When physical therapists talk about vertigo, we’re talking about the sensation of your environment spinning, sometimes intense enough to make objects genuinely look like they’re moving. The most common type is Benign Paroxysmal Positional Vertigo, or BPPV.
Vertigo usually comes from a problem in the inner ear and causes a loss of balance along with dizziness and a nauseating lightheadedness. It affects people of all ages, though risk generally increases with age: we see occasional cases in patients in their 20s, but it’s most common in patients 65 and over, where the risk of falls and fracture from imbalance is also higher.
What is vertigo, exactly?
Vertigo feels like you, or everything around you, is spinning, similar to the disorientation after a carnival ride. It’s more than just “feeling dizzy.” An episode can last anywhere from a few seconds to several hours, and severe cases can last months and seriously disrupt daily life.
Vertigo itself is a symptom, not a standalone condition. It can be influenced by migraines, strokes, viral infections, conditions affecting the central nervous system like multiple sclerosis, inner ear problems, Meniere’s disease, or in rare cases tumors. That list can sound alarming, but having vertigo doesn’t mean something dangerous is behind it, and it doesn’t mean there’s nothing you can do about it.
Certain medications, including some anti-inflammatories, cardiovascular drugs, and antibiotics, can also cause vertigo as a side effect. Because a sudden loss of balance can be genuinely dangerous, especially while driving or operating machinery, it’s worth taking seriously.
What causes vertigo?
Finding the source usually starts with a doctor visit, sometimes followed by a referral to a neurologist or ENT for a full evaluation. Vertigo is most often caused by problems with how balance works in the inner ear, though it can also stem from certain areas of the brain. Common causes include:
- BPPV, where certain head movements trigger vertigo
- Migraines
- Labyrinthitis, an inner ear infection
- Vestibular neuronitis, inflammation of the nerve that carries balance signals from the inner ear to the brain
Vertigo can also come with a fever, tinnitus (ringing in the ears), or hearing loss.
How physical therapy helps
Alongside your doctor’s diagnosis, physical therapy offers a treatment plan tailored to your specific situation, and you don’t need a doctor’s referral to come see us about it. A physical therapist has the expertise to pinpoint the exact mechanical cause of your vertigo and offer drug-free treatment that can significantly reduce, and often resolve, the dizziness, especially for BPPV.
Vertigo is most commonly tied to mechanical issues within the vestibular system, the inner-ear apparatus responsible for balance, including the vestibule and semicircular canals. Mechanical issues like these are exactly what physical therapists specialize in treating.
What treatment actually looks like
We start by asking about what you’ve been experiencing, then move into physical assessments that form a vestibular evaluation: balance exercises, listening and visual tracking exercises, and close observation of your eye movement with changes in position. These help determine whether mechanical-based physical therapy is the right fit, or whether you need additional input from a specialist.
If BPPV is the cause, small calcium crystals have become dislodged from the utricle and ended up in the semicircular canals, where they don’t belong. This is the most common vestibular disorder, and while researchers don’t fully understand why it happens, we know the risk is higher for older adults and those with a history of head trauma, migraines, reduced circulation, osteoporosis, inner ear infections, or diabetes.
For BPPV, we typically use the Epley maneuver, a series of timed positional movements that use gravity to guide displaced crystals back to the utricle. It sounds complex, but it’s a well-established, evidence-based technique, generally effective in resolving BPPV symptoms within just a couple of sessions.
If that doesn’t fully resolve things, we may move to Vestibular Rehabilitation Therapy (VRT): a progressive series of exercises that retrain your brain to compensate for abnormal vestibular signals using input from your joints, muscles, and even memory. Keeping up with these exercises consistently tends to bring relief fairly quickly.
Can physical therapy really cure vertigo for good?
It depends. Vertigo is a complex condition with multiple possible root causes, and not every cause responds fully to physical therapy, but many do. Alongside targeted treatment, we’ll also make recommendations around core strength and flexibility that support your overall balance and cardiovascular health. For most people, there’s no hidden hurdle standing between a proper evaluation, a few sessions of therapy, and getting vertigo back under control.