Vestibular rehabilitation Therapy Vancouver

Let’s talk Vertigo: Causes, Treatment and Rehabilitation 

Living with one or more episodes of vertigo can, most often, feel isolating. It falls into the category of an invisible injury; those around you cannot really see what’s going on and therefore have a hard time taking your symptoms seriously.  

Vertigo: Causes, Treatment and Rehabilitation

It’s most often laughed off; “As dizzy as a goose? Maybe you’re still hung over from last night!”. Such comments can leave you feeling dismissed and misunderstood. Nobody enjoys having to prove their authenticity, especially when symptoms are real and distressing.  

We understand that your symptoms are real and extremely distressing. You are not alone. Over 35% of adults over the age of 40 are said to experience some form of vestibular disruption, that’s over 1.5 million Canadians!   

While vertigo and dizziness are often used interchangeably, it’s important to clarify to enable the right diagnosis and subsequently, appropriate treatment. 

What is vertigo? 

Vertigo is a specific type of dizziness which is defined by the illusion of movement occurring in the environment.  If you are still but the room around you is spinning, that’s the most accurate description identified by specialists. Sometimes light-headedness and balance difficulties are also labelled vertigo. However, an accurate description to your care provider goes a long way in diagnosing the cause.  

Causes for Vertigo: 

  • Benign Paroxysmal positional Vertigo (BPPV) 
  • Antibiotic toxicity 
  • Head injury 
  • Viruses 
  • Migraine headaches etc.


Benign Paroxysmal Positional Vertigo (BPPV) 

  • We’ll address the most common reason for vertigo which is BPPV.   
  • Benign means that it is not “harmful” at least not to the point of death.   
  • Paroxysmal means a sudden fit or attack,  
  • Positional is how you are orientated,  
  • Vertigo is the type of dizziness.


When we put that all together, BPPV presents when people engage in some sort of movement, such as bending forward, looking up, lying down, or rolling in bed, they are met with a sudden episode of the room spinning on them.

That sounds scary, how can that happen? 

Great question, BPPV is a biomechanical problem. High school taught us that the inner ear, among other parts, was responsible for balance and coordination. That tells us something’s changed in the inner ear causing BPPV. 

The easiest way is to remember when you were a child and spun yourself around and around. When you came to a halt, it felt like you were still spinning. This is due to the “fluid” that keeps moving in the semicircular canals in your inner ear.   

In the case of BPPV, it arises due to the loose “crystals” in the one of the six (three on each side) semicircular canals. The semicircular canals in your ear helps you stay balanced.  When these “crystals” get dislodged from where they usually sit and are now floating freely within the fluid of the semicircular canals, your body is interpreting it as movement and you feel dizzy. 

Why do people get BPPV? 

Most of the time, BPPV is idiopathic. This means it just occurs randomly and not linked to any specific event.  Sometimes it happens after head trauma.  There are some studies that show a possible association between the side you sleep on at night and the likelihood of BPPV occurring on that side of your ear, however, the evidence for this is not strong enough to avoid sleeping on your preferred side! 

What is the physiotherapy treatment for Vertigo? 

As stated above, BPPV is a biomechanical problem and, fortunately, we have biomechanical solution. 

The solution is to position the head in a series of way to guide the crystals back to where they belong.  

Due to the multiple canals and structures in the inner ear, there are a couple variables that need to be determined by your vestibular rehabilitation specialist before selecting the correct maneuver for treatment.  

The steps are as follows: 

  • The first thing the physiotherapist will do is to perform a Dix-Halpike test.   

This will require you to lie down quickly with your head turned 45 degrees to the right or left.  When you lie down, your head will also be extended to approximately 30 degrees.  If BPPV is present, your symptoms will be elicited and your therapist will likely watch your eyes to determine which canal the crystals are in.  Your eyes will jump in a particular pattern (although not in all cases) depending on which canal is affected.  This movement is called nystagmus.   

We will wait for the symptoms to calm down and continue with the Epley’s maneuver.   

  • The Epley is a 4-step process and fortunately the first step of the Epley’s maneuver is identical to the Dix-Halpike.   

If you do not have symptoms and no nystagmus after the Dix-Halpike test, we do not continue to the Epley’s.  This first test is done on the right side and the second is done on the left side. 

  • The third step will be a horizontal head roll test.   

This is a test to test the horizontal semicircular canals.  This test is quite simple as all it requires is a head turn to the right or to the left.  If you have symptoms on either of the sides, the eyes will be observed once again to see which variant It is.   

  • Depending on the variant, a direction for the BBQ roll maneuver will be chosen.  

The BBQ roll is exactly what it sounds like.  You will start with lying on your back and making 90-degree full body turns to the right or left until you have made a full circle.   

In both maneuvers, every time a move is made, you will have to wait until symptoms resolve before moving on.  Sometimes another 15-30 seconds will be added even after symptoms resolve in case there are two “sets” of crystals.   

Post-Treatment Care

You may find on the internet a list of postural restrictions to adhere to after the Epley’s maneuver is performed.  They are usually no longer recommended because it does not seem to improve the efficacy or diminish the possible recurrence.  On the flip side, there is no harm in adhering to them if you wish. 

Sometimes even if the maneuver was successful, you could feel “off”.  Not necessarily like the room is spinning, but something is still “off”.  This is usually because your body is adapting to the new normal. Often this will resolve in a few days.   

There are also situations where you may feel more dizziness and more nauseous, or imbalance for a day or two after treatment and this is believed to be due to an autonomic dysfunction which will require a referral to your family physician.   

All in all, this is to say that you need to wait around 3-5 days to see where things settle and we will bring you back in for an evaluation at that point. 

Will it come back? 

Unfortunately, reoccurrence rates are upwards of 40%. There doesn’t seem to be any definitive pattern that applies to everyone.  

But as explained earlier, a biomechanical problem can be fixed with a biomechanical solution.  

At the Revere Physiotherapy clinic, we have specialists trained in Vestibular rehabilitation to support you with the right diagnosis and a thorough recovery. We can guide you to pin point the source of your Vertigo: Causes, Treatment & Rehabilitation. If required we can refer you to other care providers as indicated.  

Schedule an appointment now. If you have any questions or concerns email us at We offer complimentary phone consultations for you to decide if we’ll be a good fit Vertigo: Causes, Treatment & Rehabilitation. Give us a call at 604-566-5108 about Vertigo: Causes, Treatment & Rehabilitation.  

Reference: Balance and dizziness canada 

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