Quick Summary
Sudden, severe, or persistent dizziness should be checked by a doctor first, so anything urgent is ruled out. Once that is done, a physiotherapy assessment looks at how your balance system is working. Vestibular assessment is a detailed medical history, a symptom review, and specific clinical tests, including balance and gait assessments, eye movement tracking, and positional tests. This post walks through what that looks like, and when to go to a doctor before booking.
To work out whether what you feel is dizziness or vertigo in the first place, start with our guide to the difference between dizziness and vertigo.
Who Should Get Checked Before Seeing a Physiotherapist?
See a doctor first if your dizziness is sudden, severe, or persistent, because those patterns need an emergency or medical cause ruled out before any physiotherapy. Our vestibular disorder page puts it as: sudden, severe, or persistent dizziness, see a doctor to rule out medical emergencies. Symptoms lasting more than a few days warrant professional assessment.
When to Seek Medical Attention First
Call 995 or head to the nearest emergency department immediately if you experience dizziness or vertigo with any of the following red flag symptoms:
- Sudden weakness, numbness, or tingling in the face, arm, or leg
- Slurred speech, confusion, or difficulty speaking or understanding
- Double vision or sudden vision loss
- Difficulty swallowing
- Sudden inability to walk or stand without support
- Sudden, severe headache
- Sudden hearing loss
- Chest pain, shortness of breath, or fainting and blackouts
- Dizziness following a recent head trauma, injury, or fall
Below that threshold, the order still matters:
- See a doctor promptly if the dizziness is sudden and severe, or if it does not settle.
- A physiotherapy assessment suits dizziness that a doctor has already looked at, or that is brought on by head movements and has been going on for a while.
HealthHub's stroke signs and symptoms page lists face drooping, arm weakness and speech difficulty as the key signs, and says to call 995 immediately if even one of them is observed. It also lists dizziness, a feeling that the room is spinning, and loss of balance among other symptoms of stroke.
What Does a Dizziness Assessment Start With?
It starts with listening: a detailed medical history and a review of your symptoms, before any tests.
The way you describe the dizziness matters. Is the room spinning, do you feel you might faint, or do you feel unsteady on your feet? When did it start, how long does an episode last, and what were you doing at the time? HealthHub describes the vertigo of BPPV, an inner ear condition, as a spinning sensation lasting a few seconds to a minute, and always aggravated by head movements such as turning over in bed. Those details point a clinician in different directions.
Which Tests Might Be Part of It?
Tests are chosen to match your symptoms, and may include balance and gait tests, eye movement tracking, and positional tests. The tests named on our vestibular disorder page are:
| Test | What it looks at |
|---|---|
| Balance and gait assessments | How steadily you stand and walk |
| Eye movement tracking (oculomotor tests) | How your eyes follow and hold a target |
| Positional tests, such as the Dix-Hallpike manoeuvre | How your symptoms respond to changes in head position |
| Functional balance evaluations | How balance holds up in everyday movements |
Which of these apply to you depends on what you describe. Your physiotherapist decides on the day.
What Can You Note Down Before You Go?
A few notes about your episodes make the first appointment more useful. These are suggestions, not requirements.
- What does it feel like? For example spinning, rocking as if on a boat, floating, lightheadedness, or feeling unsteady on your feet.
- Onset and pattern. When did it first start? Is it constant, or does it come and go in distinct episodes?
- Triggers and positions. What movements or environments bring it on or make it worse? Rolling over in bed, looking up or down, quick head turns, busy visual environments like supermarkets, or does it happen even while sitting still?
- Duration. When an episode occurs, how long does it last? Seconds, minutes, hours, or days?
- Associated symptoms. Ear fullness, ringing in the ears (tinnitus), hearing changes, blurry or jumping vision, nausea, neck stiffness or pain, or headaches.
- Medical records and medications. Please bring along any doctor's memos, past imaging or scan results such as MRI, CT scans or audiograms, and a list of current medications.
- Getting home afterwards. Because vestibular assessments can temporarily provoke mild dizziness, we recommend arranging a ride home or having a companion accompany you if possible.
If you have not seen a doctor and any of the warning situations above apply, do that first.
What Happens After the Assessment?
The findings decide the plan: treatment at the clinic, a home programme, or a referral if something else needs looking at. For inner ear dizziness, our treatments include vestibular rehabilitation therapy, repositioning manoeuvres for BPPV, balance and gait training, and education with a home exercise programme.
HealthHub notes that for BPPV, physiotherapists may perform repositioning manoeuvres such as the Epley's manoeuvre, and teach exercises to help the brain adapt, while medication in the early stage is not recommended for long-term use.
Our physiotherapists may work alongside ENT specialists where that is appropriate. Whether physiotherapy is suitable for you is decided after the assessment, and not every cause of dizziness is one that physiotherapy treats.
When Should You See a Physiotherapist?
It is worth booking an assessment if a doctor has already looked at your dizziness, if it keeps returning with certain head movements, or if it has been going on long enough that you have started avoiding things because of it.
If any of the red flag symptoms above apply, see a doctor first.
Frequently Asked Questions on Dizziness Assessments
Do I need a referral to book a vestibular physiotherapy assessment?
You can book directly. If your dizziness has not been looked at by a doctor and it is sudden, severe or persistent, see a doctor first. Some insurers have their own requirements, so check yours.
Should I see a doctor or a physiotherapist first?
If it is sudden, severe, or persistent, see a doctor first. If a doctor has already looked at it, or it is a repeating, movement-triggered pattern, a physiotherapy assessment is a reasonable next step.
What tests will be done?
Tests depend on your symptoms. They may include balance and gait assessments, eye movement tracking, positional tests such as the Dix-Hallpike manoeuvre, and functional balance evaluations.
Can dizziness signal a stroke?
It can be one of several signs. HealthHub's key stroke signs are face drooping, arm weakness and speech difficulty, and it says to call 995 immediately if even one is observed.
Is the assessment painful?
No, vestibular assessments are not painful. You may experience temporary increase in dizziness, unsteadiness or nausea during certain parts of the assessment.
Is treatment covered by insurance?
We work with a number of insurers, and direct billing is subject to your membership terms. Check eligibility with your insurer first, and see our insurance page.
Getting the Right Check First
Dizziness has many causes, and the order matters: urgent causes first, then a proper assessment of the balance system. Note down what you feel and when it happens, and use that note at whichever appointment comes first.
Booking Your Vestibular Physiotherapy Assessment in Singapore?
If a doctor has already looked at your dizziness, book an appointment, read more about vestibular disorders, or find your nearest branch on our locations page.
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