What Happens in Your First Vestibular Physiotherapy Assessment
Senior Physiotherapist, Founder and Director · Registered with the Australian Health Practitioner Regulation Agency (PHY0002060505);
Kenny Merlevede is a Senior Physiotherapist with 18 years of experience in private practice, with a focus on complex cervical presentations and persistent musculoskeletal conditions
Last reviewed: 11 November 2026
Your first vestibular physiotherapy assessment combines a detailed discussion about your symptoms with targeted testing of your eyes, head movement, balance and walking. The physiotherapist uses the findings to identify likely causes, check for signs needing medical review, explain the working diagnosis and agree on a treatment plan. Some tests may briefly bring on dizziness, because that is how we work out what is happening, but the session is paced carefully and stopped when necessary.
Key Takeaways
The assessment begins with questions about what your dizziness feels like, when it started, what triggers it and how it affects your daily life.
Testing typically includes eye-movement checks, balance tasks, walking assessment and positional tests that may temporarily reproduce symptoms.
Most of the session is spent working out whether the inner ear, the neck, the way your brain processes balance signals or a combination of these is involved.
The physiotherapist explains the likely pattern, what treatment may help and whether you need to see your GP or a specialist.
You can expect the session to last around 45 to 60 minutes, and you should bring a list of your medications and any relevant medical reports.
Why the History Matters
The assessment usually starts with a conversation about when the dizziness began, what it feels like and how long episodes last. You may be asked whether it is a spinning sensation, a feeling of being off balance, light-headedness or something harder to describe. The physiotherapist will want to know what triggers it, such as rolling over in bed, looking up, walking, busy shops or exercise, and what makes it better or worse.
You will also be asked about falls, headaches, hearing changes, vision, medications and relevant medical conditions such as migraine, blood-pressure problems or previous ear infections. The discussion covers how symptoms affect work, driving, sport, sleep and confidence. Dizziness is a symptom, not a single condition, and the pattern of your symptoms points toward the likely cause.
At Physio K, we often see people who have been dizzy or off balance for weeks or even years, sometimes after seeing other professionals without getting a clear answer. Some come in because of a sudden spinning episode when they rolled over in bed or looked up. Others mention dizziness almost as an afterthought when they are in for something else, like a stiff neck or headaches. Behind the question is usually nervousness about what we are going to do, whether it will make things worse and whether it is going to turn out to be something serious.
What the Testing Involves
Testing typically includes observing your eye movements, checking how your eyes stay stable while your head moves, and assessing whether visual motion provokes symptoms. The physiotherapist may also test your balance in standing, with different foot positions or with your eyes closed, and watch how you walk, turn and manage head movement.
Depending on your symptoms, the assessment may include positional tests such as the Dix-Hallpike test or a supine roll test. These involve changing your head and body position and can temporarily bring on vertigo if you have benign paroxysmal positional vertigo, commonly called BPPV. The 2017 clinical guideline on BPPV published in Otolaryngology–Head and Neck Surgery recommends positional testing for suspected BPPV, including Dix-Hallpike testing for the more common posterior-canal form and a supine roll test when horizontal-canal BPPV is suspected.
"The honest answer is that some of the tests can bring the dizziness on for a short time, because that is how we find out what is going on. We go at your pace and we explain each step before we do it," says Kenny Merlevede, Senior Physiotherapist and Director at Physio K.
The neck is also assessed, because neck movement and tension can contribute to dizziness in some people. Eye tests may reveal nystagmus, a type of involuntary eye movement that can indicate inner-ear or central nervous system involvement. Balance and walking tests show how well you use information from your inner ear, eyes and feet to stay steady.
What Happens Afterwards
Once the assessment is complete, the physiotherapist explains the likely pattern, what remains uncertain and whether further assessment by a GP, ear, nose and throat specialist, neurologist or audiologist is appropriate. Treatment depends on the findings. If BPPV is identified, a repositioning manoeuvre may be performed in the same session. If reduced inner-ear function is the main problem, treatment may include gaze-stability exercises, balance training and graded exposure to movement. If neck involvement is suspected, treatment may combine manual therapy, neck exercises and advice about posture and movement.
The 2022 guideline on vestibular rehabilitation from the Academy of Neurologic Physical Therapy states that a comprehensive examination should guide vestibular rehabilitation, with assessment and treatment selected according to the pattern of vestibular impairment, symptoms, balance limitations and functional goals.
At Physio K, most of the first session is spent working out which factors are involved. That means a proper chat about what the dizziness feels like, what sets it off and how long it lasts, then checking your eye movements, your balance and your neck, and doing positional tests if they suit. One thing we often correct is that people avoid moving because they are scared of triggering symptoms. Staying completely still tends to make the balance system more sensitive, not less.
What You Can Do Before Your Appointment
Record what your dizziness feels like, how long it lasts, what triggers it and whether you notice hearing changes, vision changes, headache, weakness or numbness. This helps distinguish positional, inner-ear and non-vestibular patterns. Bring a list of your medications and any relevant medical reports. Medicines, blood-pressure changes, migraine and previous ear or neurological problems can alter assessment and treatment.
Wear comfortable clothing and supportive shoes, and arrange someone to come with you if you are at risk of falling. Tell the physiotherapist immediately if testing causes severe or unusual symptoms. Do not perform internet-sourced repositioning techniques repeatedly before assessment if the diagnosis is uncertain. Incorrect techniques may aggravate symptoms or delay investigation of another cause.
Seek urgent medical care for sudden neurological symptoms, fainting, chest pain, severe new headache, new inability to walk or sudden hearing loss. Persistent, recurrent or worsening dizziness also warrants professional assessment rather than self-management.
Common Questions
Will the assessment make me dizzy?
Some of the tests may briefly bring on your dizziness, because that is how we identify the cause. If you have BPPV, a positional test will usually reproduce the spinning for a short time. If reduced inner-ear function is the problem, head-movement tests may make you feel unsteady. We explain each test before we do it, go at your pace and stop if you need a break. The provocation is controlled and temporary, and it gives us the information we need to plan treatment.
Do I have to lie back quickly?
The Dix-Hallpike test involves lying back with your head turned and slightly extended, but it does not have to be done quickly. We move at a pace that is safe and tolerable for you. The test is designed to move tiny crystals in your inner ear if BPPV is present, and the movement itself, rather than the speed, is what matters. If you are anxious or have neck stiffness, we adjust the technique or choose a different test.
How do you know which ear is affected?
The pattern of nystagmus, the direction of the spinning and the position that triggers symptoms all point to which ear and which canal are involved. In BPPV, the Dix-Hallpike test will usually provoke symptoms when the affected ear is down. In reduced inner-ear function, the head impulse test shows which side is not responding normally. The assessment is designed to identify the side and the pattern, so treatment can be targeted.
Can I drive home afterwards?
Most people can drive home after the assessment, but it depends on your symptoms and what we find. If a repositioning manoeuvre is performed for BPPV, you may feel off balance for a short time afterwards. If testing provokes significant symptoms or if you are at risk of falling, it is safer to arrange a lift. We will let you know at the end of the session whether driving is safe for you that day.
What the Research Shows
Assessment of dizziness commonly includes a symptom-focused history, nystagmus assessment, orthostatic blood pressure when indicated, neurological screening and positional testing for triggered vertigo. The approach at Physio K reflects this. The first session is about understanding whether the inner ear, the neck, the way the brain is processing balance signals or a mix of these is driving your symptoms. That detective work, influenced by the teaching of osteopaths who showed the importance of looking beyond the painful or symptomatic area, shapes how the assessment is structured and how treatment is planned.
If you are experiencing dizziness, imbalance or vertigo, book an assessment to work out what is happening and what can be done about it.
Reviewed by Maria Josefina Canepa Bustos. Maria Josefina Cánepa Bustos is a Senior Musculoskeletal Physiotherapist with eight years of clinical experience spanning private practice, high-performance sport, and academia. Registered with the Australian Health Practitioner Regulation Agency (PHY0002918524).
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.
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