Dizziness, vertigo or a balance problem: which one do you have?
Three different problems with three different treatments. How to tell them apart, what the evidence says about repositioning for BPPV, and when to seek medical care instead.
Blog · · 645 words
Vertigo is the false sensation that you or the room is spinning. Dizziness is lightheadedness without spinning. A balance problem is neither: you feel entirely normal standing still and unreliable once you move. They have different causes and different treatments, and describing which one you have precisely is the single most useful thing you can do on a first phone call.
Key facts, with sources
- Roughly 60 to 90% of benign paroxysmal positional vertigo involves the posterior semicircular canal. [1]
- Network meta-analysis ranked the Epley manoeuvre highest for effectiveness in posterior canal BPPV, with a favourable safety profile. [1]
- Reported resolution rates for the Epley manoeuvre range from around 80% within one to three treatments to near-complete resolution by three weeks, with recurrence in a minority within a year. [2]
Vertigo: it spins, and position triggers it
The defining feature is rotation. You, or the room, is moving when it is not. The second feature is the trigger: rolling over in bed, tipping your head back to a high shelf, bending to the bottom drawer.
The most common cause is benign paroxysmal positional vertigo, in which displaced crystals in the inner ear give the balance organ false motion information. Around 60 to 90% of cases involve the posterior canal.
This is one of the few conditions in this field with a mechanical treatment and good evidence behind it. Network meta-analysis ranks the Epley repositioning manoeuvre highest for effectiveness in posterior canal BPPV, with reported resolution commonly in the region of 80% within one to three treatments and recurrence in a minority of people within a year.
If your dizziness spins and is set off by head position, say exactly that when you call. It changes which assessment gets done first.
Dizziness without spinning: usually not the inner ear
Lightheaded, faint, woozy, or a sense of nearly greying out, often on standing up. No rotation.
That pattern points somewhere other than the balance organ: blood pressure dropping on standing, medication effects, dehydration, anaemia, sometimes the heart. Several of the most common causes are medications working exactly as prescribed.
Physical therapy is often not the right first stop for this one, and part of an honest assessment is saying so and naming who is. A therapist who treats everything that walks in as a vestibular problem is not doing you a service.
Unsteadiness: no spinning, no lightheadedness, no confidence
You feel fine standing still. Walking, turning, stepping off a kerb or moving in the dark feels unreliable. Nothing rotates and you never feel faint.
This is usually strength, sensation in the feet, or the speed of your balance reactions rather than the inner ear. It is the one most people quietly file under ageing and stop mentioning.
It is also the one that responds most predictably to progressive training, which makes the resignation particularly expensive.
Why it is worse in the dark
Because vision was doing more of the work than you realised. Balance runs on three inputs, and if the inner ear or the sensation in your feet is underperforming, vision quietly compensates during the day.
Remove it and the compensation goes with it. A hallway at 3am is a diagnostic test you are taking without meaning to, and the result is why so many falls happen at night.
When not to book therapy
Seek medical care immediately, rather than booking an assessment, if dizziness is sudden and severe, or comes with any of: chest pain, weakness or numbness on one side, slurred speech, double vision, a severe headache unlike your usual, difficulty walking, or fainting.
Those are not physical therapy problems. Getting that ordering right is more important than anything else in this article.
Questions people ask about this
Can physical therapy treat vertigo?
Often, when it is positional vertigo originating in the inner ear. Assessment establishes which canal is involved and which manoeuvre applies, because the treatment differs by type.
How many sessions does BPPV take?
Published resolution rates for the Epley manoeuvre are commonly around 80% within one to three treatments, with a minority recurring within a year. Your case may differ, which is why it is re-tested rather than assumed.
Why does it get worse in the dark?
Because vision was compensating more than you realised. Remove it and whichever of the other two systems is weak becomes obvious.
Should I see a doctor first?
If dizziness is new and severe, or comes with chest pain, one-sided weakness, slurred speech, vision changes or fainting, seek medical care immediately rather than booking therapy.
Can these be treated at home?
Yes, and for someone whose dizziness makes travel unsafe, being assessed at home is both easier and safer than getting to a clinic.
Read next
Sources
- [1] Comparative efficacy and safety of repositioning manoeuvres for posterior canal BPPV: a network meta-analysis
- [2] A Review of the Efficacy of Therapeutic Manoeuvres in Posterior Canal BPPV
This article is general information, not medical advice for your situation. Published evidence is described as published evidence; we make no claim about outcomes at this practice.
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