If you’ve been feeling dizzy for months and haven’t found answers, you’re not alone. That floaty, off-balance sensation can make everything from walking through a store to scrolling on your phone or driving feel strange and overwhelming.
You may have had tests come back normal, but you still don’t feel right. What’s going on?
You could be dealing with a medical condition called persistent postural-perceptual dizziness (PPPD). This condition is more common than you might think and it’s very real, even if it’s invisible to others.
The good news is that with proper support, including physical therapy, you can start to feel better and gain more control. We spoke with Julie A. Barnett, a physical therapist with Banner Sports Medicine Scottsdale, to learn more about what PPPD is, its causes and how physical therapy can help.
First, what exactly is PPPD?
Persistent postural-perceptual dizziness is a vestibular disorder that affects the balance system. Your vestibular system (located in your inner ear) sends your brain the wrong message about how your body is moving.
“PPPD is more than just feeling unsteady,” Barnett noted. “It causes a near-constant sense of dizziness, often triggered by physical or visual movement. Unlike other vestibular disorders, symptoms occur when you’re upright and either moving or in a busy visual environment, creating a sensory mismatch.”
In simple terms, your sensory system is on high alert because your inner ear and brain are having a hard time agreeing on your movement. As a result, you develop a false sense of motion. You might feel:
- Like you’re rocking or swaying, even when you’re standing still
- Dizzy or lightheaded when watching fast-moving (TV or movies) shows or scrolling on a screen
- Off-balance in stores, crowds or busy spaces
- Foggy or veering when you walk
- Strained or unsteady when doing precision hand work, like knitting or playing an instrument
Unlike other types of dizziness, PPPD isn’t caused by a problem you can see on a scan or test. It’s not a stroke, a tumor or low blood pressure. It’s more about how your brain processes signals from your eyes, ears and body.
Medical experts typically diagnose PPPD when dizziness has lasted more than three months and tests for other causes like stroke or BPPV (a type of positional vertigo) come back clear.
What causes PPPD?
One of the most frustrating parts of PPPD is that it often begins after a vestibular event, like an ear infection, a concussion or a bad case of vertigo. The first problem usually improves, but the brain remains stuck in “alert mode.”
“Our vestibular system is responsible for telling us how we are moving in space — if we are turning, bending over, moving forward, etc.,” Barnett said. “When you experience a triggering event, our vestibular system isn’t able to work at its normal capacity. Our brain will shift to an increased reliance on the visual system.”
Barnett compares it to a three-person coworker team. “If one of them is not doing their job, one of the other members will have to step up and do more work,” she said.
In this case, the visual system tries to take over. But that’s not a long-term solution. The brain becomes overly dependent on vision and things like bright lights, patterns or fast movement can make your symptoms worse.
How physical therapy helps you heal
If your dizziness feels like it’s “all in your head,” the idea of physical therapy might sound odd. But for PPPD, it’s actually one of the key parts of recovery. Targeted vestibular physical therapy helps retrain your brain to process movement and balance signals, so your body and mind start working together again.
“A physical therapy program for any vestibular disorder, especially PPPD, needs to be an individualized program,” Barnett said. “Through specific balance and vestibular testing, a targeted program plan is developed and individualized to help rewire the brain and get you back to what you love.”
That plan might include:
- Habituation exercises (to gradually decrease sensitivity to movements that provoke dizziness)
- Head and eye movements (to gently and gradually expose your brain to motion)
- Habituation exercises (to gradually decrease sensitivity to provoking movements)
- Relaxation techniques (to help reduce stress and anxiety that often come with dizziness)
How long does recovery take?
The length of physical therapy depends on a few things: how long you’ve had symptoms, how severe they are and how consistent you are with the home exercises your therapist gives you.
“Eight to 12 weeks is a general timeframe for vestibular rehab,” Barnett said.
But recovery isn’t about rushing. It’s about building confidence with movement, because confidence is the number one predictor of fall risk for people experiencing dizziness. It’s also about retraining your sensory system so your brain and body reconnect.
Barnett noted that therapists try to keep symptoms manageable during sessions. “We prefer your symptoms don’t increase more than three or four out of 10 and/or last longer than 15 to 20 minutes,” she said. “It’s important that we are bringing on symptoms in a prescribed manner to help retrain our vestibular system.”
Why it’s important to get help
When you feel dizzy for weeks or months, you may start avoiding the things that make you feel worse, like driving, shopping or even social events. That might feel safe at first, but over time it shrinks your world.
Physical therapy gives you the tools to expand your world again.
A multi-disciplinary approach can also be helpful. “Your treatment may include cognitive behavioral therapy to address anxiety and avoidance behaviors, medications that assist with serotonin levels and medical specialists, including an ENT and neurologist,” Barnett said.
And if you’ve been dizzy for a long time but don’t know why, don’t ignore it. “There are many medical conditions, as well as medications, that can cause dizziness,” she says. “We want to make sure your dizziness is associated with movement. Then we know we can help you with vestibular physical therapy.”
Takeaway
If you’re tired of feeling off-balance, you’re not weak — you’re human. PPPD is real and it’s treatable. With the right help, you can feel steady again.
You don’t have to keep waiting for things to get worse. Talk to your health care provider and ask about vestibular therapy. You deserve to move through the world feeling strong, grounded and safe in your body.
Banner Health offers expert care for people with dizziness, balance problems and PPPD. Find a vestibular therapist near you or learn more about our neurology and rehabilitation services.
