Vestibular and concussion physiotherapy in Scarborough

Vestibular physiotherapy, also called vestibular rehabilitation, is exercise-based treatment for dizziness, vertigo and imbalance caused by the inner ear or the brain’s balance pathways. It includes repositioning manoeuvres for BPPV, gaze stabilization, habituation and balance training.

It is an informal name, not a separate regulated profession in Ontario. It usually describes a registered physiotherapist who provides vestibular rehabilitation. Physiotherapists in Ontario are regulated by the College of Physiotherapists of Ontario.

Yes, when the dizziness comes from the inner ear, the neck or a balance problem. A physiotherapist tests for the cause first. Light-headedness from blood pressure, heart rhythm or medication needs a doctor instead.

Often, yes. The most common cause of vertigo, BPPV, is treated with repositioning manoeuvres that physiotherapists perform. Vertigo from inner ear weakness is treated with vestibular exercises. Vertigo from other causes, such as Meniere’s disease or a stroke, needs medical care.

By finding the cause with eye movement and positional tests, then using the matching treatment: a repositioning manoeuvre for BPPV, or gaze stabilization, habituation and balance exercises for inner ear weakness and motion sensitivity.

For BPPV, repositioning manoeuvres help many people within one to a few sessions. For one-sided inner ear weakness, a Cochrane review found moderate to strong evidence that vestibular rehabilitation is safe and effective. Results vary, and no treatment works for everyone.

BPPV, vestibular neuritis and labyrinthitis after the acute phase, dizziness and imbalance after concussion, neck-related dizziness, motion and visual sensitivity including PPPD, and general unsteadiness and fall risk. It can also support people with vestibular migraine or Meniere’s disease alongside medical care.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It happens when tiny calcium crystals in the inner ear move into one of the balance canals.

Dizziness with diplopia (double vision), dysarthria (slurred speech), dysphagia (trouble swallowing) or drop attacks (sudden falls) are warning signs that the problem may involve the brainstem or its blood supply rather than the inner ear. If dizziness comes with any of them, call 911.

It depends on the condition: loose inner ear crystals in BPPV, inflammation of the balance nerve in vestibular neuritis, fluid pressure changes in Meniere’s disease, or brain pathways in vestibular migraine and concussion. Testing is how the cause is found.

Vestibular neuritis is inflammation of the balance nerve, often after a viral illness. It causes sudden, constant vertigo, nausea, vomiting and unsteadiness that can last for days, without hearing loss. When hearing is also affected it is called labyrinthitis. See a doctor at the start; vestibular exercises help once the worst has settled.

It usually means dizziness or imbalance that has lasted months, for example an inner ear weakness the brain has not fully compensated for, or persistent postural-perceptual dizziness (PPPD). Exercise-based rehabilitation is a main part of treatment.

Common causes are inner ear crystals moving (BPPV), viral inflammation of the balance nerve, head injury, migraine, Meniere’s disease, age-related changes, and some medications that are toxic to the inner ear. Your doctor reviews medications; your physiotherapist tests how your balance systems are working.

No. You can book physiotherapy at Physio Cottage without a referral. Some insurance plans ask for a doctor’s note before they reimburse, so check your plan. New or sudden dizziness should be seen by a doctor first.

Physio Cottage offers vestibular physiotherapy at 2231 Victoria Park Ave, Unit #5, in Scarborough, open Monday to Friday 10am to 8pm and Saturday 9am to 5pm. If your vertigo is new, severe or comes with other symptoms, see a doctor or go to an emergency department first.

Short spells of spinning, usually under a minute, that start when you change head position: rolling over in bed, lying down, getting up, bending or looking up. There is usually no hearing loss. A positional test such as the Dix-Hallpike test confirms it.

Head position changes trigger the spells. BPPV itself often starts with no clear reason, and it is more common with age, after a head injury, after a long time lying down (such as an illness or surgery), and with some inner ear conditions.

A sequence of four head and body positions, each held for about 30 seconds to a minute, that moves loose crystals out of the posterior canal of the inner ear and back to where they cause no symptoms. It is the standard treatment for the most common type of BPPV.

Only after left posterior canal BPPV has been confirmed. Sitting on a bed, turn your head 45 degrees to the left, lie back quickly with your head slightly below the shoulders and hold; turn your head 90 degrees to the right and hold; roll onto your right side looking toward the floor and hold; then sit up. Do not do it at home if you have neck or back problems or have been told not to. Ask your physiotherapist to show you.

BPPV can settle on its own over weeks, but repositioning usually relieves it sooner. Because other conditions can look like BPPV, it is worth having it tested rather than waiting.

If your physiotherapist confirms which canal is affected, they can teach you a home version of the right repositioning manoeuvre. Brandt-Daroff exercises are an older option that works more slowly. Doing the wrong manoeuvre for your canal is not helpful, so get it tested first.

Usually not. The 2017 clinical practice guideline on BPPV recommends against routine movement or sleeping restrictions after repositioning. Follow the specific advice you are given at your visit.

It often clears completely after treatment, but it can come back months or years later. If it returns, the same tests and manoeuvres are used again, and many people learn to recognize it early.

There is no guaranteed way to prevent it. A 2020 randomized trial found that people with low vitamin D who took vitamin D and calcium had fewer recurrences, so ask your doctor whether a vitamin D test makes sense for you. Staying active also helps your balance in general.

No vitamin deficiency is proven to cause BPPV. Low vitamin D has been linked with BPPV and with recurrence, and correcting a deficiency reduced recurrences in one trial. Testing and supplements should be discussed with your doctor.

Usually nothing: most vertigo comes from the inner ear, not a deficiency. Low vitamin D is linked with BPPV recurrence, and dehydration, anemia or low blood sugar can cause light-headedness, which is a different feeling. Your doctor can check these with blood tests.

No method reliably stops all vertigo at once. A BPPV spell usually stops within a minute if you stay still, sit or lie down and fix your eyes on one point. Treating the cause, such as repositioning for BPPV, is what reduces future spells. Severe or new vertigo needs medical care.

Online tricks claim this, but no quick fix works for every type of vertigo. If you have confirmed BPPV, a repositioning manoeuvre taught by your physiotherapist can relieve it within minutes for many people. For other causes, a 30-second fix does not exist.

For BPPV, repositioning manoeuvres. For inner ear weakness and motion sensitivity, regular vestibular exercises, walking and balance training help the brain adapt. Good sleep, hydration and avoiding alcohol support recovery. None of these replace a medical check for new or severe vertigo.

No drink stops vertigo. Water helps if you are dehydrated, which can cause light-headedness. Alcohol and large amounts of caffeine can make dizziness worse, and people with Meniere’s disease are often advised to limit salt and caffeine by their doctor.

Rest during a severe attack, then return to gentle activity as soon as you safely can. Staying still for long periods slows the brain’s adaptation. Your physiotherapist will set a level of activity that is safe for you.

Yes, for most people once it is safe. Walking challenges the balance systems in a natural way and is part of most vestibular programs. Use a cane or walk with someone at first if you feel unsteady.

During an acute attack, a doctor may prescribe medication for a few days. Over the longer term, the nervous system settles through gradual, repeated exposure in vestibular exercises. Long-term use of dizziness-suppressing medication can slow that adaptation.

Avoid long-term use of anti-dizziness medication unless your doctor prescribes it, staying inactive, driving while dizzy, alcohol, and trip hazards at home. Avoid testing manoeuvres you found online before the cause is confirmed.

Do not drive while you have vertigo, unsteadiness or blurred vision. Ask your doctor when it is safe to drive again. If you are coming to the clinic while dizzy, have someone drive you or take transit.

A detailed history and safety screen, eye movement tests, positional tests for BPPV such as the Dix-Hallpike and roll tests, balance and walking tests, and a neck examination. You leave with the likely cause, a plan and your first home exercises.

It varies. BPPV often improves within one to a few sessions. Inner ear weakness usually takes several weeks of regular exercise. Long-standing dizziness can take longer. Your physiotherapist reviews progress at each visit.

For BPPV, many people feel better right after a successful manoeuvre, with some lingering unsteadiness for a few days. For other causes, improvement is gradual over weeks of exercise. There is no guaranteed timeline.

A mild, short-lived increase in dizziness during or after exercises is common and expected, especially with habituation and gaze exercises. It should settle within a short time. Tell your physiotherapist if symptoms are severe or last for hours, so the exercises can be adjusted.

Most of it is. After the assessment and any repositioning in the clinic, the program is mainly home exercises done several times a day, with clinic visits to check progress and move you forward.

Common examples are gaze stabilization (keeping your eyes on a target while turning your head), standing balance with feet closer together or on a cushion, and walking with head turns. The right ones depend on your test results, so they are prescribed individually.

There is no reset button. In BPPV, the crystals are moved back with a manoeuvre. In other conditions, the brain recalibrates over time through repeated, graded exercise. That process is called vestibular compensation.

It can help as part of a plan led by your doctor, who manages the migraine itself. Vestibular exercises may reduce motion sensitivity and unsteadiness, and treating neck pain can help some people. Progress is usually slower and steadier than with BPPV.

No vitamin deficiency is established as a cause of vestibular migraine. Your doctor may discuss migraine triggers and preventive options. Sleep, regular meals and hydration help many people with migraine.

For many people, yes, or it improves enough that it no longer limits daily life. Some people with permanent inner ear damage keep a small deficit but function well because the brain compensates. Regular exercise makes the biggest difference.

Many people do, especially with BPPV and vestibular neuritis. Some conditions, such as Meniere’s disease or vestibular migraine, can come and go over years. Your physiotherapist and doctor can tell you what to expect for your diagnosis.

A concussion is a brain injury caused by a blow to the head, face or neck, or a blow to the body that makes the brain move inside the skull. It cannot be seen on X-rays, CT scans or MRIs. You can have one without losing consciousness.

No. In Ontario, a suspected concussion should be assessed by a physician or nurse practitioner, and they are the only health care providers who can give medical clearance to return to amateur competitive sport under Rowan’s Law. Physiotherapists help with recovery after that assessment.

Neck pain or tenderness, double vision, weakness or tingling in the arms or legs, a severe or worsening headache, a seizure, loss of consciousness, increasing confusion or drowsiness, repeated vomiting, and increasing restlessness, agitation or combativeness. Any of these means call 911.

Five important ones are loss of consciousness, a seizure, repeated vomiting, a headache that is severe or getting worse, and increasing confusion or drowsiness. Weakness, tingling, double vision and neck pain are also emergencies. Call 911 if any appear.

Possibly. Concussion symptoms can appear right away or days after the injury. See a doctor or nurse practitioner to be assessed, or call Health811 for advice. If the headache is severe or worsening, or you have vomiting, confusion, weakness or vision changes, go to an emergency department.

Do not return to sport the same day, drive, drink alcohol, use recreational drugs, or take medication your doctor has not approved. Limit screens, avoid activities that could cause another head injury, and do not stay alone if you are getting worse.

Rowan’s Law requires sport organizations to have athletes, parents, coaches and officials review concussion awareness resources each year, to have a concussion code of conduct, and to use removal-from-sport and return-to-sport protocols. Schools follow the Ministry of Education’s PPM 158. Most protocols follow Parachute’s Canadian Guideline on Concussion in Sport.

The current Canadian guideline uses six steps, not five: daily activities and relative rest; light then moderate aerobic exercise; individual sport-specific activity; non-contact drills; full-contact practice; and return to sport. Medical clearance is required before the contact steps.

As of November 2026, the current Canadian sport guideline is Parachute’s Canadian Guideline on Concussion in Sport, 2nd edition, published in March 2024. It moved to early light activity after a maximum of 24 to 48 hours of relative rest, with stepwise return to school and sport. Adults with longer symptoms are covered by Ontario’s Living Concussion Guidelines.

It is an eye-strain tip: every 20 minutes, look at something about 20 feet away for 20 seconds. It is not part of the Canadian concussion guideline, but regular screen breaks fit the advice to limit and gradually reintroduce screen time after a concussion.

Many people are improving by then and are back to light daily activity and light aerobic exercise. Some symptoms such as headache, fatigue or poor concentration may still come and go. Your primary care provider should see you again 1 to 2 weeks after the injury. Worsening symptoms need a medical review.

Most people make a full recovery within four weeks. Parachute reports that about 15 to 30 per cent have symptoms beyond that, and many of them still recover with coordinated care. No one can promise a timeline for an individual.

Symptoms lasting longer than four weeks are now called persisting symptoms. How long they last varies a lot. Care is tailored to the main problems, such as headache, dizziness, neck pain, sleep, mood or concentration, often with several professionals involved.

After a doctor or nurse practitioner has assessed you. Light activity usually starts after the first 24 to 48 hours. Physiotherapy is especially useful when dizziness, balance problems, neck pain or exercise intolerance are slowing your return to normal activity.

It can when the neck contributes, which is common after a concussion or whiplash. Treatment of the neck, posture and graded exercise can reduce these headaches. Migraine-type headaches after a concussion are managed by your doctor.

Older systems graded concussions from 1 to 3. Current international and Canadian guidelines no longer use grades. Each concussion is managed according to the person’s symptoms and recovery.

Your family doctor or nurse practitioner decides whether you need a neurologist, usually for persisting or unusual symptoms. New weakness, numbness, worsening headache, seizures or confusion need emergency care, not a booked appointment.

Low mood, anxiety and irritability are common concussion symptoms, and they can persist with other symptoms. Tell your doctor, as mental health care is part of recovery. If you have thoughts of suicide, call or text 9-8-8 any time.

Yes. The rapid whipping motion of a collision can move the brain inside the skull. Concussion symptoms and whiplash often appear together after car accidents, sometimes a day or two later.

It is billed at our physiotherapy rates: $115 for the initial assessment and $105 for each follow-up visit. Physiotherapy is HST exempt. Your fee is confirmed when you book.

Not at Physio Cottage, which is a private clinic. Ontario funds physiotherapy at designated clinics for people who qualify, such as people 65 and older, people 19 and under, people recently discharged from hospital who need physiotherapy for that condition, and people on Ontario Works or ODSP.

Usually, under the physiotherapy benefit, because it is provided by a registered physiotherapist. Check your plan’s annual maximum and any referral rules. We bill many plans directly.

Yes. For approved auto insurance claims, we bill the insurer directly where the claim covers the treatment. Bring your claim number and adjuster details to your first visit.

Your health card, insurance details, a list of your medications, any hospital or doctor letters, and comfortable clothes. If you feel unsafe travelling while dizzy, bring someone with you.

The TTC 24 Victoria Park and 924 Victoria Park Express buses stop at Victoria Park Ave and Pachino Blvd, about 100 metres from the clinic. The 95 York Mills bus stops at Ellesmere Rd, a short walk away. A family member can also drop you at the door, with on-site parking.

English, Farsi and Tagalog.

Monday to Friday 10am to 8pm and Saturday 9am to 5pm. We are closed on Sunday. Book online or call (416) 445-5353.