Let’s Clear the Fog Surrounding Vertigo

One in three adults experiences dizziness and balance issues that in most cases, can be treatable with Physical Therapy. Many body systems including your muscles, bones, joints, eyes, the balance organ in the inner ear, nerves, heart and blood vessels must work normally for you to have normal balance. When these systems aren’t functioning well, you can experience balance problems. Many medical conditions can cause these issues. However, most balance problems result from issues in your balance organ in the inner ear, also known as your vestibular system.

The Vestibular System

Have you ever had an ear infection and noticed that you had difficulty with balance or dizziness? That’s because your ears aren’t just for hearing. They also serve as your centers for balance and spatial equilibrium, without which your brain wouldn’t have the necessary information to understand your body’s relationship with your external environment.

The vestibular system is a collection of structures in your inner ear that provides you with your sense of balance and an awareness of your spatial orientation, meaning a sense of whether you are right-side-up or upside-down. Your brain then integrates that information with other sensory information from your body to coordinate smooth and well-timed body movements.

It’s a pretty complex series of actions and not something we’re born innately knowing to do. We all learned to walk as toddlers by honing and refining these interacting systems, and every time you learn something new that requires balance (like riding a bike, snowboarding, surfing, or paddleboarding) your brain further modifies and refines these integration processes.

Causes of vertigo or balance issues

Balance problems can be caused by several different conditions. The cause of balance problems is usually related to the specific sign or symptom. Here is a list of some common causes.

  • Benign paroxysmal positional vertigo (BPPV). BPPV occurs when calcium crystals in your inner ear — which help control your balance — are dislodged from their normal positions and move elsewhere in the inner ear. BPPV is the most common cause of vertigo in adults. You might experience a spinning sensation when turning in bed or tilting your head back to look up.
  • Vestibular neuritis. This inflammatory disorder, probably caused by a virus, can affect the nerves in the balance portion of your inner ear. Symptoms are often severe and persistent, and include nausea and difficulty walking. Symptoms can last several days and gradually improve without treatment. This is a common disorder second to BPPV in adults.
  • Persistent postural-perceptual dizziness. This disorder occurs frequently with other types of vertigo. Symptoms include unsteadiness or a sensation of motion in your head. Symptoms often worsen when you watch objects move, when you read or when you are in a visually complex environment such as a shopping mall. This is the third most common disorder in adults.
  • Meniere’s disease. In addition to sudden and severe vertigo, Meniere’s disease can cause fluctuating hearing loss and buzzing, ringing or a feeling of fullness in your ear. The cause of Meniere’s disease isn’t fully known. Meniere’s disease is rare and typically develops in people who are between the ages of 20 and 40.
  • Migraine. Dizziness and sensitivity to motion (vestibular migraine) can occur due to migraine. Migraine is a common cause of dizziness.
  • Acoustic neuroma. This noncancerous (benign), slow-growing tumor develops on a nerve that affects your hearing and balance. You might experience dizziness or loss of balance, but the most common symptoms are hearing loss and ringing in your ear. Acoustic neuroma is a rare condition.
  • Ramsay Hunt syndrome. Also known as herpes zoster oticus, this condition occurs when a shingles-like infection affects the facial, auditory and vestibular nerves near one of your ears. You might experience vertigo, ear pain, facial weakness and hearing loss.
  • Head injury. You might experience vertigo due to a concussion or other head injury.
  • Motion sickness. You might experience dizziness in boats, cars and airplanes, or on amusement park rides. Motion sickness is common in people with migraines.

Please enjoy this video this great video made University of San Francisco Otolaryngology explaining BPPV.

Symptoms of Vertigo or Balance issues

Signs and symptoms of balance problems include:

  • Sense of motion or spinning (vertigo)
  • Feeling of faintness or lightheadedness (presyncope)
  • Loss of balance or unsteadiness
  • Falling or feeling like you might fall
  • Feeling a floating sensation or dizziness
  • Vision changes, such as blurriness
  • Confusion

What now?

If you feel off balance or dizzy, one of these systems may not be working correctly, or the information from these systems may not be being “put together” or “integrated” correctly. A physical therapist can help to determine how you are using these systems (or not) to keep your balance and can instruct you in exercises that can improve how your body uses all these systems together.

Vertigo affects people of all ages. Although it is very rare among children, it is common in adults over the age of 20. Vertigo and balance problems are more dangerous for people ages 65 and over. Older adults are at greater risk for fractures and major injuries from a fall caused by imbalance.

How Can Physical Therapy Help?


A physical therapist can help people manage vertigo and dizziness symptoms so they can get moving again. Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. 

No prescription is needed for you to be evaluated for BPPV so if you feel you are having symptoms please reach out to your closest WESTARM Physical Therapy facility. 


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