Vestibular Physiotherapy in Sydney CBD.
Dizziness is not vague. It is not something to push through. And it’s not something a non-specialist physiotherapist should be guessing their way through.
City Physio & Pilates offers dedicated vestibular physiotherapy delivered by a clinician with specific training in vestibular diagnosis and rehabilitation. If you’ve been dizzy, off-balance, or spinning, and nobody has given you a straight answer — this is where that changes.
The vestibular system is the sensory apparatus responsible for your sense of balance, spatial orientation, and stable vision during movement.
It lives in your inner ear and communicates constantly with your brain, eyes, and musculoskeletal system to keep you upright and oriented. When something goes wrong — displaced inner ear crystals, reduced vestibular organ function, cervical spine dysfunction, or post-concussion disruption — the result is dizziness, vertigo, nausea, unsteadiness, and visual disturbance that can make ordinary daily tasks genuinely difficult.
Vestibular physiotherapy is a clinical speciality that uses structured assessment and targeted treatment to diagnose the specific cause of your dizziness and address it directly. It is not massage. It is not generic balance exercises. It’s a precise diagnostic and therapeutic process that, done properly, produces rapid and lasting results for most patients.
The most common cause of vertigo. Caused by calcium crystals becoming displaced in the semicircular canals of the inner ear, triggering sudden intense spinning with head movement. Highly treatable with the correct repositioning manoeuvre — most patients notice improvement within one to two sessions. Accurate canal identification before treatment is non-negotiable; the correct manoeuvre depends entirely on which canal is affected. We diagnose before we treat.
Reduced or absent function in one or both vestibular organs, often following viral illness, head trauma, or without identifiable cause. Presents as chronic unsteadiness, difficulty focusing visually during movement, and dizziness with activity. Managed with structured vestibular rehabilitation exercises to drive central compensation.
Dizziness originating from dysfunction in the upper cervical spine rather than the inner ear. Often misdiagnosed as an inner ear problem. Associated with neck pain, stiffness, headache, and dizziness that worsens with sustained postures or neck movement.
Persistent dizziness, balance disruption, and visual disturbance following a concussion or head injury. One of the most common and debilitating sequelae of concussion, and one of the most responsive to specialist vestibular rehabilitation when assessed correctly.
A functional vestibular disorder characterised by chronic dizziness and unsteadiness, often triggered or worsened by busy visual environments, prolonged standing, or movement-rich settings. Requires a different management approach to peripheral vestibular conditions — including education, graded exposure, and vestibulo-ocular rehabilitation.
Ed Germanos — dedicated vestibular training, and the overlapping expertise dizziness presentations actually need.
Vestibular physiotherapy at City Physio is led by Ed Germanos, who has completed comprehensive postgraduate training in Australia. His clinical background spans vestibular rehabilitation, cervicogenic dizziness, cervicogenic headache, TMJ dysfunction, and sports injury management — a combination that reflects the reality that dizziness presentations rarely exist in isolation.
If your dizziness comes with neck pain, headaches, jaw symptoms, or a history of concussion, Ed’s breadth of training across these overlapping areas is directly relevant to your care — not a separate referral to a separate clinician.
Your first vestibular appointment is a dedicated, structured clinical consultation — not a standard initial physio assessment with vestibular testing bolted on at the end.
A thorough account of your dizziness — onset, triggers, duration, associated symptoms including nausea, tinnitus, hearing changes, visual disturbance, neck pain, and headache. Previous episodes, investigations, and treatments all matter.
Positional testing (Dix-Hallpike, Roll Test), nystagmus observation, balance and gait assessment, and cervical screening where indicated. The goal is to identify the specific condition driving your symptoms — not offer a working hypothesis and see how you go.
Not all dizziness is vestibular. Where the history or examination raises concerns requiring medical investigation or specialist referral, you’ll be told clearly and promptly.
For BPPV, canal repositioning typically begins in the initial consultation once the diagnosis is confirmed. You should leave your first appointment with a clear diagnosis, a management plan, and in most cases, already feeling different.
Vestibular physio — what you actually want to know.
Why does specialist assessment matter for dizziness?
Dizziness is one of the most common presentations in primary care, and one of the most poorly managed. Most patients with BPPV wait months before seeing someone with the training to diagnose and treat it properly — many are told their dizziness is anxiety, labyrinthitis, or just something to manage. A vestibular physiotherapist doesn’t manage dizziness. They diagnose it, treat it, and in the majority of cases, resolve it. The difference between a specialist vestibular assessment and a general physiotherapy appointment is the difference between an Epley manoeuvre guessed at the wrong canal and a precise repositioning manoeuvre performed after confirmed diagnosis. One works. One doesn’t.
Do I need a referral from my GP or ENT?
No. Physiotherapists are primary contact practitioners — you don’t need a GP referral to book a vestibular assessment with us. In many cases, patients who have already seen their GP, an ENT, or a neurologist without resolution find that a vestibular physiotherapist is the clinician who finally provides a working diagnosis and effective treatment. We communicate with referring practitioners and specialists where relevant and welcome co-management of complex presentations.
How quickly will I feel better?
For BPPV, most patients notice significant improvement within one to two sessions once the correct canal is identified and treated with the appropriate repositioning manoeuvre. Other conditions — vestibular hypofunction, PPPD, post-concussion dizziness — typically require a structured rehabilitation program over several weeks. You’ll get a realistic timeline at your initial assessment based on the specific diagnosis.
What if my dizziness isn’t vestibular?
Not all dizziness originates in the inner ear. Cervicogenic dizziness, for example, comes from the upper cervical spine rather than the vestibular system, and requires a different treatment approach entirely. Part of a proper vestibular assessment is determining the actual source of your symptoms — including red flag screening for presentations that need medical investigation rather than physiotherapy. You’ll be told clearly if that’s the case.
Can dizziness be related to my neck or headaches?
Yes — cervicogenic dizziness and cervicogenic headache frequently overlap, and TMJ dysfunction can also contribute to dizziness-adjacent symptoms in some patients. This overlap is exactly why our vestibular physiotherapist Ed Germanos also has training in cervicogenic headache and TMJ dysfunction. Read more about headache and migraine physio.
I had a concussion months ago and I’m still dizzy. Can you help?
Yes — persistent dizziness after concussion is one of the most common and debilitating sequelae, and one of the most responsive to specialist vestibular rehabilitation when properly assessed. If your dizziness, balance, or visual symptoms haven’t resolved since a head injury, a vestibular assessment is a logical next step regardless of how much time has passed.
Is vestibular physiotherapy covered by private health insurance?
Yes — vestibular physiotherapy consultations are covered under physiotherapy extras with most major private health funds. Bring your HICAPS card and we’ll process your rebate on the spot. Check your specific extras cover if out-of-pocket cost is a consideration.
Dizziness often overlaps with:
Ready for an actual answer?
Book a vestibular assessment online or call us. No GP referral needed.
hello@cityphysio.com.au · Shop 10, Level 6, 25 Martin Place
— The City Physio team