Vestibular Physiotherapy

"Vestibular" refers to the balance system of the inner ear. Vestibular physiotherapy is the part of the profession that works with people whose dizziness, unsteadiness or balance trouble comes from that system, rather than from a joint or muscle that's been injured or overloaded.

In practice that means the people who end up on this page are rarely in pain. They're the ones who have stopped driving at night, who plan their day around not having to look up at a high shelf, or who have quietly given up the things that involve a crowd and a hard floor. The problem isn't always big enough to sound serious when you describe it. It's usually big enough to have changed how you live.

We start with what you actually mean by "dizzy." It's a single word doing a lot of work. Spinning is one thing, lightheaded is another, and "unsteady on my feet" is a third, and people use all three interchangeably when they describe it. Pinning down which one you mean isn't a formality. It shapes everything after it, so expect to be asked to describe it more than once, in more than one way.

Then what sets it off, and what it does afterwards. Whether it happens when you roll over, when you stand up, when you turn your head quickly, or for no reason you can pick. Whether it lasts seconds, minutes or the better part of a day. Whether it comes on its own or brings other things with it. Whether this is the first time or the fifth. These answers narrow things down faster than almost anything else.

Then a structured physical assessment. This is what separates a proper assessment from being told to take it easy: we look at how steady you are standing and walking, how you're holding yourself, what you're bracing against without realising it, and how your symptoms respond when we change what you're doing. You're not expected to push through anything. Tell us when something feels wrong and we'll work around it.

You leave with an explanation and a plan. What we think is driving it, in plain English. What the program involves and what your part of it is. What to do between appointments, and what would make us send you back to your GP rather than keep treating you. If we don't have a clear answer yet, you'll be told that too, along with what we'd want to check next.

Most people who come to us for dizziness have already been managing it for a while, and the management has mostly meant avoiding things. Fewer stairs. No ladders. Standing up slowly. A hand on the trolley. None of that is unreasonable advice, but it isn't treatment, and over months it tends to shrink your life a little at a time without ever quite fixing the problem.

The point of a structured vestibular program is the opposite. It's built around a working explanation of what's happening, with a plan that changes as you do, and it's meant to be checked: you and your physiotherapist should both be able to tell whether you're better than you were a month ago, and by what. That's a different conversation from "be careful."

It also means telling you where the limits are. Not every cause of dizziness has a quick fix, some need input from your GP or a specialist alongside physiotherapy, and we'd rather say so at the first appointment than string out a program that isn't working. Where physiotherapy is the right tool, the work is yours as much as ours: most of what changes happens between appointments, which is why the program you leave with has to be one you can stick to.

The rest of what we offer is on our services page.

Both send people looking for the same words ("unsteady," "off balance," "I don't trust my legs"), but they lead to different programs, and booking into the wrong one wastes your time.

If the trouble starts with a sensation (the room moving, a swimming feeling when you change position, a head that doesn't settle after you turn it), that's what this page is for. The work is directed at the balance system itself.

If there's no dizziness and the issue is that your legs aren't as reliable as they were (you're slower getting out of a chair, less confident on uneven ground, you've had a fall or a near-miss), that's a strength, confidence and fall-risk problem, and it's what our Falls Prevention program is built for.

Plenty of people have some of both, and that's fine. It's a question we can sort out at the first appointment rather than something you need to diagnose yourself before booking.

If you want to read about vertigo itself (what it is and what's behind it), that's covered properly on our Vertigo & Dizziness page. The exercises used for BPPV are explained in What Is Vertigo? Exercises for BPPV Explained.

This matters more than anything else on this page, so it's worth reading even if you skim the rest.

Get emergency help immediately (call 000) if sudden, severe dizziness or vertigo comes with any of:

• slurred speech or trouble getting words out
• drooping on one side of the face
• weakness or numbness in an arm or leg
• loss of vision or sudden changes to your sight

Those can be signs of a stroke or TIA. They are not a physiotherapy problem, and they are not something to wait out or book an appointment for. If you're unsure, treat it as urgent. That is the right call every time.

Dizziness that's new, getting worse, or arrives with a bad headache, a head injury, fever, hearing loss or ringing in one ear should also be seen by your doctor first, not booked straight in with us.