Positional vertigo
When symptoms are triggered by rolling in bed, looking up, bending, or other head-position changes, positional testing may help determine whether benign paroxysmal positional vertigo (BPPV) is present.
Vestibular Rehabilitation
Dizziness and vertigo are not all the same—and the evaluation matters.
Symptoms such as spinning, dizziness, imbalance, motion sensitivity, or unsteadiness can come from different causes. At Nick Rinard Physical Therapy in Portland, vestibular physical therapy starts by looking at your history, symptom pattern, balance, eye and head movement, and positional testing when appropriate.
The goal is to determine whether your presentation appears consistent with a vestibular problem that can be addressed with physical therapy and to choose treatment that matches the findings.
What we may evaluate
Vestibular symptoms can overlap with other medical problems, so the evaluation is designed to identify useful patterns and determine whether physical therapy is an appropriate next step.
Vestibular function
We may assess eye and head movement, gaze stability, motion sensitivity, and how symptoms change with specific tasks.
Balance and mobility
Walking, balance, transfers, and other functional tasks may be assessed when unsteadiness or fall risk is part of the presentation.
BPPV is one cause of vertigo—not the only cause
Benign paroxysmal positional vertigo (BPPV) is a common vestibular condition in which specific head positions can provoke brief episodes of vertigo and characteristic eye movements. When testing supports BPPV, treatment may include a canalith-repositioning maneuver chosen for the involved canal and side.
Not every person with dizziness has BPPV. If positional testing does not fit a BPPV pattern, the evaluation may point toward a different vestibular presentation or the need for further medical assessment.
Symptoms we commonly evaluate
- Brief spinning with rolling in bed or changing head position
- Dizziness with looking up, bending, or turning quickly
- Unsteadiness or imbalance while walking
- Motion sensitivity in busy environments
- Difficulty keeping vision clear during head movement
- Persistent dizziness after a vestibular event
- Reduced confidence with balance or mobility
- Symptoms that may require differentiation from non-vestibular causes
What vestibular treatment may include
Treatment depends on the evaluation. The same exercise or maneuver is not appropriate for every person with dizziness.
Canalith repositioning
For confirmed BPPV, treatment may use a repositioning maneuver based on the involved canal and side.
Gaze and motion exercises
When appropriate, vestibular rehabilitation may include gaze-stability, habituation, or head-movement exercises to improve tolerance and function.
Balance and walking
Balance, walking, and functional activities can be progressed to improve confidence and reduce limitations related to unsteadiness.
When dizziness needs medical evaluation
Dizziness can have vestibular, neurologic, cardiovascular, medication-related, and other causes. New severe headache, new weakness or numbness, difficulty speaking, fainting, chest pain, sudden vision changes, or other concerning neurologic symptoms require prompt medical evaluation rather than routine vestibular rehabilitation.
If your history or examination does not fit a physical-therapy presentation, we will recommend the appropriate next step.
Related resources from our Portland clinic
Frequently asked questions
Is all vertigo BPPV?
No. BPPV is one common cause of positional vertigo, but dizziness and vertigo can come from many different conditions. Testing helps determine whether the presentation fits BPPV or something else.
Will I get a repositioning maneuver?
Only if testing supports BPPV and the findings indicate which maneuver is appropriate. Other vestibular problems are treated differently.
Do I need a referral?
Referral requirements can depend on your insurance or situation. See our referral information, or call the clinic and we can help you determine the next step.
Southwest Portland
Schedule a vestibular physical therapy evaluation
Nick Rinard Physical Therapy is located at 9700 SW Capitol Hwy, Suite 140, Portland, OR 97219.