What Is Vestibular Physiotherapy and How Does It Differ?
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: 4 November 2026
Vestibular physiotherapy is exercise-based physiotherapy for dizziness, vertigo (the sensation that the room is spinning), balance problems and visual disturbance caused by disorders of the inner ear, brain or sensory systems. It differs from general physiotherapy through targeted assessment of the balance system, eye and head coordination exercises, balance retraining, and repositioning manoeuvres for certain types of vertigo.
Key Takeaways
Vestibular physiotherapy focuses on the balance system, not just pain or movement, using specific tests for eye movement, head position and balance
Treatment is tailored to the cause and may include gaze exercises, balance training, gradual exposure to symptom triggers, and repositioning techniques for crystals in the inner ear
Dizziness and vertigo are not the same thing: vertigo is one specific type of dizziness, and the treatment depends on the underlying cause
Some people live with dizziness for a long time before seeking assessment
How the balance system normally works
Your balance relies on three systems working together: the inner-ear balance organs, your eyes, and sensors in your neck, joints and muscles that tell your brain where your body is in space. When all three systems send matching information to your brain, you feel steady and oriented. When one system sends faulty signals, or the brain struggles to process the information, you may feel dizzy, off balance, or as though the world is moving when it isn't.
The inner ear contains tiny fluid-filled tubes and crystals that detect head movement and gravity. Damage, inflammation, or displaced crystals in this system can cause vertigo, imbalance, or a sensation that your eyes can't focus when you move your head.
What happens during vestibular physiotherapy
A vestibular assessment starts with a detailed history: when the dizziness started, what triggers it, how long it lasts, whether you've noticed hearing changes, headaches, neck pain, or falls. The physiotherapist observes your eye movements, tests how your eyes track and stabilise during head movement, assesses your balance standing and walking, and may use positional tests if benign paroxysmal positional vertigo (BPPV, a condition where tiny crystals in the inner ear move out of place) is suspected.
Treatment is individually selected based on what the assessment finds. It may include gaze-stability exercises (keeping your vision steady while moving your head), balance and walking practice, gradual exposure to movements or environments that provoke symptoms, education about managing daily activities safely, and home exercises. For BPPV, a trained physiotherapist may perform a canalith-repositioning manoeuvre, a specific series of head and body positions that guides the displaced crystals back to where they belong.
At Physio K, some people who come in for neck problems don’t mention their dizziness until we ask about it directly. The assessment can help work out whether the dizziness may be coming from the inner ear, the neck, a combination of both, or something that requires medical review. Treatment is then tailored to what we find.
How it differs from general physiotherapy
General physiotherapy commonly focuses on pain, strength, joint mobility, movement quality and physical function after injury or surgery. The assessment looks at how joints move, how muscles work, posture, and movement patterns that may be contributing to pain or dysfunction.
Vestibular physiotherapy focuses on the balance system and how symptoms respond to head movement, visual information and changes in position. It requires specific clinical tests such as observing eye movements during head turns, assessing balance with eyes open and closed, and using positional manoeuvres to identify which inner-ear structure is affected. The treatment often involves carefully dosed exposure to dizziness-provoking activities, because avoiding movement may make the balance system more sensitive over time.
"The painful area isn't always the whole story. When someone comes in with dizziness, I'm interested in the symptom itself, but I'm equally interested in why the balance system has become overloaded or why the brain is struggling to make sense of the signals it's receiving," says Kenny Merlevede, Senior Physiotherapist, Founder and Director at Physio K.
The approach is not limited to one diagnosis. Vestibular physiotherapy may help people with reduced inner-ear function on one or both sides, BPPV, persistent dizziness after concussion, vestibular migraine (migraine-related dizziness), Ménière’s disease (a condition causing episodes of vertigo, hearing loss and ringing in the ears), or balance impairment associated with ageing. For concussion, vestibular migraine and Ménière’s disease, physiotherapy is usually used alongside medical care.
What the research shows
International clinical guidelines support vestibular rehabilitation for a range of balance and dizziness disorders. A 2022 guideline from the Academy of Neurologic Physical Therapy found strong evidence for vestibular rehabilitation, including gaze-stability, habituation and balance exercises, in adults with reduced inner-ear function on one or both sides.
For BPPV, one of the most common cause of vertigo, a 2017 clinical practice guideline published in Otolaryngology–Head and Neck Surgery emphasises accurate positional diagnosis and therapeutic repositioning manoeuvres.
Research also supports vestibular physiotherapy after concussion. A 2023 systematic review of athletes with sport-related concussion (International Journal of Sports Physical Therapy) found that early vestibular rehabilitation may help reduce symptoms and time to return to sport, though the authors note more research is needed.
A common misconception is that dizziness and vertigo are the same thing. Vertigo is one specific type of dizziness, the sensation that the room is spinning or that you are moving when you're not. Other types of dizziness include feeling lightheaded, feeling off balance without spinning, or a constant sense of unsteadiness. The treatment for each is quite different, which is why a clear diagnosis matters.
When other medical assessment is needed
Dizziness can arise from cardiovascular problems, neurological conditions, medication side effects, visual disorders, neck dysfunction, or psychological factors. Vestibular physiotherapists screen for features that require medical review and work alongside GPs, vestibular physicians, neurologists, audiologists, and ear, nose and throat specialists when needed.
Seek urgent medical care for sudden weakness, facial drooping, difficulty speaking, sudden vision changes or double vision, numbness or tingling in the face or limbs, fainting, severe new headache, chest pain, sudden hearing loss, dizziness after a head injury, or inability to walk safely. These features are not appropriate for self-management and require immediate medical assessment rather than routine physiotherapy.
What you can do
Keep a symptom record noting what triggers your dizziness, how long it lasts, whether you've noticed hearing changes, headaches, neck pain, falls, or medication changes. This helps distinguish positional vertigo from other causes and gives your physiotherapist or doctor useful information. Seek assessment from your GP or a physiotherapist if symptoms are new, recurrent or unexplained.
Avoid repeatedly performing internet-sourced manoeuvres without a diagnosis. Incorrect techniques may worsen symptoms or be unsafe if you have neck, vascular, or spinal conditions. Arrange assessment with a trained physiotherapist or medical practitioner who can identify the cause and select the appropriate treatment.
If you've been prescribed gaze, balance, or habituation exercises, follow them consistently. Expect mild, short-lived symptom provocation rather than severe or prolonged deterioration: the exercises are designed to retrain your balance system, and some temporary dizziness during the exercise is normal. Contact your treating clinician if symptoms escalate or your daily function declines.
Common questions
What happens during vestibular physiotherapy treatment?
Treatment depends on what the assessment finds. It may include gaze-stability exercises, balance retraining, walking practice, education about managing symptoms safely, and repositioning manoeuvres for BPPV. The approach is tailored to the specific cause. Some people present with dizziness that isn’t vertigo at all: they describe feeling off balance, a constant sense of unsteadiness, or visual disturbance when they move their head. The treatment for these presentations is quite different from the treatment for spinning vertigo.
Can a physiotherapist help with crystals in the ear?
Yes, when the assessment confirms BPPV, a trained physiotherapist with appropriate training, can perform a canalith-repositioning manoeuvre to move the displaced crystals back into the correct position. This is a specific series of head and body positions, not a generic exercise. However, not all dizziness is caused by displaced crystals, so the assessment must identify BPPV before the manoeuvre is appropriate.
How do the exercises feel during treatment?
Vestibular exercises may provoke mild, temporary dizziness because they are designed to retrain your balance system. This is expected and usually settles within a few minutes of finishing the exercise. The dose is carefully controlled so the symptoms remain manageable and short-lived. If the exercises cause severe or prolonged worsening, or if your daily function declines, contact your physiotherapist. Avoiding all movement because you're worried about symptoms can make the balance system more sensitive over time, which is why graded exposure under guidance is part of the treatment.
Do I need a scan or a referral first?
Many vestibular conditions do not require imaging before physiotherapy assessment. A trained physiotherapist can screen for features that require medical review and will refer you if needed. Scans are usually reserved for cases where the history or examination suggests a central nervous system problem, a structural issue, or when symptoms do not fit a typical pattern. You can book directly at Physio K without a referral, and we'll coordinate with your GP or specialist if further investigation is needed.
If dizziness or balance problems are affecting your day, book an assessment with Physio K or contact the clinic to talk it through.
Reviewed by Mark Howlin. Mark Howlin is an Associate Physiotherapist at Physio K, with a focus on 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 experience 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.
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