to expect during treatment

Your first session involves a detailed assessment of your symptoms, medical history and how dizziness affects your daily life. The physiotherapist will perform specific tests to identify which part of the vestibular system is involved. For suspected BPPV, the Dix-Hallpike test involves moving you from sitting to lying with your head turned and extended, watching for characteristic eye movements (nystagmus) and reproducing your vertigo. Other tests assess balance, gait, neck movement and how your eyes track during head movements.

If BPPV is confirmed, the physiotherapist will perform a repositioning manoeuvre during that first session. You may feel intense vertigo during the manoeuvre, which is normal and expected. Many people feel significantly better immediately afterwards, though some residual unsteadiness can persist for a few days. You'll usually return for one or two follow-up sessions to confirm the crystals have stayed in place and address any remaining symptoms.

For other vestibular conditions, treatment involves learning a tailored exercise programme. Exercises are designed to deliberately provoke mild to moderate symptoms, which can feel counterintuitive and uncomfortable at first. This temporary worsening is necessary for your brain to adapt and is not harmful. Most exercises take 10 to 20 minutes daily at home, with clinic reviews every one to two weeks to progress the programme.

Manual therapy for neck stiffness or muscle tension may be included, particularly if cervicogenic factors contribute. Education about your condition, what to expect and how to manage flare-ups is a critical part of treatment.

One case that stands out involved a 65-year-old woman who had experienced dizziness for over five years. She had seen an ear, nose and throat specialist, taken antibiotics and even had a brain scan, but her symptoms persisted. She felt dizzy turning over in bed and turning her head whilst driving, which stopped her going to the gym and significantly limited her daily life. During the first session, the Dix-Hallpike test was positive on the right side, so the Epley manoeuvre was performed three times. She responded well immediately. Over the following two sessions, tightness in her upper neck, including suboccipital trigger points, was treated. After just three sessions, she reported she was 95% better and said she had never felt this good in five years.

What the research shows

A randomised controlled trial published in the BMJ (2012) tested booklet-based vestibular rehabilitation delivered in primary care for chronic dizziness. At three months, the vestibular rehabilitation group showed a mean improvement of around 5 to 7 points on the Dizziness Handicap Inventory compared with usual care, a clinically meaningful reduction. The trial concluded vestibular rehabilitation was cost effective and produced significant improvements in dizziness-related quality of life.

A meta-analysis in Frontiers in Neurology (2023) found combining vestibular rehabilitation with anti-vertigo medication significantly reduced Dizziness Handicap Inventory scores and improved balance more than medication or vestibular rehabilitation alone in vestibular neuronitis. However, medication is typically used only in the acute phase, as prolonged use of vestibular suppressants can delay the brain's natural compensation process.

Research in the International Journal of Audiology (2019) showed vestibular rehabilitation therapy was more effective than other conservative treatments for reducing dizziness in the short term (up to three weeks), though longer-term differences were less clear, likely reflecting the natural recovery trajectory of some conditions.

The evidence consistently supports specialist vestibular physiotherapy over generic balance exercises. Tailored programmes that address specific vestibular deficits, gaze stability and habituation produce better outcomes than downloadable exercise sheets.

Common misconceptions about dizziness and vertigo

The biggest misconception is that dizziness isn't fixable, especially after seeing multiple health professionals without getting answers. Over time, people get used to living with the dizziness and believe that's just how life will be. It's often only when their symptoms improve that they realise how much better they can actually feel.

Many people think rest is the answer and avoid movement to prevent triggering symptoms. Whilst rest may help in the first few days of acute vertigo, prolonged avoidance delays recovery. Your brain needs movement and sensory input to recalibrate the vestibular system.

Another common belief is that dizziness and headaches are separate, unrelated problems. Vestibular migraine combines both, and many headache disorders have vestibular components that need specialised treatment.

Some people expect exercises to work immediately and give up when symptoms temporarily worsen. Vestibular rehabilitation often provokes mild symptoms initially, which is a normal and necessary part of retraining your brain, not a sign of harm.

Finally, many assume dizziness is just part of getting older or something you have to live with. Most vestibular disorders are treatable with appropriate physiotherapy, regardless of age.

When to seek urgent medical help

Seek immediate medical attention if you experience sudden severe dizziness or vertigo with any of the following: sudden severe headache (worst headache of your life), double vision, difficulty speaking or slurred speech, weakness or numbness in your face, arm or leg, difficulty walking or loss of coordination beyond what you'd expect from dizziness alone, sudden hearing loss, chest pain or difficulty breathing, or loss of consciousness.

These symptoms may indicate a stroke, brain haemorrhage or other serious neurological problem and require urgent assessment in an emergency department.

If your dizziness follows a significant head injury, or if you have persistent vomiting that prevents you keeping fluids down, seek prompt medical review.

Cost and funding in Australia

Physiotherapy for dizziness and vestibular rehabilitation may be partly funded through several schemes. If you have a chronic condition, your GP can prepare a Chronic Disease Management Plan (also called a GP Management Plan and Team Care Arrangement), which allows you to claim Medicare rebates for up to five allied health sessions per calendar year. A gap payment usually applies, as the rebate does not cover the full session cost. Rebate amounts are set by Medicare and change periodically, so confirm the current rate with your GP or the clinic.

If you have private health insurance with extras cover, you may be able to claim a rebate for physiotherapy sessions, depending on your level of cover and annual limits. Check with your insurer before booking.

For accepted work-related injuries, WorkCover may fund treatment. If you are an NDIS participant, physiotherapy may be funded where it is reasonable and necessary as part of your plan.

Confirm your eligibility, current costs and rebate amounts with your GP, insurer, plan manager or the clinic before starting treatment.

Common questions

How long does vestibular rehabilitation take to work?

BPPV often improves within one to three sessions, with many people feeling significantly better immediately after the repositioning manoeuvre. Other vestibular conditions typically improve over 4 to 12 weeks with daily home exercises and regular clinic reviews. Some residual symptoms may take longer to fully resolve, particularly if you've had symptoms for months or years before starting treatment.

Will the exercises make me feel worse?

Yes, temporarily. Vestibular exercises are designed to provoke mild to moderate symptoms so your brain can adapt and recalibrate. This is normal, necessary and not harmful. The key is finding the right level of challenge, enough to stimulate adaptation without overwhelming you. Your physiotherapist will guide you on how much symptom provocation is appropriate and adjust exercises as you progress.

Can dizziness come back after treatment?

BPPV can recur, with around 15 to 30% of people experiencing another episode within a year, though it usually responds well to repeat treatment. Other vestibular conditions are less likely to recur if you complete the full rehabilitation programme and address contributing factors such as neck stiffness or migraine triggers. Learning self-management strategies during treatment helps you recognise and manage any future flare-ups early.

What's the difference between vestibular physiotherapy and general physiotherapy?

Vestibular physiotherapy requires specialist training in assessing and treating balance and inner ear disorders. It involves specific diagnostic tests such as the Dix-Hallpike test, repositioning manoeuvres for BPPV, and tailored exercises targeting gaze stability, habituation and balance. General physiotherapists may not have this training, and generic balance exercises do not address the underlying vestibular deficits as effectively as a specialist programme.

Reviewed by Mark Howlin. Mark Howlin is an Associate Physiotherapist at Physio K, specialising in sporting injuries and post-operative rehabilitation, with advanced dry needling training from Ireland and Sydney. Across six years of clinical practice in Ireland and Australia, he has developed particular expertise in chronic conditions such as anterior knee pain and Achilles tendinopathy, and acute lower limb muscle strains, using an integrated approach combining manual therapy, dry needling, and progressive rehabilitation. He has also served as team physiotherapist to elite GAA athletes, including during a championship-winning run at Croke Park. Registered with the AHPRA (PHY0004060355).

This article is for general information only and is not a substitute for personal medical advice. If you have concerns about your health, please consult a qualified clinician or your GP.