Vertigo and Dizziness Treatment in Sydney CBD
Vertigo is not just feeling a bit off-balance. When it hits, it is genuinely debilitating – the room spins, your stomach turns, and something as simple as rolling over in bed or looking up at a shelf becomes something you dread. For many people, it goes on for weeks or months before they find someone who can actually diagnose and treat it properly.
That someone is a vestibular physiotherapist. And we have them at City Physio & Pilates!
What Makes Us Different
Not every physiotherapist is trained to assess and treat vestibular conditions. This is a specialist area that requires specific clinical training in vestibular diagnosis, canal mechanics, and repositioning techniques.
Our clinicians treating dizziness and vertigo are Extended Scope Physiotherapists with dedicated vestibular training. They see dizziness patients regularly, stay current with vestibular rehabilitation research, and use structured diagnostic testing to identify exactly what is going on before any treatment begins.
This is not a generalised physio appointment with a quick Epley thrown in at the end.
What Is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, and one of the most successfully treated conditions in physiotherapy when it is correctly diagnosed.
Inside your inner ear are fluid-filled canals set at different angles. Tiny calcium crystals sit within this system and help your brain track head position and movement. When those crystals become dislodged and move into one of the semicircular canals, the signals your brain receives no longer match what your eyes and body are telling it. The result is sudden, intense dizziness triggered by head movement.
Common triggers include:
- Rolling over in bed
- Getting up from lying down
- Looking up or tilting your head back
- Checking your blind spot while driving
- Bending forward to pick something up
The spinning sensation typically lasts seconds to a minute, but the nausea and disorientation that follow can last much longer. Left untreated, BPPV significantly increases fall risk — particularly in older adults.
How Is BPPV Diagnosed?
Accurate diagnosis is everything with BPPV. The specific canal affected, and the type of crystal displacement, determines the correct treatment. Getting this wrong means the wrong repositioning manoeuvre, which either does nothing or makes things worse.
At your vestibular assessment, your physiotherapist will:
- Take a detailed history of your dizziness episodes, triggers, and duration
- Conduct specific positional testing (including the Dix-Hallpike and Roll Test) to reproduce and observe your nystagmus
- Identify which canal is affected and what type of BPPV is present
- Rule out other causes of dizziness where indicated
This structured diagnostic process is what separates a vestibular specialist appointment from a general physiotherapy consultation.
How Is BPPV Treated?
Once diagnosed, BPPV is treated with canal repositioning manoeuvres – precise, guided head movements designed to move the displaced crystals out of the semicircular canal and into a part of the inner ear where they no longer trigger dizziness.
The most well-known is the Epley Manoeuvre, though the correct technique depends entirely on your specific diagnosis.
Most patients notice a significant reduction in symptoms from the first session. Many resolve in one to two treatments. You should notice a change almost immediately.
Your physiotherapist will also assess whether any home exercises are appropriate between sessions, and advise on positioning and activity in the days following treatment.
Other Causes of Vestibular Dizziness
BPPV is common, but it is not the only vestibular condition a physiotherapist can assess and manage. Our clinicians also see patients with:
Vestibular hypofunction — reduced function in one or both vestibular organs, often following viral illness, head trauma, or without a clear cause. Symptoms include persistent unsteadiness, difficulty with visual focus during movement, and dizziness with activity.
Cervicogenic dizziness — dizziness originating from dysfunction in the upper cervical spine rather than the inner ear. Often associated with neck pain, headache, and dizziness that worsens with sustained neck postures.
Post-concussion vestibular dysfunction — persistent dizziness, visual disturbance, and balance disruption following a concussion or head injury.
Persistent Postural-Perceptual Dizziness (PPPD) — a functional vestibular disorder characterised by chronic dizziness and unsteadiness, often triggered by busy visual environments or prolonged standing.
Accurate identification of the condition driving your dizziness is the foundation of effective treatment. A vestibular physiotherapist does not guess.
What to Expect at Your Vestibular Assessment
Your vestibular appointment is a dedicated, specialist consultation. It is longer and more structured than a standard physiotherapy initial consult because the diagnostic process requires time and precision.
Your clinician will:
- Take a thorough history of your dizziness, including onset, triggers, duration, associated symptoms (nausea, hearing changes, tinnitus, visual disturbance, neck pain), and any previous episodes
- Screen for red flags that require medical referral
- Conduct specific vestibular and balance testing
- Arrive at a working diagnosis
- Begin treatment in the same session where appropriate
- Give you a clear explanation of what is causing your dizziness and what the management plan involves
You will leave knowing what is wrong and what happens next. That matters when you have been dizzy for weeks and nobody has given you a straight answer.
When to See a Vestibular Physiotherapist
Book a vestibular assessment if you are experiencing:
- Sudden dizziness or spinning triggered by head movement
- Dizziness when rolling over in bed or getting up
- A sensation that the room is moving when you are still
- Persistent unsteadiness or balance problems
- Dizziness following a head injury or concussion
- Dizziness with neck pain or headache
- Nausea associated with head movement
- Dizziness that has not resolved after several weeks
If you have already seen a GP and been told to wait and see, a vestibular physiotherapy assessment is a useful next step.
When Dizziness Needs a Doctor First
Some causes of dizziness require urgent medical assessment before physiotherapy. Please seek immediate medical attention if your dizziness is accompanied by:
- Sudden severe headache
- Slurred speech, facial drooping, or arm weakness
- Double vision or sudden vision loss
- Difficulty swallowing
- Loss of consciousness
These can indicate a neurological or cardiovascular event and require emergency care, not a physio appointment.
Frequently Asked Questions
How many sessions will I need?
BPPV often resolves in one to two sessions. Other vestibular conditions vary depending on the diagnosis and how long symptoms have been present. Your physiotherapist will give you a realistic timeline at your first appointment.
Do I need a referral?
No. You can book directly. Bring any relevant imaging, a list of current medications, and a note of when your symptoms started and what triggers them.
Will the treatment make me feel worse before I feel better?
Repositioning manoeuvres can briefly reproduce dizziness during the procedure — that is expected and normal. Most people feel significantly better within 24 hours of a successful treatment. Your physiotherapist will explain exactly what to expect.
Can dizziness come back after treatment?
BPPV can recur, particularly in the first year after an episode. If it does, it is treated the same way. Many patients find subsequent episodes resolve faster once they know what is happening.
Is this covered by private health insurance?
Yes. Vestibular physiotherapy is rebated under standard physiotherapy benefits with most private health funds. Rebates are processed on the spot at the clinic.
Book a Vestibular Assessment
City Physio & Pilates consults for vertigo and dizziness are conducted by Extended Scope Physiotherapists with dedicated vestibular training. These are specialist appointments, not general physio consults with a dizziness add-on.
If you have been dizzy, unsteady, or spinning and you want a clear diagnosis and a plan to fix it, book a vestibular assessment at our Sydney CBD clinic.
City Physio & Pilates | 25 Martin Place, Sydney CBD