Dizziness and Vertigo: How Physiotherapy Can Help You Find Your Balance

Dizziness and vertigo are common problems that can be frightening and disruptive, but in many cases they respond well to specialist physiotherapy. By understanding the difference between dizziness and vertigo, identifying likely causes, and using targeted vestibular rehabilitation, many people can improve their balance, confidence, and day-to-day function.

At Costa Health in Riviera del Sol, physiotherapist Danielle provides detailed assessment and evidence-based treatment for dizziness, vertigo, and balance difficulties.

Dizziness vs vertigo: what is the difference?

People often use the words dizziness and vertigo to mean the same thing, but they describe different sensations.

Dizziness is a broad term that can include feeling:

• Lightheaded or as if you might faint
• Unsteady on your feet
• Disoriented or “swimmy headed”
• Off balance, as though the ground is moving slightly

Vertigo is a specific type of dizziness where you feel as though you or your surroundings are spinning, tilting, or moving when there is no real movement.

For your clinician, understanding exactly what you are feeling is an important first step in working out where the problem is coming from.

Seek urgent medical help if: Your dizziness starts suddenly with chest pain, shortness of breath, severe headache, difficulty speaking, weakness in the face, arm, or leg, double vision, or loss of consciousness. These may be signs of a medical emergency such as stroke or heart problems and need immediate hospital assessment.

Common causes of dizziness and vertigo

Dizziness and vertigo can have several causes. Some are related to the inner ear and balance system, and others come from the cardiovascular or nervous systems, or from medication. A careful assessment helps to distinguish between these.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is one of the most frequent causes of vertigo seen in clinic. It happens when tiny calcium carbonate crystals in the inner ear become dislodged and move into part of the balance canals where they should not be.

Typical triggers for a short burst of spinning vertigo include:

• Rolling over in bed
• Looking up, for example to reach a high shelf
• Bending down, such as tying shoelaces
• Getting in or out of bed

These episodes are usually brief, often lasting seconds, but can feel very intense. Although symptoms can be alarming, BPPV often responds well to specific repositioning manoeuvres carried out by a trained clinician.

Vestibular neuritis and labyrinthitis

Vestibular neuritis and labyrinthitis involve inflammation affecting the inner ear or the vestibular nerve, often after a viral illness. They can cause a sudden onset of:

• Moderate to severe vertigo, sometimes lasting hours or days
• Nausea and vomiting
• Marked unsteadiness or balance problems
• Sensitivity to head and body movements

The most intense vertigo usually settles over days or weeks, but some people are left with ongoing dizziness, imbalance, or motion sensitivity. Vestibular rehabilitation can support the brain to adapt and restore more normal balance function.

Vestibular migraine

Migraine does not always present as a severe headache. In vestibular migraine, dizziness and vertigo can be prominent symptoms.

People may notice:

• Repeated episodes of dizziness or vertigo
• Motion sensitivity, for example in the car or supermarket
• Visual symptoms, such as flickering vision or sensitivity to light
• Unsteadiness or imbalance
• Headaches, which may be mild or absent during some attacks

Because vestibular migraine can mimic other inner ear conditions, a detailed history and examination are important. Physiotherapy is often part of a wider management approach that may also involve your GP or neurologist.

Age-related balance changes

As we get older, the systems that keep us steady - our vision, inner ear balance organs, joints, muscles, and sensation in the feet - can become less efficient. This can contribute to:

• Unsteadiness when walking, especially on uneven ground
• Increased risk of trips and falls
• Difficulty walking in busy places, such as shops
• Reduced confidence getting out and about

Targeted balance training can help maintain independence and reduce fall risk, particularly when started early.

Cardiovascular and other medical causes

Not all dizziness comes from the inner ear. Other causes can include:

• Low blood pressure or blood pressure that drops on standing
• Heart rhythm problems
• Side effects of certain medications
• Dehydration or anaemia
• Neurological conditions affecting the brain or nerves

This is why a comprehensive assessment is essential. Part of a physiotherapist’s role is to identify when dizziness is likely to benefit from vestibular rehabilitation and when you may need referral to your GP or another specialist.

Quick Tip: If you feel faint or lightheaded when you stand up, try rising more slowly, flexing your ankles and squeezing your calf muscles before standing, and ensuring you are well hydrated. If this keeps happening, speak to your GP.

How physiotherapy can help dizziness and vertigo

Specialist physiotherapists with training in vestibular rehabilitation can assess many forms of dizziness and vertigo and provide tailored treatment. The aim is to reduce symptoms, improve balance, and help you return to everyday activities more confidently.

What to expect at your assessment

During a vestibular and balance assessment, Daniele will typically:

• Take a detailed history of your symptoms, medical background, and triggers
• Ask you to describe your dizziness in your own words
• Check your eye movements and how your eyes and inner ears work together
• Assess your balance and walking patterns
• Look at head and neck movement
• Carry out positional tests to check for BPPV

The goal is not only to confirm that you are dizzy, but to work out which part of the balance system is affected so that treatment can be targeted appropriately.

Treatment options used in vestibular physiotherapy

Treatment is always tailored to your individual diagnosis, symptoms, and goals. It is usually based around specific exercises and hands-on techniques, along with clear advice and support.

Canalith repositioning manoeuvres for BPPV

For suitable cases of BPPV, Daniele may use canalith repositioning manoeuvres, such as the Epley manoeuvre. These gentle, structured head and body movements are designed to guide the displaced inner ear crystals back to where they belong.

Many people notice a significant reduction in spinning sensations quite quickly, although some may need more than one session and a short period of modified activity while the inner ear settles.

Vestibular rehabilitation exercises

Vestibular rehabilitation is a specialised exercise programme that helps the brain adapt to changes or damage in the balance system. It usually includes a combination of:

• Gaze stabilisation exercises to improve how well your eyes stay focused when your head moves
• Balance retraining exercises to challenge your balance safely in different positions and surfaces
• Habituation exercises that gradually expose you to movements or positions that normally provoke your dizziness, to reduce sensitivity
• Walking and turning practice to build confidence in everyday environments

Exercises are progressed at a pace that suits you, with regular review and adjustment.

Balance and falls prevention training

For people who feel unsteady or have had one or more falls, Danielle may design a specific balance and strength programme. This might include:

• Exercises to strengthen the legs and core muscles
• Tasks that challenge balance in a controlled way
• Practice with turning, stepping, and negotiating obstacles
• Advice on safe footwear and home set-up to reduce trip hazards

Education and self-management

Understanding what is causing your symptoms often reduces anxiety and makes dizziness feel more manageable. As part of treatment, you can expect:

• Clear explanations of your assessment findings
• Guidance on which movements to practise and which to temporarily modify
• Strategies for pacing activity so that you build tolerance without overdoing it
• Advice on when to seek further medical input

Quick Tip: Keeping a simple diary of when your dizziness occurs, how long it lasts, and what you were doing just before it started can be very helpful for your physiotherapist in identifying patterns and triggers.

Why specialist expertise matters

Many vestibular and balance conditions can look similar on the surface, yet require very different treatment approaches. Accurate diagnosis relies on specialist knowledge, careful clinical reasoning, and experience interpreting vestibular tests.

If dizziness is misdiagnosed or treated with the wrong exercises, symptoms may persist for longer than necessary and confidence can decline. Being assessed by a physiotherapist who regularly treats vestibular disorders helps ensure that your care is appropriate and that you are referred on when needed.

When to seek help for dizziness or vertigo

You should arrange a professional assessment if you experience:

• Recurrent episodes of dizziness or vertigo
• Persistent unsteadiness or difficulty walking
• Vertigo triggered by specific head movements or positions
• A recent fall or near-miss related to feeling dizzy
• Dizziness that is affecting work, driving, exercise, or social activities

Many vestibular conditions respond well to physiotherapy, particularly when addressed early. Your physiotherapist can also advise if further medical tests or specialist opinions are needed.

Vestibular physiotherapy with Daniele at Costa Health

Daniele is an experienced physiotherapist with a special interest in dizziness, vertigo, and balance disorders. At Costa Health in Rivieria and Marbella, he provides thorough assessments to identify the likely source of your symptoms and creates individualised treatment plans based on current evidence.

If dizziness or vertigo is limiting your everyday life, you do not have to manage it alone. Contact Costa Health to arrange an assessment with Daniele and explore whether vestibular physiotherapy could be appropriate for you.

Frequently Asked Questions

Can physiotherapy cure dizziness and vertigo?

Physiotherapy can significantly reduce or resolve symptoms for many causes of dizziness and vertigo, particularly conditions such as BPPV and some vestibular disorders. However, not all dizziness has a vestibular cause, and no treatment can guarantee a complete cure in every case. Your physiotherapist will assess whether vestibular rehabilitation is suitable for you and may recommend involving your GP or another specialist if needed.

How many sessions will I need?

The number of sessions varies depending on the cause and severity of your symptoms. Some people with straightforward BPPV improve noticeably within one or two treatments. Others with longer-standing or more complex balance problems may benefit from a short course of sessions over several weeks, combined with home exercises. Your physiotherapist will discuss a realistic plan with you after your assessment.

Is vestibular rehabilitation safe?

Vestibular rehabilitation is generally safe when prescribed and supervised by a trained clinician. It is normal for some exercises to temporarily increase your symptoms as your balance system is being challenged, but this is carefully monitored and the programme is adjusted to your tolerance. Your physiotherapist will also screen for any red flags that would require medical review before starting treatment.

Should I stop driving if I feel dizzy?

If your dizziness affects your ability to concentrate, react quickly, or see clearly, you should avoid driving until you have been assessed. In the UK, the Driver and Vehicle Licensing Agency provides guidance on fitness to drive with certain medical conditions, and your GP or specialist can advise you. The same principle of safety first applies while living or driving abroad. Your physiotherapist can help you judge when symptoms are stable enough for you to consider driving again, but the final decision should prioritise safety.

Can I do vestibular exercises on my own from online videos?

Some online exercises may be helpful for certain conditions, but without a proper assessment it is easy to choose exercises that are not right for your specific problem. In some cases, the wrong manoeuvre could worsen symptoms or delay improvement. It is safer to have an initial assessment, then follow an exercise plan that is tailored to you. Your physiotherapist can then advise which exercises are appropriate to continue independently.