The Hidden Causes of Dizziness—and How Physical Therapy Can Help

Dizziness is one of those symptoms that can be difficult to describe—and even harder to understand. You might feel like the room is spinning, feel unsteady when walking, become lightheaded when standing up, or simply feel “off.”

While dizziness can have many different causes, one thing is important to know: dizziness is not always something you have to live with. Physical therapy can play an important role in identifying and treating several common causes of dizziness and balance problems.

What Causes Dizziness?

Dizziness is often associated with the inner ear (the vestibular system), but your balance system is actually much more complex. Your brain and body are constantly communicating with input from three systems – your inner ear, your visual system, and your muscles/bones/joints – to find and maintain balance.

When these systems aren't communicating properly, dizziness or unsteadiness can occur.

Some common causes for dizziness include:

1. Vestibular Conditions – Dizziness related to your inner ear 

One of the most common causes of dizziness is an issue with the vestibular system, which is located within your inner ear. The vestibular system helps your brain detect head movement and maintain your balance.

A common vestibular condition is benign paroxysmal positional vertigo (BPPV). BPPV occurs when tiny calcium crystals inside the inner ear become displaced. This can cause brief but intense episodes of spinning, particularly when rolling over in bed, looking up, bending down, or getting in and out of bed.

Fortunately, BPPV can often be treated effectively with specific repositioning techniques performed by a trained physical therapist.

Other vestibular conditions, such as unilateral vestibular hypofunction (UVH) may cause a more vague sense of being “off” or feeling like it takes the environment a second to “catch up”, especially when moving fast. Motion sensitivity or dizziness with head movements may also be related to your vestibular system. 

2. Cervicogenic Dizziness – Dizziness related to your neck 

Your neck contains muscles and joints that provide your brain with important information about the position of your head. If there is a mismatch between information coming from your neck, eyes, and inner ear, you may experience dizziness or a sense of unsteadiness.

This can sometimes occur following a neck injury, whiplash, prolonged poor posture, or other neck conditions. It may also occur without obvious cause. 

Physical therapy can address mobility restrictions, muscle tension, posture, and movement coordination that may be contributing to these symptoms.

3. Balance and Strength Deficits

Sometimes dizziness isn't caused by a single problem but rather by changes in strength, mobility and/or balance.

As we age, it can become more difficult for the body to react quickly enough to prevent a loss of balance. Weakness, sensory loss, or impaired coordination of movement may impair your ability to make corrections necessary to maintain balance.  

Physical therapy can help identify these deficits and develop exercises specifically designed to improve strength, coordination, balance, and confidence with movement.

4. Other medical conditions

Dizziness can also occur as a result of neurological conditions including migraines, concussion, or other disorders affecting the brain and nervous system. It can also occur as a result of other medical conditions or as a medication side effect.

This is one reason a thorough evaluation is important. A physical therapist can assess your movement, balance, eye movements, coordination, and other factors to help determine whether your symptoms appear appropriate for physical therapy or whether further medical evaluation is needed.

How Can Physical Therapy Help?

A physical therapist doesn't simply treat “dizziness.” Instead, they look at why you are experiencing it.

Your evaluation may include:

• Balance and walking assessments

• Eye and head movement testing

• Positional testing for BPPV

• Vestibular system screening

• Neck mobility and strength assessment

• Neurological screening

• Functional movement testing

  
  

Based on your results, your therapist may use a combination of hands-on treatment and targeted exercises.

Treatment might include canalith repositioning maneuvers, vestibular exercises, balance training, gaze stabilization exercises, strengthening, neck mobility exercises, or strategies to safely return to activities that make you feel dizzy.

The goal isn't simply to help you feel better in the clinic. It is to help your brain and body become better at processing movement and maintaining balance so you can feel more confident in your everyday life. 

Don't Ignore Persistent Dizziness

Because dizziness can have many different causes, it's important not to assume that feeling dizzy or unsteady is simply a normal part of aging.

If you regularly experience dizziness, spinning sensations, imbalance, or difficulty walking confidently, a physical therapy evaluation may be a helpful first step toward understanding what's contributing to your symptoms.

You don't have to stop doing the things you enjoy because you're afraid of feeling dizzy or losing your balance. With the right evaluation and individualized treatment plan, Activate Physical Therapy can help you move with greater confidence and get back to the activities that matter most to you.

If dizziness is sudden or severe, or occurs with symptoms such as new weakness, difficulty speaking, severe difficulty with walking, visual changes, severe headache, fainting, chest pain, or other concerning neurological symptoms, seek immediate medical attention.

by: Minda Bucholz