Written by Nicolas Marchant, Registered Physiotherapist. Before founding PhysioHome, I worked as a physiotherapist with Vancouver Coastal Health, where dizziness was one of the most common reasons older patients quietly stopped walking outside, stopped driving, and started falling.

Dizziness is one of the most under-assessed problems in adult health care. People describe it in vague terms, get told it is "just part of getting older," then reorganise their life around avoiding the feeling. They stop looking up at kitchen cupboards. They stop rolling over in bed. They stop walking to the community centre because it feels unsafe.

That matters, because a meaningful share of dizziness has a mechanical and treatable cause in the inner ear, and because untreated dizziness is linked to falling. The 2022 World Falls Guidelines, published in Age and Ageing, recommend that clinicians routinely ask older adults about dizziness and follow up to identify cardiovascular, neurological or vestibular causes, and that anyone with a fall history who reports vertigo be screened for benign paroxysmal positional vertigo (BPPV) using positional testing.

Dizziness is a symptom, not a diagnosis

The first job of an assessment is working out which kind of dizziness you have, because the treatments are completely different.

Vertigo: a false sense of spinning, often triggered by head position.
Lightheadedness or presyncope: feeling faint, close to blacking out. Often related to blood pressure, hydration, heart rhythm or medication.
Disequilibrium: no spinning, but persistent unsteadiness on your feet, often worse in the dark or on uneven ground.
Visual or motion sensitivity: symptoms provoked by busy environments, scrolling on a phone, or riding as a passenger.

A physiotherapist assessing dizziness sorts your symptoms into these categories, then tests the vestibular system directly. Only some of them are ours to treat. The rest belong with your family doctor, a cardiologist or an ENT specialist, and part of a good assessment is telling you clearly which one you are.

BPPV: the common cause that responds quickly

Benign paroxysmal positional vertigo happens when small calcium carbonate crystals (otoconia) that normally sit in one part of the inner ear become displaced into one of the semicircular canals. When you move your head, those loose crystals shift fluid that should not be moving, and your brain receives a brief but powerful signal that you are spinning.

The classic pattern is short, intense, position-triggered vertigo: rolling over in bed, lying down, sitting up, tipping the head back, bending forward. Episodes typically last seconds to a minute rather than hours, and often settle when you hold still.

BPPV is diagnosed with positional tests, most commonly the Dix-Hallpike test, where the physiotherapist moves your head and body into a specific position and watches your eyes for a characteristic pattern of involuntary eye movement (nystagmus). That pattern tells us which ear and which canal is involved.

Treatment is a canalith repositioning manoeuvre, most commonly the Epley manoeuvre: a sequence of guided head and body positions that uses gravity to move the displaced crystals back where they belong. It is a mainstream, well established treatment, and for many people symptoms improve substantially over a small number of visits.

Two caveats. Self-treating from a video is a bad idea, because the manoeuvre has to match the affected canal. And not all vertigo is BPPV, so a manoeuvre will not help if the diagnosis is something else.

What else vestibular physiotherapy addresses

Beyond BPPV, vestibular rehabilitation is used for reduced vestibular function on one or both sides (for example after vestibular neuritis or labyrinthitis), persistent dizziness after a concussion, unsteadiness in older adults where the vestibular system is one contributor alongside strength, vision, footwear and medication, and dizziness after stroke, which we address alongside the wider neurological rehabilitation work we do at home.

The common thread is that the brain adapts to a vestibular problem when given the right graded exposure. That is what the home exercise program is for, and it is why what you do between visits matters more than anything we do in the session itself.

Why the home setting is genuinely better for this

For most conditions, in-home physiotherapy is about access and convenience. For dizziness, the home visit changes the assessment itself.

We can test the actual triggers. Your BPPV is provoked by your bed, at your pillow height, with your particular way of rolling over. We reproduce that, treat it, then have you repeat the exact movement to check the result.

Travel does not contaminate the picture. Asking someone with active vertigo to drive or take transit to a clinic either makes them symptomatic on arrival or makes them cancel altogether.

We see the real hazards. Dizziness plus a dark hallway, a bath mat and a steep set of stairs is a different risk profile from dizziness alone. That overlaps directly with a home safety and fall prevention review.

Nobody has to be a chauffeur. Across Vancouver, North and West Vancouver, Burnaby, New Westminster, the Tri-Cities, Surrey and Richmond, family members are the transport plan by default. Removing that removes a real barrier to finishing treatment.

Red flags: when this is not a physiotherapy problem

Vestibular physiotherapy is appropriate for many causes of dizziness, but some presentations need medical assessment first. Call 911 or go to your nearest emergency department (Lions Gate, VGH, Burnaby, Royal Columbian, Eagle Ridge, Surrey Memorial or Richmond Hospital) if dizziness comes with:

Sudden severe headache, or the worst headache of your life
New weakness, numbness or drooping on one side of the face or body
Slurred speech, trouble finding words, or new confusion
Double vision or sudden vision loss
Chest pain, palpitations, fainting or shortness of breath
New difficulty swallowing, or sudden loss of coordination
Dizziness following a significant head injury

See your family doctor first for new hearing loss or ringing in one ear, dizziness with fever or a stiff neck, dizziness that started right after a medication change, or constant dizziness that never eases with rest. Physiotherapy does not replace medical assessment, and we refer you back to your physician when the picture calls for it.

Costs and billing

Visits happen at your home across Greater Vancouver. Assessments are $180 for 45 minutes and $210 for 60 minutes, with kinesiology and rehabilitation assistant visits from $130 for exercise progression between physiotherapy sessions. We bill private pay, ICBC and WorkSafeBC separately, so tell us at booking which applies. Details are on our fees page, and dizziness that began after a motor vehicle crash is usually handled under our ICBC physiotherapy stream.

If unsteadiness rather than spinning is the main problem, our seniors physiotherapy service covers the strength and balance side, and our post on falls and hospitalisation in BC seniors explains how the two fit together.

Frequently asked questions

How many visits will I need?

It depends on the cause. Uncomplicated BPPV often improves over a small number of visits. Dizziness from reduced vestibular function or after a concussion usually needs a longer course of graded exercise, because the goal is retraining the brain rather than repositioning crystals. We give you an honest estimate after the assessment, not before.

Will the assessment make me dizzy?

Positional testing is meant to provoke your symptoms briefly so we can see the pattern, so you may feel vertigo for a short period during the test. It settles. We explain each step first, and you can stop at any point.

Can the Epley manoeuvre be done at home?

Yes. It needs a bed or firm surface you can lie flat on with your head supported past the edge, which most homes have. If your neck or back limits the standard position, there are alternative manoeuvres.

I feel unsteady but the room never spins. Worth assessing?

Yes. Non-spinning unsteadiness is usually multifactorial: vestibular function, leg strength, vision, footwear, medications and home layout all contribute. An in-home assessment covers those at once.

Do I need a doctor's referral?

Not in British Columbia. You can book physiotherapy directly. Some extended health plans ask for a referral for reimbursement, so check your policy. ICBC and WorkSafeBC claims have their own process, and we can walk you through it.

Book an assessment

If dizziness is changing what you are willing to do, it is worth assessing properly rather than working around. Call 778-488-5934, email info@physiohome.ca, or book an in-home assessment through our contact page. We are available Monday to Friday 8am to 7pm and Saturday 9am to 3pm across Greater Vancouver.

Vertigo, Dizziness and BPPV: How In-Home Vestibular Physiotherapy Helps