Vertigo and Dizziness: Causes, Symptoms and How Physiotherapy Can Help

The world suddenly spinning around you, a sickening sensation that the ground is moving beneath your feet, the fear of losing your balance and falling – vertigo is a frightening experience that affects millions of people. In Malaysia, vertigo and dizziness are among the most common complaints presented to doctors, yet many patients are surprised to learn that physiotherapy offers highly effective treatment for most vestibular causes of dizziness.

Vertigo Versus Dizziness: An Important Distinction

While people often use these terms interchangeably, they describe different sensations that point to different causes:

Vertigo is the false sensation that you or your surroundings are spinning or moving. It is typically caused by problems in the inner ear or the brain's vestibular processing centres. Vertigo episodes may last seconds, minutes, or hours depending on the cause.

Dizziness is a broader term encompassing feelings of lightheadedness, unsteadiness, faintness, or a sensation of floating. It can stem from vestibular, cardiovascular, neurological, or psychological causes.

Accurate identification of which type you are experiencing is essential for directing treatment to the right cause.

Common Vestibular Causes of Vertigo

Several conditions affecting the vestibular system (your inner ear balance organs) cause vertigo:

• Benign paroxysmal positional vertigo (BPPV) – The most common cause, responsible for about 50% of vertigo cases. Tiny calcium crystals (otoconia) become dislodged and float into the semicircular canals, sending false movement signals. Triggered by specific head positions such as rolling over in bed, looking up, or bending down
• Vestibular neuritis – Inflammation of the vestibular nerve, usually following a viral infection. Causes sudden, severe vertigo lasting days, with gradual recovery over weeks
• Meniere's disease – Characterised by episodes of vertigo lasting 20 minutes to several hours, accompanied by fluctuating hearing loss, tinnitus (ringing), and a feeling of pressure in the ear
• Cervicogenic dizziness – Dizziness originating from the neck, often associated with neck pain, stiffness, and a history of whiplash or cervical spine dysfunction
• Persistent postural-perceptual dizziness (PPPD) – A chronic functional dizziness disorder characterised by persistent non-spinning dizziness worsened by upright posture, visual stimulation, and active or passive movement

When to Seek Help Immediately

While most vertigo is benign, certain symptoms require urgent medical attention:

• Vertigo accompanied by severe headache, especially if sudden onset
• Double vision, slurred speech, difficulty swallowing, or facial drooping alongside dizziness
• Weakness or numbness on one side of the body
• New onset of severe imbalance with inability to walk
• Sudden hearing loss in one ear

For non-emergency dizziness and vertigo, a physiotherapist trained in vestibular rehabilitation can provide expert assessment and treatment.

Struggling with Vertigo & Dizziness? A physiotherapist can assess your condition and create a personalised recovery plan. Chat with a physiotherapist near you

Vestibular Rehabilitation: The Physiotherapy Approach

Vestibular rehabilitation therapy (VRT) is an evidence-based, specialised form of physiotherapy designed to reduce dizziness, improve balance, and restore function.

BPPV Treatment: Repositioning Manoeuvres

BPPV is one of the most treatable causes of vertigo. Your physiotherapist will first determine which semicircular canal is affected using diagnostic tests (Dix-Hallpike and Roll tests), then perform specific repositioning manoeuvres:

• Epley manoeuvre – The most common treatment for posterior canal BPPV, involving a series of head position changes that guide the displaced crystals out of the semicircular canal. This resolves symptoms in 80-90% of cases within 1-3 sessions
• Semont manoeuvre – An alternative technique for posterior canal BPPV that uses rapid side-to-side movements
• BBQ roll (Lempert manoeuvre) – Specifically for horizontal canal BPPV, involving a series of 90-degree body rolls

Vestibular Exercises for Other Causes

For vestibular neuritis, labyrinthitis, and chronic dizziness, a customised exercise programme promotes vestibular compensation – the brain's ability to adapt to and overcome the vestibular deficit:

• Gaze stabilisation exercises – Keeping your eyes focused on a target while moving your head, training the vestibular-ocular reflex to maintain clear vision during head movement
• Habituation exercises – Repeated exposure to specific movements or positions that provoke mild dizziness, gradually desensitising the nervous system
• Balance retraining – Progressive balance exercises on different surfaces, with eyes open and closed, to rebuild confidence and stability in daily activities
• Walking exercises – Practising walking with head turns, in busy environments, and on uneven surfaces to prepare for real-world demands

Living with Vestibular Conditions in Malaysia

• Stay hydrated – dehydration can worsen dizziness, and Malaysia's hot, humid climate increases fluid loss. Drink water consistently throughout the day
• Manage stress and anxiety – dizziness and anxiety have a bidirectional relationship. Breathing exercises and relaxation techniques help break the cycle
• Avoid sudden head movements until your condition is adequately treated – take extra care when looking up at high shelves, turning quickly, or bending to pick things up
• Make your home safer – ensure adequate lighting, remove tripping hazards, and install grab bars in bathrooms if balance is significantly affected
• Continue your vestibular exercises consistently – even when symptoms improve, ongoing exercises help maintain the brain's vestibular compensation

Regain Your Balance and Confidence

Vertigo and dizziness are not conditions you have to endure. With accurate diagnosis and expert vestibular rehabilitation, most patients experience dramatic improvement.

A qualified physiotherapist trained in vestibular rehabilitation can assess your specific situation and create a treatment plan designed for your needs. Find a physiotherapist near you and take the first step toward getting back to the activities you love.