Unsteadiness has many causes, and they need separating before they can be treated. Balance depends on three systems working together — the inner ear, vision, and the sensation coming from your feet and joints. When one is disrupted, the others have to compensate, and rehabilitation works by retraining that compensation deliberately.
When dizziness needs urgent medical assessment
Go to hospital straight away if vertigo comes on suddenly alongside any of the following: double vision, slurred speech, weakness or numbness on one side, a severe or unusual headache, or difficulty walking that is worse than the dizziness alone would explain. Vertigo can occasionally be caused by a stroke affecting the back of the brain, and that needs emergency assessment rather than a physiotherapy appointment.
Short of that, if dizziness is new, severe, or comes with hearing loss or ringing in one ear, please see a doctor first so the cause can be identified. Where the cause has been established and is suitable for rehabilitation, physiotherapy can be an effective part of management.
BPPV and repositioning manoeuvres
The most common cause of true spinning vertigo is BPPV — benign paroxysmal positional vertigo — where tiny crystals in the inner ear move out of place and send false movement signals when you turn your head, roll over in bed or look up.
BPPV is unusual among the conditions we treat because it often responds to a specific repositioning technique rather than a course of exercise. Your physiotherapist first identifies which ear and which canal is involved through positional testing, then performs the appropriate repositioning manoeuvre — the Epley manoeuvre being the best known. This is available at all APARC centres. You may feel briefly worse during the manoeuvre itself; that is expected, and your physiotherapist will talk you through what to expect beforehand.
Not all vertigo is BPPV, which is why the positional testing comes first. Where the cause is different, the treatment is different. For a fuller explanation of how vertigo happens, see our guide to vertigo and dizziness.
Assessment
Rather than judging balance by eye, APARC uses dynamic posturography — a system that measures how well you hold balance under different sensory and surface conditions. That shows which of the three systems is contributing to the problem, so training can target the right one, and it gives a measurement to re-test against later.
Treatment
Programmes use evidence-based balance training including the Otago programme, virtual-reality balance systems and force-platform training, chosen according to what the assessment shows. Work is graded so it is challenging enough to drive change while staying safe, and it is progressed as steadiness improves.
Booking an assessment
Vertigo and balance rehabilitation is available across APARC’s centres, with home visits for people at high risk of falling, and connects closely with our geriatric physiotherapy and neurological physiotherapy services. Call +91 98189 11195.