Dizziness & Physiotherapy

Dizziness is one of the most common reasons people see a health professional, and one of the most frustrating to get to the bottom of. It's invisible, it's hard to describe, and the word itself means completely different things to different people.

Thanks to a grant from Rural Workforce Agency Victoria (RWAV), we've been able to bring a piece of equipment to our Warrnambool clinic that changes what we can see during a dizziness assessment: Inventis SYNAPSYS video Frenzel goggles.

They're a real step up in what we can observe. The goggles pick up small, involuntary eye movements that are difficult to see with the naked eye, and they record them — so we can review the footage properly rather than rely on what we caught in the moment.

But a tool is only as good as the clinician using it. The goggles don't produce a diagnosis. They give us better information to reason from, and the history, the hands-on testing and the clinical thinking still do the heavy lifting.

That's why all of our physiotherapists have completed additional training in vestibular assessment and rehabilitation.

Here's what that funding made possible, and why the cause of dizziness matters so much.

The grant

RWAV supports the rural and regional Victorian health workforce, and part of that work is helping smaller practices outside the major centres build capability that would otherwise be out of reach. For a practice of our size, dedicated vestibular assessment equipment is a significant investment.

Being awarded the RWAV Allied Health New Service Grant meant that we were able to purchase this equipment, and since March 2026 it has been well used in our clinical service.

Ever wondered how you stay upright with your eyes closed?

Deep in your inner ear sits your vestibular system — tiny fluid-filled canals that detect every tilt and turn of your head. It works constantly with your eyes and your brain to keep your vision steady and your balance stable.

When it works, you never notice it. When it doesn't, the world can spin.

"Dizzy" isn't one thing

This is where assessment starts, and it's the step that gets skipped most often. "Dizzy" describes at least four quite different experiences:

• Spinning — the room moves, or you do (vertigo)

• Lightheaded — like you might faint

• Off-balance — unsteady on your feet, veering, unsure in the dark

• Woozy or foggy — a heavy, disconnected feeling

These point towards different causes: the inner ear, blood pressure, migraine, and more. Getting the description right is the first step towards getting the answer right, which is why a careful history comes before any hands-on testing.

When it is the inner ear

Some of the most common causes of dizziness come from the vestibular system itself:

BPPV (benign paroxysmal positional vertigo) — displaced inner-ear crystals causing brief, intense spinning triggered by position changes: rolling over in bed, looking up, lying back at the dentist.

Vestibular neuritis — inflammation of the balance nerve, often following a virus, causing sustained vertigo that settles over days to weeks but can leave lingering unsteadiness.

Age-related balance change — a gradual decline in vestibular function that often shows up as unsteadiness rather than spinning.

Many of these respond well to vestibular physiotherapy. A thorough assessment is what tells us which one we're dealing with.

When it's not the inner ear

Not all dizziness comes from the ears, and knowing the difference matters.

Dizziness can also be linked to:

• Orthostatic hypotension — blood pressure dropping on standing

• POTS (postural orthostatic tachycardia syndrome) — a rapid heart-rate rise on standing, often with lightheadedness and fatigue

• Migraine — which can cause dizziness even without any headache

As physiotherapists, we assess for these patterns and work alongside your GP and specialists when your dizziness points beyond the inner ear. We don't diagnose or medically manage these conditions — but recognising the pattern early means you get to the right person sooner, instead of cycling through treatments aimed at the wrong problem.

We can also support you with plans for managing exercise and your symptoms — worked out at a pace that suits you, and alongside whatever medical management your GP or specialist has in place.

Vestibular migraine: common, and commonly missed

Migraine can cause dizziness with no headache at all.

Vestibular migraine is one of the more common causes of recurring dizziness and vertigo, and one of the most frequently missed. It can look like an inner-ear problem on the surface, but it behaves differently — the episodes, the triggers and the timeline don't follow the same pattern — and it's managed differently too.

Recognising the pattern is a large part of the work. We assess for it and coordinate care with your GP where medical management is needed.

How we assess — and where the goggles fit

A comprehensive dizziness assessment isn't a single test. It's a picture built from several:

A detailed symptom history. What does the dizziness actually feel like, what sets it off, how long does it last, what else comes with it.

Physical and positional testing. Moving you into positions that reproduce your symptoms, and watching what happens.

Video Frenzel goggles. This is what the RWAV grant funded. The goggles use an infrared camera to record the small, involuntary eye movements — nystagmus — that are linked to vestibular problems.

Two things make them useful. First, these eye movements can be very fast and very subtle; a camera recording lets us review the footage frame by frame rather than relying on what we caught in the moment. Second, and more importantly, the goggles block vision. Being able to fix your eyes on something in a lit room suppresses nystagmus — so the very sign we're looking for can disappear the moment you open your eyes. Testing in darkness removes that suppression, and the infrared camera means we can still see clearly.

The goggles are an observation and recording tool. They show us eye movements in more detail than the naked eye can; they don't produce a diagnosis on their own.

Clinical reasoning that ties it together. The history, the physical findings and the recordings, interpreted together, into a plan.

If dizziness is affecting your life

Living with dizziness is exhausting, and unsettling. The reassuring part is that many causes are very treatable, and even the more complex ones are considerably easier to manage once they've been properly identified.

Our physiotherapists assess dizziness from every angle — inner ear, blood pressure, migraine and more — using hands-on testing alongside tools like video Frenzel goggles to understand what's going on.

A thorough assessment is a good first step.

This equipment was funded by the Allied Health New Service Grant from Rural Workforce Agency Victoria.

The information in this article is general in nature and is not a substitute for individual assessment or medical advice.