If the room spins when you roll over in bed, or the ground feels unreliable every time you turn your head, the problem is usually in the balance system rather than anywhere you can point to. Vestibular rehabilitation is the branch of physiotherapy that assesses and treats that system directly, and for one of the most common causes it can resolve symptoms in a small number of visits. We provide it at our North York and Richmond Hill clinics. This page explains what actually causes dizziness, how the assessment tells one cause from another, and what treatment looks like for each.
A small number of causes of sudden vertigo are serious and need a physician rather than physiotherapy. Go to an emergency department or call 911 if vertigo or unsteadiness arrives alongside any of the following.
These point to causes that need imaging or medical treatment, not exercise. Once they have been ruled out, vestibular rehabilitation is a reasonable next step.
The word covers at least four different experiences, and telling them apart is most of the work. What you describe in the first ten minutes usually narrows the cause considerably.
| What it feels like | Common cause | Typical pattern |
|---|---|---|
| The room spins for under a minute, triggered by rolling over, lying down or looking up | BPPV | Sharp episodes with clear triggers, settled in between |
| Constant severe spinning for hours or days, then weeks of unsteadiness | Vestibular neuritis or labyrinthitis | Often follows a viral illness, worst at the start then slowly improving |
| Unsteadiness rather than spinning, worse in the dark or on uneven ground | Age related balance loss, or reduced vestibular function on one side | Gradual onset, worse when tired |
| Light headedness on standing up quickly | Blood pressure or medication related | Tied to position change, often worse in the morning |
| Dizziness that comes with neck pain and stiffness | Cervicogenic dizziness | Follows neck movement or sustained postures |
| Daily fogginess and swaying, worse in shops and busy visual environments | Persistent postural perceptual dizziness | Constant background sensation, months rather than days |
The blood pressure and medication group is the one we most often refer back to a physician rather than treat, because the answer usually lies in a medication review.
If your dizziness began after a concussion, the assessment and the plan are different, and concussion rehabilitation is the page you want.
Where the cause is a reduced or unreliable vestibular signal rather than loose crystals, there is no single manoeuvre that fixes it. Treatment instead retrains the brain to rely on the remaining information, and it takes weeks rather than visits.
These exercises are meant to bring on mild symptoms. That is how the adaptation happens, and the skill is in setting a dose that provokes a little without wiping out your afternoon.
The structure is consistent even though the timeline varies with the cause.
What triggers it, how long an episode lasts, whether hearing is affected, what medication you take, and what you have stopped doing because of it.
Dix-Hallpike and related tests, head impulse testing, and eye movement assessment to separate a canal problem from a reduced vestibular signal.
Standing and walking tests, including with eyes closed and on a soft surface, plus a neck examination.
Immediate treatment where possible, If the finding is BPPV, the repositioning manoeuvre is performed in that same appointment.
Where retraining is needed, you leave with a small set of exercises at a specific dose, reviewed and advanced at each visit.
A mild flare after a step up is normal information, not a setback. It tells us the last increase was slightly too large, and the programme is adjusted accordingly.
A few practical things make the first visit considerably more useful, particularly because parts of the assessment depend on being able to provoke your symptoms.
Vestibular rehabilitation at both clinics is delivered by our registered physiotherapists, working alongside our physiotherapy assistant. Every physiotherapist in Ontario appears on the College of Physiotherapists of Ontario public register, where their current registration category and any controlled act authorisations are listed before you book.
Caseload centred on musculoskeletal assessment and graded exercise progression.
Treats at both clinics in English and Farsi. Certified in dry needling for post-concussion neck and upper trapezius tension.
Supports the exercise portion of your programme under the direction of your treating physiotherapist.
You can request a specific therapist when you book, and you can ask to be treated in Farsi or Turkish. Verification is available on the CPO public register.
Both clinics run the same assessment and share one patient file, so you can start at one address and continue at the other without repeating your history. If your vertigo is currently triggered by head movement, choose the clinic closer to home and arrange a ride rather than driving to the one with the earlier appointment.
Sunday hours matter more here than for most services, since a BPPV episode that starts on a Saturday night otherwise waits until Monday. Patients travel in from Downsview, Bathurst Manor, Clanton Park, Willowdale, Bayview Village and York Mills.
951 Wilson Ave, Unit 15, North York
This clinic sees a higher proportion of older patients, where dizziness and falls risk are usually part of the same conversation rather than separate problems. Patients come from Langstaff, Bayview Hill, Doncrest, Crosby, Mill Pond, Oak Ridges and north Thornhill.
9555 Yonge St, Unit 307, Richmond Hill
For BPPV, commonly one to three. For vestibular retraining after neuritis or a one-sided loss, expect several weeks with most of the progress coming from the daily home exercises rather than the appointments themselves.
Briefly, yes, and that is deliberate. Positional testing has to provoke the response in order to identify which canal is involved. It settles within about a minute, and we tell you before each position what to expect.
Not to book a physiotherapy assessment. BPPV is diagnosed by positional testing rather than imaging, so a scan is usually not required. Some benefits plans ask for a referral before reimbursing, so check your policy if you intend to claim.
It is possible, but the manoeuvre depends entirely on which canal is affected, and performing the wrong one can move the crystals into a different canal and make things worse. The value of the appointment is the testing that comes before the manoeuvre.
Sometimes, and the assessment tests for it specifically. Cervicogenic dizziness usually presents as unsteadiness with neck pain and stiffness rather than true spinning, and it responds to neck treatment combined with balance work.
Very common. Once the acute episode resolves, the balance system often stays under-confident and the habit of moving carefully persists. That residual unsteadiness responds well to graded balance and habituation work.
Yes. Mention it when you book and we will schedule you with a therapist who speaks it.
