Evidence-Based Care at Vantage Point in Bondi Junction
Vestibular Physiotherapy for Dizziness and Vertigo
Vertigo, dizziness and unsteadiness usually come from the inner ear, the brain’s balance networks or the neck, and often more than one at once. We find out which is driving yours, explain our reasoning, and build a plan around the research and around you.
- APA Musculoskeletal Physiotherapists
- Inner ear, neck and concussion assessed together
- No referral needed
- Private health rebates on the spot
What is vestibular physiotherapy?
Around 1 in 14 adults will experience vertigo from the inner ear or its brain connections at some point in their life. (Neuhauser et al., 2005)
Treatment for the Balance System, Not Just the Symptoms
Your vestibular system is the balance organ of the inner ear and the brain networks that interpret it. When it is disrupted, by loose inner ear crystals, a viral inflammation, a concussion, migraine or changes with age, the result can be vertigo, dizziness, unsteadiness or blurred vision with movement.
Vestibular physiotherapy is an exercise-based treatment that helps your brain recalibrate. It uses repositioning manoeuvres when crystals are loose, and specific gaze, balance and habituation exercises when signals have changed. It is supported by a Cochrane review (McDonnell and Hillier, 2015) and international clinical practice guidelines (Hall et al., 2022).
Symptom profiles
Which best describes your dizziness?
Each profile explains what is usually happening, what we assess and where treatment starts. Select the one closest to yours.
Brief Spinning With Changes in Head Position
Short, intense spins when you lie down, roll over in bed, look up or bend forward, which settle within a minute if you keep still.
You might notice
- Spinning when rolling over in bed or getting up in the morning
- Each spin lasting seconds, usually under a minute
- Feeling off-balance or queasy for hours afterwards
What is usually happening
Tiny calcium carbonate crystals (otoconia) normally sit in one part of the inner ear. In benign paroxysmal positional vertigo (BPPV), some come loose and drift into one of the balance canals, so fluid keeps moving after your head stops and your brain reads it as spinning. BPPV is the most common inner ear cause of vertigo, with a lifetime prevalence of 2.4% (von Brevern et al., 2007).
Common causes
Posterior canal BPPV
The most common form, set off by lying down, rolling over and looking up. We identify it with the Dix-Hallpike test.
Horizontal canal BPPV
Strongest when rolling from side to side in bed. It is identified with the supine roll test and needs a different manoeuvre.
BPPV after a head knock or bed rest
Head injury, prolonged bed rest and other inner ear conditions can all dislodge crystals, and both ears can be involved after trauma.
What we look at in your assessment
Positional tests, including the Dix-Hallpike and supine roll test, while we watch your eye movements to identify which ear and which canal is involved, plus checks for any pattern that does not fit BPPV.
How treatment usually starts
A repositioning manoeuvre matched to the affected canal, such as the Epley manoeuvre, which is the guideline-recommended first treatment for posterior canal BPPV (Bhattacharyya et al., 2017). We retest on the day and show you what to do if it returns.
Related services
Sudden Vertigo That Lasted Days
Vertigo that came on over minutes to hours and stayed constant for a day or more, often with nausea and vomiting, followed by weeks of unsteadiness or dizziness with head movement.
You might notice
- Constant spinning at the start, needing to lie still
- Unsteadiness and dizziness with head movement in the weeks after
- Hearing loss or ringing in one ear, in labyrinthitis
What is usually happening
Inflammation of the balance nerve (vestibular neuritis) or of the inner ear itself (labyrinthitis) suddenly reduces signals from one side, and your brain has to recalibrate. Many people recover well, but some are left with movement-provoked dizziness because recalibration stalls, often when the movements that provoke symptoms are avoided. A stroke can look similar, so new, continuous vertigo needs same-day medical assessment first.
Common causes
Vestibular neuritis
Inflammation of the balance nerve with hearing unaffected, now also called acute unilateral vestibulopathy (Strupp et al., 2022).
Labyrinthitis
The same picture plus hearing loss or tinnitus. Sudden hearing loss needs prompt review by your GP or ENT, because early treatment matters.
Persistent dizziness after an inner ear injury
Months after the acute illness, head movement, screens or busy places still provoke dizziness because one side has not fully recalibrated.
What we look at in your assessment
Head impulse testing to see how well the balance reflex on each side is working, gaze stability during head movement, balance on firm and soft surfaces, and screening for signs that need medical review.
How treatment usually starts
Gaze stabilisation exercises to recalibrate the balance reflex, graded balance and walking work, and a plan back to driving, screens and busy places. Clinical practice guidelines strongly support vestibular rehabilitation, started early (Hall et al., 2022).
Related services
Vertigo Attacks With Ear Symptoms
Attacks of spinning lasting from 20 minutes to several hours, with fullness, muffled hearing or roaring tinnitus in one ear before or during the attack.
You might notice
- Attacks that arrive without an obvious trigger
- Ear pressure, muffled hearing or tinnitus on one side
- Unsteadiness between attacks that can build over time
What is usually happening
Ménière’s disease is linked to a build-up of fluid pressure in the inner ear (endolymphatic hydrops). It is diagnosed and medically managed by your GP and ENT, using criteria that include hearing tests (Lopez-Escamez et al., 2015). Physiotherapy does not stop attacks, but it helps with unsteadiness between attacks and after medical or surgical treatment.
Common causes
Ménière’s disease
Recurrent attacks with fluctuating hearing loss, tinnitus and ear fullness in the affected ear, managed alongside your ENT and audiologist.
Vestibular migraine
Can also bring ear fullness and tinnitus, and the two conditions can overlap, which is why ENT and hearing assessment matter.
What we look at in your assessment
Your attack pattern and history, balance and gaze stability between attacks, and coordination with your ENT and audiologist, including referral for a hearing test if you have not had one.
How treatment usually starts
Balance and gaze exercises for unsteadiness between attacks, strategies to stay active with confidence, and shared care with your ENT.
Related services
Dizziness With Headache, Light or Motion Sensitivity
Episodes of vertigo or dizziness lasting minutes to days, with or without headache, often with sensitivity to light, sound or motion and a personal or family history of migraine.
You might notice
- Dizzy episodes, sometimes with no headache at all
- Discomfort with scrolling, supermarkets or car travel
- Episodes linked to poor sleep, stress, hormones or missed meals
What is usually happening
Vestibular migraine is the most common cause of recurrent spontaneous vertigo, affecting around 1% of adults (Neuhauser et al., 2006). A migraine-prone brain processes balance and visual information with heightened sensitivity. It is diagnosed using joint Bárány Society and International Headache Society criteria (Lempert et al., 2022), and medical care from your GP or neurologist is often part of the plan.
Common causes
Vestibular migraine
Episodes of vertigo with migraine features such as headache, light sensitivity or visual aura in at least half of episodes.
Migraine with neck involvement
Neck pain is common with migraine, and a sensitised upper neck can feed into headache. Our directors have completed Watson Headache® Approach training.
What we look at in your assessment
Your episode pattern and triggers, eye movements and balance, motion sensitivity testing, and examination of the upper neck.
How treatment usually starts
Habituation exercises for motion and visual sensitivity, a graded return to triggering environments, upper neck treatment where it contributes, and coordinated care with your GP or neurologist.
Related services
Constant Dizziness or Unsteadiness
Swaying, rocking or unsteadiness on most days for three months or more, worse standing and walking, in busy visual environments and with movement.
You might notice
- Feeling worse in supermarkets, crowds or scrolling a screen
- Feeling better lying down or sitting with support
- Symptoms that started after an inner ear problem, migraine, concussion or a stressful period
What is usually happening
Persistent postural-perceptual dizziness (PPPD) is a common cause of long-term dizziness, defined by the Bárány Society (Staab et al., 2017). After a dizzy trigger, the brain stays in a high-alert balance strategy, relying heavily on vision and stiffening posture. Nothing is structurally damaged, and it responds to vestibular rehabilitation, often alongside psychological therapy or medication (Popkirov et al., 2018).
Common causes
Persistent postural-perceptual dizziness (PPPD)
Daily non-spinning dizziness for three months or more, worse upright, with motion and with complex visual scenes.
Incomplete recovery after an inner ear injury
Ongoing movement-provoked dizziness when one side of the balance system has not fully recalibrated.
What we look at in your assessment
When and where symptoms build, standing and walking balance, visual and motion sensitivity, and checks for a treatable cause such as BPPV or a weak balance reflex.
How treatment usually starts
Graded exposure to movement and busy visual environments, balance retraining that eases an over-guarded posture, and coordination with your GP or a psychologist where helpful.
Related services
Dizziness With Neck Pain
Unsteadiness or light-headedness, rather than room-spinning, that comes and goes with neck pain, stiffness or particular neck positions.
You might notice
- Dizziness that rises and falls with neck pain
- Onset after whiplash or a neck injury, or with longstanding neck pain
- Unsteadiness rather than true spinning
What is usually happening
The upper neck is rich in position sensors that feed the brain’s balance centres, and when the neck is painful or injured that input can become unreliable. Cervicogenic dizziness is diagnosed only after inner ear, brain and blood vessel causes have been considered (Reiley et al., 2017), and manual therapy with exercise has trial support (Reid et al., 2014).
Common causes
Cervicogenic dizziness
Dizziness driven by altered position sense from a painful upper neck, confirmed once other causes are ruled out.
Whiplash-associated disorders
Dizziness is common after whiplash, and we accept CTP claims with fees set by SIRA.
What we look at in your assessment
Upper neck movement and joint testing, neck position sense, eye tracking with the neck turned (the smooth pursuit neck torsion test), and positional testing to rule out BPPV.
How treatment usually starts
Manual therapy to the upper neck, such as sustained natural apophyseal glides (SNAGs), with neck position sense and eye-head coordination exercises.
Related services
Dizziness After a Concussion
Dizziness, headache, fogginess, light sensitivity or trouble with busy environments that persists after a knock to the head or a sudden jolt in sport, a fall or a car accident.
You might notice
- Dizziness with head movement or screens
- Headaches and neck pain since the injury
- Fatigue, poor concentration or feeling foggy
What is usually happening
Concussion can disturb the inner ear, the brain’s balance processing and the upper neck at once, which is why persisting symptoms rarely have a single cause. The 2023 Amsterdam consensus statement recommends active, graded rehabilitation (Patricios et al., 2023), and combined neck and vestibular treatment improved the rate of medical clearance to return to sport in a randomised trial (Schneider et al., 2014).
Common causes
Persisting symptoms after concussion
Symptoms lasting beyond the usual recovery window, often a mix of vestibular, eye movement, neck and exertion-related drivers.
Post-traumatic BPPV
Loose inner ear crystals after a head knock, which can be missed when everything is put down to concussion.
Neck injury alongside concussion
The same forces that cause concussion commonly strain the upper neck, adding headache and dizziness.
What we look at in your assessment
Eye movement, gaze and balance testing, your symptom response to graded exertion, upper neck examination and positional testing for BPPV.
How treatment usually starts
Vestibular and eye movement exercises, neck treatment, graded exertion, and a staged, medically cleared return to work, study or sport.
Related services
Unsteadiness and Falls Risk
Feeling unsteady when walking, especially in the dark, on uneven ground or when turning, sometimes with bouncing or blurred vision as you move.
You might notice
- Worse in the dark or on soft ground such as sand or grass
- Blurred or bouncing vision when walking
- A recent fall, or avoiding activities for fear of falling
What is usually happening
Balance relies on the inner ear, vision and the sensors in your feet and legs. When inner ear input is reduced on both sides (bilateral vestibulopathy), or several systems decline together with age, the brain has less to work with. Vestibular dysfunction is associated with a higher risk of falls (Agrawal et al., 2009), and balance-based exercise reduces falls in older adults (Sherrington et al., 2019).
Common causes
Bilateral vestibulopathy
Reduced balance function in both inner ears, causing unsteadiness in the dark and blurred vision with movement (Strupp et al., 2017).
Age-related balance decline
Gradual changes in the inner ear, vision, sensation and strength that add up to unsteadiness.
What we look at in your assessment
Balance on firm and soft surfaces with eyes open and closed, walking and turning, gaze stability, and leg strength, with force plate balance testing arranged offsite for a later session if it would add useful detail.
How treatment usually starts
Balance and walking retraining, strength work, strategies for low light and uneven ground, and a home programme you can keep up.
Quick symptom checker
How Does Your Dizziness Behave?
Not sure which profile fits? Answer two questions. How long dizziness lasts and what brings it on are the best clues to its cause, so together they narrow down what commonly fits. This is a guide, not a diagnosis (Newman-Toker and Edlow, 2015).
1. How long does each episode last?
2. What brings it on?
Choose an answer to both questions to see what commonly fits.
Common causes for this pattern. Your assessment confirms which applies.
If this is happening now for the first time, seek same-day medical assessment, ideally at an emergency department. A stroke can look like inner ear vertigo, and needs ruling out before rehabilitation.
When Dizziness Needs Urgent Care
Call 000 or go to an emergency department if dizziness comes with any of these.
- Weakness, numbness or drooping on one side of the face or body
- Slurred speech, difficulty swallowing or double vision
- A sudden, severe or unusual headache
- Being unable to stand or walk without help
- New, continuous vertigo with no obvious trigger
- Chest pain, palpitations or fainting
See your GP or ENT promptly for sudden hearing loss in one ear, as early treatment matters. We screen for these signs at every assessment and refer on the same day when needed.
Our approach
How We Work With Dizziness
Dizziness can narrow your world quickly, making it hard to drive, work or trust your balance at home. Our job is to find the cause, explain it clearly and give you a structured way back to what you want to do.
Diagnosis Before Exercises
Dizziness has many causes, and the right treatment depends on which one. We test before we treat and tell you what we think is driving your symptoms.
Why it matters: a repositioning manoeuvre helps BPPV but does little for a weak balance reflex, and the reverse is also true.
Neck, Jaw and Inner Ear Together
As APA Titled Musculoskeletal Physiotherapists, we assess the upper neck and jaw alongside the inner ear.
Why it matters: overlapping causes are common after whiplash, concussion and with headache, and treating only one can leave you partly better.
Exercise That Retrains the Brain
Gaze, habituation and balance exercises are graded to bring on mild, manageable symptoms, which is how the brain recalibrates.
Why it matters: avoiding movement is understandable, but it can slow recovery.
Coordinated Care
We work alongside GPs, ENTs, neurologists and audiologists, and the co-located Sydney Tinnitus Clinic.
Why it matters: some causes need medical tests or medication as well as rehabilitation.
Your first visit
Your 45-Minute Vestibular Assessment
Every consultation is 45 minutes, which gives us time to test properly and explain what we find in plain language.
If we find signs that point to a medical cause, we write to your GP or refer you directly to an ENT or neurologist.
- 01
History
How long each episode lasts and what sets it off narrows the likely causes faster than describing the feeling alone (Newman-Toker and Edlow, 2015). We also ask about your hearing, headaches, injuries and medications.
- 02
Positional Testing
The Dix-Hallpike and supine roll tests check each canal of both ears for BPPV. Throughout, we watch for nystagmus, the involuntary eye movements that show what the inner ear is signalling and which canal is involved.
- 03
Balance Testing
Head impulse and gaze stability tests show how well each side keeps your vision steady as your head moves, alongside standing balance on firm and soft surfaces, walking and turning. If objective data would add value, such as before returning to sport, we can arrange force plate balance testing offsite for a later session.
- 04
Neck & Jaw Assessment
Upper neck movement, position sense and jaw function, because they often contribute after whiplash, concussion or with headache.
- 05
Management Plan
We explain what we found and what is likely driving your symptoms, treat what we can on the day, such as repositioning for BPPV, and set out your home exercises and next steps.
Your recovery
From Dizzy to Confident
Not everyone needs every stage. BPPV may settle at stage one, while recovery after vestibular neuritis or concussion usually moves through all five. You move on when you reach each goal, not after a set number of weeks.
Vestibular rehabilitation for one-sided inner ear loss is supported by a Cochrane review of 39 trials (McDonnell and Hillier, 2015).
A typical path, adjusted to your cause
- 1
Stage 1 · Assess
Find the Cause
We identify the likely cause, treat what we can on the day, such as repositioning for BPPV, and explain the plan.
Goal: A clear explanation and a plan
- 2
Stage 2 · Settle
Calm Symptoms
Short daily exercises and strategies for sleep, work and screens, so symptoms ease and moving feels safer.
Goal: Fewer and milder symptoms day to day
- 3
Stage 3 · Retrain
Recalibrate
Progressive gaze stabilisation and habituation exercises, so head movement and busy places become comfortable again.
Goal: Head movement no longer setting off symptoms
- 4
Stage 4 · Rebuild
Restore Balance
Walking, turning, uneven ground and dual tasks, with a return to driving, work, exercise or sport.
Goal: Back to your usual activities
- 5
Stage 5 · Self-manage
Stay Independent
Visits taper as you take over, with a maintenance routine and a written plan for flare-ups or a return of BPPV.
Goal: Managing independently, with a plan
Fees and funding
Consultations and Rebates
All consultations are 45 minutes, whether it is your first visit or a follow-up, so there is time to assess, treat and explain at every session.
Book a Vestibular AssessmentWays to claim
- Private health: rebates claimed on the spot with HICAPS
- Medicare: rebates with a GP referral
- Workers compensation: fees set by SIRA
- CTP: fees set by SIRA
Common questions
Do I need to see a doctor first?
Not usually. You can book directly, and we refer you to your GP, an ENT or a neurologist if your assessment points to a medical cause. If your vertigo is new, severe and continuous, or comes with any of the warning signs above, seek same-day medical care first.
What is the Epley manoeuvre?
A sequence of head and body positions that guides loose crystals out of the balance canal and back to where they belong. It briefly brings on vertigo while it works, so it helps to bring someone to drive you home if you are very dizzy. Current guidelines do not recommend restricting your activity afterwards (Bhattacharyya et al., 2017).
Will the exercises make me dizzy?
Some exercises are designed to bring on mild, short-lived symptoms, because that is how the brain recalibrates. We grade them to your tolerance and adjust as you improve.
Can my neck cause dizziness?
It can. A painful or injured upper neck can send unreliable position information to the brain. Because inner ear and brain causes need to be considered first, we assess both together.
Should I keep taking my dizziness medication?
Discuss this with your GP. Medications that suppress vertigo can help in the first few days, but longer-term use can slow your brain’s recovery. Clinical guidelines advise against their routine use for BPPV (Bhattacharyya et al., 2017).
Can I drive with vertigo?
Not while you are having unpredictable episodes or significant dizziness. Fitness to drive in Australia follows the Austroads Assessing Fitness to Drive standards, and we discuss a safe return to driving with you and your GP.
I feel light-headed when I stand up. Is that vestibular?
Light-headedness on standing is more often related to blood pressure, medication or hydration than the inner ear. We screen for it and refer you to your GP when that looks more likely.
Do I need a scan?
Usually not. Most vestibular conditions are diagnosed from your history and a bedside examination. Your doctor may arrange an MRI or hearing tests if findings suggest another cause.
How many sessions will I need?
It depends on the cause. BPPV may need only a few visits, while recovery after vestibular neuritis, concussion or PPPD usually takes a longer course of rehabilitation. We give you an estimate at your first visit and review it as you progress.
Do I need a referral?
No. You only need a GP referral to claim a Medicare rebate. Workers compensation and CTP claims need a claim number, and fees are set by SIRA.
Where is the clinic, and should someone drive me?
We are at 80 Bronte Road, Bondi Junction. There is paid street parking around the clinic, the Westfield Bondi Junction car park is within walking distance, and a loading zone out the front for dropping off patients with accessibility needs. The building is wheelchair accessible. If you are feeling dizzy, or positional testing or repositioning is likely, arrange for someone to drive you, as you may feel off-balance for a few hours afterwards. Bring comfortable clothing, a list of your medications, and any hearing tests, scans or letters from your doctor or ENT.
How soon can I get an appointment?
You can book online at any time and see live availability for each physiotherapist. If you cannot find a time that suits, call us on (02) 8528 2985 and we will do our best to fit you in. We are open Monday to Thursday 8am to 6pm, and Friday 8am to 5pm.
What research is this page based on?
The studies, clinical practice guidelines and diagnostic criteria referenced on this page are listed below.
- Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Arch Intern Med. 2009;169(10):938–944.
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3 Suppl):S1–S47.
- Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther. 2022;46(2):118–177.
- Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res. 2022;32(1):1–6.
- Lopez-Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Menière’s disease. J Vestib Res. 2015;25(1):1–7.
- McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;(1):CD005397.
- Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65(6):898–904.
- Neuhauser HK, Radtke A, von Brevern M, et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology. 2006;67(6):1028–1033.
- Newman-Toker DE, Edlow JA. TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin. 2015;33(3):577–599.
- Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695–711.
- Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2018;18(1):5–13.
- Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of Mulligan sustained natural apophyseal glides and Maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther. 2014;94(4):466–476.
- Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017;7:12.
- Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014;48(17):1294–1298.
- Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;(1):CD012424.
- Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191–208.
- Strupp M, Kim JS, Murofushi T, et al. Bilateral vestibulopathy: diagnostic criteria. Consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2017;27(4):177–189.
- Strupp M, Bisdorff A, Furman J, et al. Acute unilateral vestibulopathy/vestibular neuritis: diagnostic criteria. J Vestib Res. 2022;32(5):389–406.
- von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–715.
- Clinically reviewed by David Cohen and Zachary Ehrenfeld, APA Musculoskeletal Physiotherapists and Directors of Vantage Point Physiotherapy. Last reviewed October 2026.
