Dizziness is a poor referral category. It covers the older woman who tips sideways when she rolls toward the bedside table, the cyclist who hasn’t felt right since a crash, and the man whose hearing dropped the same morning the room began to turn. All three arrive under the same one-word label, and their appropriate care pathways may be very different .
This piece is for the people who have to sort them. It covers where vertigo treatment in Langley at Divine Care Physiotherapy fits into that sorting, what we offer according to our published service pages and where the line sits between your clinic and ours.
Sort by timing and triggers
Patients use “dizzy” for spinning, swaying, floating and near-fainting and the words overlap too much to lean on. The TiTrATE framework from Newman-Toker and Edlow shifts the focus to timing and triggers. That carries over well into a physiotherapy referral. Our own vestibular rehabilitation page keeps the same distinction : dizziness is the broad term and vertigo is one kind of it.
What the history looks like | Think about | Usual physiotherapy role |
Seconds to under a minute, only with a change of head position (rolling, looking up, bending) | BPPV | Positional testing, then repositioning if the findings fit. This is the core of our vertigo work. |
Continuous vertigo for hours to days, nausea, trouble walking | Acute vestibular syndrome, including peripheral vestibular disorders and potentially serious central causes. | Medical evaluation first. Medical assessment first; vestibular rehabilitation when clinically appropriate. |
Spontaneous episodes lasting minutes to hours, with hearing change or tinnitus | Ménière’s or other inner-ear disease | Medical or ENT lead. Physiotherapy for residual imbalance. |
Episodes with headache and light or sound sensitivity | Vestibular migraine | Medical lead. Rehab may address motion sensitivity between episodes. |
New dizziness after concussion, head injury or whiplash | Often several at once: BPPV, neck, vestibular, visual | Our vestibular and concussion pathways overlap here. |
Chronic unsteadiness, falls, older adult, long medication list | Multifactorial: drug effects, neurological, visual | Fall-risk assessment and balance work, alongside medical review. |
The table is a conversation aid, not an algorithm. Bedside oculomotor assessment in acute vestibular syndrome (the HINTS exam) is best left to clinicians trained in it. A physiotherapy visit is not a substitute. New weakness or numbness, double vision, slurred speech, a severe or sudden headache, inability to stand unaided, or sudden hearing loss belongs on an emergency or urgent medical pathway, not in our booking system.
What happens when BPPV is the working diagnosis
Our pages describe the sequence like this:
- History. Onset, triggers, balance and walking.
- Positional testing. A Dix-Hallpike or roll test, with the physiotherapist watching the eyes for nystagmus. The findings help identify the affected canal.
- Repositioning. When the findings fit, controlled head movements use gravity to guide displaced crystals back toward their proper place.
- Afterwards. Advice on movement and activity, and exercises for balance, coordination and visual stability if they’re still needed.
Our BPPV page is open about the variables. Recovery differs, particularly when more than one canal is involved or the BPPV followed trauma. There is no fixed session count, though some people with accurately identified BPPV improve after a small number of treatments. Treatment response varies between individuals. Rather than suggesting a clinic-specific success rate, we refer to established clinical guidelines when discussing expected outcomes.
For reference, the 2017 AAO-HNSF guideline supports Dix-Hallpike for posterior canal BPPV, a canalith repositioning procedure as treatment, and reassessment within a month. It advises against routine imaging or vestibular testing in patients who meet diagnostic criteria for BPPV. It also advises against routine vestibular suppressant drugs, and it asks clinicians to discuss recurrence and fall risk. That is the standard we’d expect any service in this area to be held to.
When the dizziness outlasts the crystals
If symptoms continue after BPPV treatment, or the assessment points to another vestibular or balance problem, our pages describe rehabilitation built around the findings. It can include:
- balance and coordination retraining
- gaze-stability and visual-vestibular exercises where appropriate
- walking confidence
- a home program
The conditions listed on our vestibular page are:
- vestibular neuritis and labyrinthitis
- Ménière’s disease
- age-related vestibular degeneration
- ototoxicity
- barotrauma
- head trauma
Acoustic neuroma is also listed, with the note that it needs proper medical evaluation.
For peripheral vestibular hypofunction, the 2022 updated Hall et al. guideline in the Journal of Neurologic Physical Therapy gives vestibular rehabilitation a strong recommendation. That is the evidence behind the exercise side of the service.
A composite case : the post-collision patient
This is an illustration built to show the reasoning, not a real patient.
A 34-year-old driver, three weeks after a rear-end collision. Rolling over in bed sets off a short burst of spinning. Separately, she has neck stiffness, a headache by mid-afternoon, and screens tire her quickly. Her family doctor has excluded anything urgent.
There are three questions here, and they don’t share an answer:
- Does a positional test reproduce the spinning?
- What is the neck contributing?
- How do balance, walking and eye movement look when she’s tired?
Our BPPV page lists those same areas for assessment: balance, walking, eye movement, neck movement and positional responses. Our concussion page adds that concussion can sit alongside cervical and peripheral vestibular injury, which is why the three questions get asked together.
The useful point for the referring doctor is that the bedroom spinning and afternoon headache may require different assessment and treatment approaches. Sorting them early keeps the whole picture from being filed under one slow label.
If her ICBC claim is approved, our fees page states she pays nothing for physiotherapy.
What makes a referral note useful
Patients can book without a referral. Our pages say so, and they say that a physiotherapist who finds something needing a doctor’s opinion will refer the patient on. A few lines from you still help. For anyone you’re sending our way for vertigo treatment in Langley, the most useful are:
- when it started, and what came before it (injury, infection, a new medication)
- how long episodes last and what sets them off
- any hearing change, tinnitus or ear fullness
- what you’ve examined and excluded, and any imaging or tests already done
- medications that may affect balance (ototoxicity is on our list of vestibular considerations)
- whether an ICBC or WorkSafeBC claim is open
Questions about a specific patient can go to info@divinecarephysio.com or 604-401-2946.
details
- D109 – 20159 88 Ave, Thunderbird Village, Langley, BC V1M 0A4
- Mon–Fri 8 AM–8 PM, Sat 9 AM–2 PM, closed Sunday
- Book online or call 604-401-2946
- Approved ICBC claims: no patient fees for physiotherapy. Approved WCB claims: no fees for physiotherapy.
- Extended benefits depend on the plan.
- MSP covers $23 for Premium Assistance candidates only, with an additional user fee.
Who sees the patient
Rama Nanthial Alagesava Raja, Registered Physiotherapist (BPT, MPT) has more than 20 years of experience. His published profile lists advanced training in vestibular rehabilitation and concussion management, among other areas.
Questions clinicians ask us
Does the patient need a referral?
Not for physiotherapy at Divine Care. Some extended health plans have their own requirements for reimbursement, so patients should check theirs.
Should imaging come before positional testing?
The guideline advises against routine imaging in patients who meet diagnostic criteria for BPPV. Atypical features, or any central sign, change that, and that call sits with the referring clinician.
How many sessions will it take?
There is no fixed number. It depends on the person and the problem, and some people with accurately identified BPPV improve after a small number of treatments.
Where can I send a patient who needs vertigo treatment in Langley after a car accident?
Divine Care takes direct bookings, and the fees page says patients with an approved ICBC claim pay nothing for physiotherapy. Book online or call 604-401-2946.
Do you see patients after a concussion?
Concussion management is a listed service. It can address cervical, vestibular, balance and activity-progression concerns, and the clinic states it performs baseline assessments. Red-flag symptoms go to emergency care, not to a physiotherapy booking.
For the patient on your list
A patient waiting on vertigo treatment in Langley doesn’t need a long pathway. They need someone to examine them early and give an honest answer about what is and isn’t a physiotherapy problem. If that sounds like someone on your list, book an assessment or call 604-401-2946.