Dizziness & Balance Disorders

BPPV — Benign Paroxysmal Positional Vertigo

BPPV is the most common cause of vertigo in adults, accounting for up to 50% of all vestibular complaints. It occurs when tiny calcium carbonate crystals (called otoconia or ‘ear rocks’) become dislodged from their normal position in the inner ear and migrate into one of the semicircular canals. Even small head movements — looking up, rolling over in bed, bending down — trigger brief but intense spinning sensations.
BPPV is highly treatable with a technique called canalith repositioning. Depending on which canal is affected, your therapist will use a specific maneuver — most commonly the Epley maneuver — to guide the displaced crystals back to their correct position. Most patients experience dramatic improvement or complete resolution within 1–3 sessions.

Vestibular Hypofunction (Reduced Vestibular Function)

Vestibular hypofunction occurs when one or both sides of the inner ear’s balance system are damaged or no longer functioning correctly. This can result from viral infections (vestibular neuritis or labyrinthitis), trauma, medication side effects, or aging-related degeneration. Patients typically experience:

• Persistent dizziness or unsteadiness (not necessarily spinning) that worsens with movement
• Difficulty walking on uneven surfaces or in the dark
• Visual disturbance with head movement (oscillopsia) — objects appear to ‘jump’ when the head moves
• Difficulty concentrating or ‘brain fog’
• Chronic fatigue from the constant effort of maintaining balance

Vestibular rehabilitation for hypofunction uses gaze stabilization exercises, habituation protocols, and progressive balance training to retrain the brain to compensate for the reduced vestibular signal. Recovery is gradual but consistent, and most patients achieve significant improvement in function and quality of life.

Cervicogenic Dizziness

Cervicogenic dizziness is caused by dysfunction in the cervical spine — the neck — rather than the inner ear. The neck contains proprioceptors (position-sensing receptors) that play a critical role in the body’s balance system, working in concert with the inner ear and visual system. When neck joints or muscles are injured, irritated, or degenerated, these proprioceptors can send inaccurate signals, producing dizziness, unsteadiness, or a floating sensation.
Cervicogenic dizziness is commonly associated with:

• Whiplash injury and motor vehicle accidents
• Cervical arthritis and degenerative disc disease
• Chronic neck pain and muscle tightness
• Post-concussion syndrome
• Upper cervical instability

Because cervicogenic dizziness originates from the neck — not the inner ear — standard vestibular exercises alone are insufficient. Treatment at Healing Star PT targets the cervical spine directly with manual therapy, joint mobilization, dry needling, and postural correction, combined with sensorimotor retraining exercises that help the brain recalibrate its use of neck signals for balance.

Meniere’s Disease

Meniere’s disease is a chronic inner ear disorder caused by abnormal fluid pressure (endolymph) in the labyrinth. It is characterized by recurring episodes of:

• Sudden-onset vertigo — intense spinning lasting 20 minutes to several hours
• Fluctuating hearing loss — typically affecting one ear
• Tinnitus — ringing, roaring, or buzzing in the affected ear
• Aural fullness — a sensation of pressure or congestion in the ear

While there is no cure for Meniere’s disease, vestibular rehabilitation plays an important role in managing its impact on daily life. Physical therapy cannot stop the episodes themselves, but it can dramatically improve the central compensation between attacks — reducing the background unsteadiness, improving gaze stability, enhancing balance, and building the overall resilience of the vestibular system. Patients with Meniere’s often benefit significantly from a structured, progressive vestibular rehabilitation program between acute episodes.