By Andrea Mulligan DPT, physical therapy
Nearly everyone experiences the unsettling feeling caused by dizziness at some point in their life. But not all dizziness is the same and understanding the difference matters more than most people realize. Whether it’s the brief intense spinning triggered by a head movement, the aftermath of a concussion or chronic balance issues related to migraines or neck tension, dizziness is rarely something to brush off. It’s one of the leading causes of falls, especially among older adults, which can contribute to further health complications, decline in mobility and potential hospitalization.
But here’s the good news: Physical therapy offers targeted, effective treatment for many of the most common causes of dizziness, helping many people feel better in just days.
Not all dizziness is the same
Dizziness as an umbrella term often used to describe unsteadiness, lightheadedness or a sensation of instability, whereas true vertigo is the feeling your surroundings are moving. There are multiple systems that might contribute to dizziness, these include cardiovascular, inner ear, brain or musculoskeletal issues.
The most common cause of dizziness is benign paroxysmal positional vertigo or BPPV. This specifically impacts the inner ear or the vestibular system, which helps the brain sense balance and motion. BPPV occurs when small calcium carbonate crystals become loose within your semicircular canals, so when you turn head or quickly change positions you become very dizzy or experience vertigo. If you have short lasting but moderate to severe vertigo when changing positions, you may have BPPV.
Other causes of dizziness or vertigo include:
- Cervicogenic dizziness, which originates in the neck, or vestibular migraines. Often, there will be associated neck pain, tightness and/or stiffness, headaches, migraines, ear pain or pressure.
- Post-concussion syndrome can frequently cause dizziness as well. Post-concussion syndrome is a mild brain injury (concussion) caused by a fall, accident or sports injury. In addition to dizziness, symptoms include headaches and trouble with concentration or memory.
- Low blood pressure can also cause dizziness and a sensation of lightheadedness. Common causes include dehydration (from heat or not drinking enough fluids) blood pressure medications or the interaction between multiple medications. It’s important to talk with your primary care provider about the underlying cause of low blood pressure.
- Vestibular neuritis is typically caused by a virus. Symptoms include sudden and severe vertigo and/or intense dizziness and balance issues. It usually resolves within a few days but can cause lingering but mild symptoms.
How can physical therapy treat dizziness or vertigo?
Before initiating a program, an assessment to help determine the cause of dizziness may include an analysis of strength, range of motion, vision, balance and gait and vestibular/positional tests.
For people with BPPV, repositioning maneuvers help guide the crystals back to their normal anatomical location. BPPV is the easiest to treat and the maneuvers and exercises can be done at home. Most people see their symptoms start to resolve within days.
For other causes of chronic dizziness, such as motion sickness, vestibular migraines or cervicogenic dizziness with associated balance issues, we use specific exercises to help strengthen the inner ear system and address balance and fall risk. This approach is known as vestibular rehabilitation. Depending on a patient’s symptoms, we may guide them through habituation or gaze-stabilization exercises.
- Habituation exercises put patients in conditions that trigger dizziness, done deliberately and repeatedly so the brain learns to reduce its abnormal response.
- Gaze-stabilization exercises improve eye control, so vision stays clear during head movement.
Unlike BPPV, which can be resolved in days, chronic dizziness and vertigo can take much longer, potentially months.
Staying ahead of dizziness and falls
Physical therapy isn’t only for people already experiencing dizziness or vertigo, it can play a role in fall prevention, too. For older adults especially, identifying what is contributing to fall risk is the first step. From there, a physical therapist can address underlying issues directly, or, when certain risk factors can’t be changed, provide education on adjustments — whether that’s modifications in the home or changes to how a person moves — to reduce risk going forward.
Whether you’re currently dealing with dizziness or vertigo, or simply want to reduce your risk of a future fall, a physical therapist can help. Don’t wait for a fall to happen — reach out to the physical therapy team at The Portland Clinic to build a personalized plan for better balance and long-term vestibular health.
